在NERD人群中使用高剂量双联疗法根除幽门螺杆菌的临床研究  

Clinical Study of Helicobacter Pylori Eradication Using High Dose Dual Therapy in a NERD Population

作　　者：王秀红 陈辉杰 郑亚本 吴惠贞 庄婉糖 吴晓锐 WANG Xiuhong;CHEN Huijie;ZHENG Yaben;WU Huizhen;ZHUANG Wantang;WU Xiaorui(Department of Gastroenterology,Zhangzhou Third Hospital,Zhangzhou,Fujian Province,363000 China)

机构地区：[1]福建省漳州市第三医院消化内科,福建漳州363000

出　　处：《中外医疗》2023年第20期102-105,共4页China & Foreign Medical Treatment

摘　　要：目的 评价在非糜烂性胃食管反流病(non-erosive gastroesophageal reflux disease,NERD)人群中使用高剂量双联疗法(high dose dual therapy,HDDT)根除幽门螺杆菌(helicobacter pylori,Hp)的疗效、不良反应及安全性。方法 便利选取2020年9月—2021年9月福建省漳州市第三医院收治的139例合并Hp感染的NERD患者为研究对象,先使用艾司奥美拉唑40 mg qd+铝碳酸镁1.0 g tid+枸橼酸莫沙必利5 mg tid治疗1周,缓解患者胃食管反流症状;其后随机分为A组(艾司奥美拉唑20 mg qid+阿莫西林0.75 g qid,疗程14 d)和B组(艾司奥美拉唑20 mg bid+枸橼酸铋钾220 mg bid+阿莫西林1.0 g bid+克拉霉素0.5 g bid,疗程14 d),治疗结束后4周复查尿素呼气试验,判断Hp根除疗效。结果 共132例完成临床研究。A组和B组按意向治疗(intentionto-treat,ITT)分析Hp根除率分别为86.6%和87.5%,按方案(per-protocol,PP)分析Hp根除率分别为90.6%和92.6%,两组的根除率对比,差异无统计学意义(χ^(2)=0.027、0.176,P>0.05)。A组的不良反应发生率(3.1%)明显低于B组(14.7%),差异有统计学意义(χ^(2)=5.350,P<0.05)。结论 在NERD人群中,高剂量双联疗法和铋剂四联疗法对Hp根除率疗效相当,但高剂量双联疗法比铋剂四联疗法的不良反应更少,高剂量双联疗法根除Hp安全性更高、根除过程更舒适。Objective To evaluate the efficacy,adverse reactions and safety of high dose dual therapy (HDDT) in the eradication of helicobacter pylori (Hp) in patients with non-erosive gastroesophageal reflux disease (NERD).Methods A total of 139 NERD patients with Hp infection admitted to the Third Hospital of Zhangzhou City,Fujian Province from September 2020 to September 2021 were conveniently selected as the research objects.The patients were treated with esomeprazole 40 mg qd+hydrotalcite 1.0 g tid+mosapride citrate 5 mg tid for 1 week to relieve the symptoms of gastroesophageal reflux.Then they were randomly divided into group A (esomeprazole 20 mg qid+amoxicillin 0.75 g qid,course of treatment 14 d) and group B (esomeprazole 20 mg bid+bismuth potassium citrate 220 mg bid+amoxicillin 1.0 g bid+clarithromycin 0.5 g bid,course of treatment 14 d).After 4 weeks of treatment,the urea breath test was reviewed to determine the efficacy of Hp eradication.Results A total of 132 patients completed the clinical study.The eradication rates of Hp in group A and group B were 86.6%and 87.5%respectively according to intention-totreat (ITT) analysis,and 90.6%and 92.6%respectively according to per-protocol (PP) analysis.There was no statistically significant difference in eradication rate between the two groups (χ^(2)=0.027,0.176,P>0.05).The incidence of adverse reactions in group A (3.1%) was significantly lower than that in group B (14.7%),and the difference was statistically significant (χ^(2)=5.350,P<0.05).Conclusion In the NERD population,the high-dose dual therapy and the bismuth quadruple therapy have similar efficacy on Hp eradication rate,but the high-dose dual therapy has fewer adverse reactions than the bismuth quadruple therapy,and the high-dose dual therapy has higher safety and more comfortable eradication process.

关 键 词：非糜烂性胃食管反流病 幽门螺杆菌感染 高剂量双联疗法 临床研究 

分 类 号：R5[医药卫生—内科学]