雷贝拉唑联合阿莫西林或呋喃唑酮二联疗法根除幽门螺杆菌感染的临床疗效研究  

Efficacy of Rabeprazole Combined with Amoxicillin or Furazolidone Dual Therapy in Eradicating Helicobacter pylori Infection

作　　者：邵俏俏 马菁 余雪纯 于淼 祁亚宾 胡若冰 卫珮如 肖伟 贾百灵 丁松泽 SHAO Qiaoqiao;MA Jing;YU Xuechun;YU Miao;QI Yabin;HU Ruobing;WEI Peiru;XIAO Wei;JIA Bailing;DING Songze(Department of Gastroenterology,People's Hospital of Zhengzhou University/Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院消化内科,河南省郑州市450003

出　　处：《中国全科医学》2022年第29期3640-3645,共6页Chinese General Practice

基　　金：国家自然科学基金联合基金项目(U1604174);河南省卫生计生委员会-省部共建项目(20170123);河南省卫生计生科研创新人才工程项目(51282)。

摘　　要：背景幽门螺杆菌(H.pylori)感染与消化性溃疡、胃癌、胃淋巴瘤等疾病密切相关。国内外新的二联疗法在根除H.pylori方面疗效显著,但在我国感染率较高的部分中原地区尚未得到验证。目的探索雷贝拉唑联合阿莫西林或呋喃唑酮二联疗法根除H.pylori感染的临床疗效。方法选取2020年4月至2021年10月在河南省人民医院消化内科初次诊断为H.pylori现症感染者161例为研究对象,采用随机数字表法将患者分为标准铋剂四联疗法组〔A组:雷贝拉唑(20 mg)+枸橼酸铋钾(220 mg)+阿莫西林(1000 mg)+呋喃唑酮(100 mg),2次/d;n=55〕、雷贝拉唑联合莫西林二联疗法组〔B组:雷贝拉唑(20 mg)+阿莫西林(1000 mg),3次/d;n=54〕和雷贝拉唑联合呋喃唑酮二联疗法组〔C组:雷贝拉唑(20 mg)+呋喃唑酮(100 mg),3次/d;n=52〕,三组疗程均为14 d。比较各组H.pylori根除率、药物不良反应情况及成本-效果比。结果意向性分析(ITT分析)结果显示A、B、C组的H.pylori根除率分别为83.6%(46/55)、81.5%(44/54)、48.1%(25/52);符合方案集分析(PP分析)分析结果显示A、B、C组H.pylori根除率分别为88.5%(46/52)、83.0%(44/53)、51.0%(25/49)。A组和B组H.pylori根除率(ITT分析及PP分析)高于C组(P<0.0167)。PP分析结果显示药物不良反应发生率为24.0%(37/154),A、B、C组不良反应发生率分别为38.5%(20/52)、7.5%(4/53)、26.5%(13/49),具体表现为恶心、呕吐、厌食、腹痛、腹泻、皮疹、心悸、头晕、乏力等,其中最常见的不良反应为恶心,占9.7%(15/154)。B组不良反应发生率低于A组和C组(P<0.0167)。A、B、C组的成本-效果比依次是3.33、4.17、3.78,A组成本-效果比最低。结论雷贝拉唑联合阿莫西林二联疗法与标准铋剂四联疗法对H.pylori感染患者初次根除H.pylori疗效相似,雷贝拉唑联合阿莫西林二联疗法可考虑作为一线治疗的备选方案。此外,本研究显示雷贝拉唑联合呋喃唑酮二联疗法H.pylori根�Background Helicobacter pylori(H.pylori)infection is strongly associated with peptic ulcer,gastric cancer,gastric lymphoma,and other diseases.A new dual therapy has proven effective in the eradication of H.pylori,but it has not been verified in some areas with a high prevalence of H.pylori infection in central China.Objective To explore the clinical efficacy of rabeprazole combined with amoxicillin or furazolidone dual therapy in the eradication of H.pylori infection.Methods 161 patients with a first diagnosis of H.pylori infection were recruited from Department of Gastroenterology,Henan Provincial People's Hospital during April 2020 to October 2021,and randomized into three groups with different 14-day therapies:group A(n=55)received a twice-daily quadruple therapy consisting of rabeprazole(20 mg)+bismuth potassium citrate(220 mg)+amoxicillin(1000 mg)+furazolidone(100 mg),group B(n=54)received a three-time daily dual therapy consisting of rabeprazole(20 mg)+high-dose amoxicillin(1000 mg),and group C(n=52)received a three-time daily dual therapy consisting of rabeprazole(20 mg)+high-dose furazolidone(100 mg).The eradication rate,side effects and cost-effectiveness ratio were compared among the groups.Results Intention-to-treat analysis(ITT)revealed that,the eradication rates of H.pylori in groups A,B and C were 83.6%(46/55),81.5%(44/54)and 48.1%(25/52),respectively.Per-protocol(PP)analysis found that,the eradication rates of H.pylori in groups A,B and C were 88.5%(46/52),83.0%(44/53)and 51.0%(25/49),respectively.Both analyses demonstrated that groups A,B had higher eradication rates of H.pylori than group C(P<0.0167).Based on the PP analysis,the overall incidence of side effects was 24.0%(37/154),which were mainly manifested as nausea,vomiting,anorexia,abdominal pain,diarrhea,skin rash,palpitation,dizziness and debilitation,with nausea as the most common side effect〔9.7%(15/154)〕.The incidence of side effects in groups A,B and C was 38.5%(20/52),7.5%(4/53)and 26.5%(13/49),respectively.The incidence of side ef

关 键 词：幽门螺杆菌 二联疗法 阿莫西林 呋喃唑酮 成本效果分析 

分 类 号：R573[医药卫生—消化系统] R377[医药卫生—内科学]