嗜酸乳杆菌联合优化四联方案根除难治性幽门螺杆菌的疗效  

Efficacy of Lactobacillus Acidophilus Combined with Optimized Quadruple Therapies for Refractory Helicobacter Pylori Infection

作　　者：杨雪[1] 高采平[1] 张颖慧[1] 雷蕾[1] Yang Xue;Gao Caiping;Zhang Yinghui(Sichuan Academy of Medical Sciences·Sichuan Provincial People′s Hospital Gastroenterology,Chengdu,Sichuan 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院消化内科,四川成都610072

出　　处：《四川医学》2020年第11期1147-1151,共5页Sichuan Medical Journal

摘　　要：目的比较嗜酸乳杆菌联合与非联合优化四联方案治疗难治性幽门螺杆菌(Hp)的疗效及安全性。方法纳入Hp根除失败2次的Hp阳性慢性胃炎伴消化不良患者280例,随机分为4组:A组(AFRB)阿莫西林1000 mg+呋喃唑酮100 mg+雷贝拉唑10 mg+胶体果胶铋200 mg,2次/d,疗程14 d;B组(LAFRB)嗜酸乳杆菌500 mg,3次/d,14 d后以相同剂量+阿莫西林1000 mg+呋喃唑酮100 mg+雷贝拉唑10 mg+胶体果胶铋200 mg,2次/d,联合治疗14 d;C组(TFRB)四环素750 mg+呋喃唑酮100 mg+雷贝拉唑10 mg+胶体果胶铋200 mg,2次/d,疗程14 d;D组(LTFRB)嗜酸乳杆菌500mg,3次/d,14 d后以相同剂量+四环素750 mg+呋喃唑酮100 mg+雷贝拉唑10 mg+胶体果胶铋200 mg,2次/d,联合治疗14 d。治疗结束停药4周后行14C尿素呼气试验确定Hp根除情况。对Hp根除率进行意向性分析(ITT)和符合方案分析(PP)。治疗前后对4组患者的症状进行DSSI评分。分析4组方案的疗效、安全性及成本-效果。结果4组的Hp根除率分别为:ITT 84.29%、88.57%、82.86%、91.43%和PP 88.06%、91.18%、89.23%、95.52%。4组的不良反应发生率分别为:18.57%、5.71%、24.29%、8.57%。4组的症状改善有效率分别为:38.81%,55.88%,35.38%,49.25%。成本-效果比(C/E)C组<A组<D组<B组。结论LTFRB方案根除率最高(ITT和PP分析均>90%),不良反应率低,成本效益适中,适宜临床推广治疗难治性幽门螺杆菌。Objective To evaluate efficacy and safety of lactobacillus acidophilus combined with or without optimized quadruple therapies respectively in the treatment of refractory Helicobacter pylori(Hp).Methods 280 Hp positive patients with chronic gastritis and dyspepsia were recruited after two ineffective eradication attempts.They were randomly divided into four groups:group A(AFRB):amoxicillin(AMPC)1000 mg+furazolidone(FRZD)100 mg+rabeprazole(RPZ)10 mg+colloidal bismuth pectin(CBP)200 mg bid×14 d;group B(LAFRB):lactobacillus acidophilus(LA)500 mg tid×14 d,then at the same dose combined with AMPC 1000 mg+FRZD 100 mg+RPZ 10 mg+CBP 200 mg bid×14 d;group C(TFRB):tetracycline(TTCL)750 mg+FRZD 100 mg+RPZ 10 mg+CBP 200 mg bid×14 d;group D(LTFRB):LA 500 mg tid×14 d,then at the same dose combined with TTCL 750 mg+FRZD 100 mg+RPZ 10 mg+CBP 200 mg bid×14 d.14 C urea breath test was used to determine the eradication of Hp 4 weeks after the end of treatment.The Hp eradication rates was analyzed by intention to treat(ITT)and Per-Protocol(PP)analysis.Before and after treatment,DSSI scores for symptoms of 4 groups were evaluated.The efficacy,safety and cost-effectiveness of 4 groups were also evaluated.Results The eradication rates based on ITT analysis were 84.29%,88.57%,82.86%,91.43%and on PP analysis were 88.06%,91.18%,89.23%,95.52%in group A,B,C,D respectively.The incidence of adverse reactions in the 4 groups were 18.57%,5.71%,24.29%and 8.57%respectively.The effective rates of symptom improvement in the 4 groups were 38.81%,55.88%,35.38%and 49.25%respectively.On cost effectiveness analysis(C/E)group C<group A<group D<group B.Conclusion Combined optimized regimen(LTFRB)with the highest eradication rate(>90%both on ITT and PP analysis),less adverse reaction and moderate cost is suitable for clinic practice for refractory Helicobacter pylori.

关 键 词：难治性幽门螺杆菌 嗜酸乳杆菌 四环素 呋喃唑酮 阿莫西林 铋剂 

分 类 号：R573.3[医药卫生—消化系统]