含米诺环素、克拉霉素的铋剂四联方案在青霉素过敏的幽门螺杆菌感染初治患者中的应用价值  

The application value of the quadruple therapy regimen containing bismuth,Minocycline and Clarithromycin in the initial treatment patients with Helicobacter pylori infection allergic to penicillin

作　　者：韩强 程艳丽 刘秀清 王亚丽 董佳璐 庞梦瑶 张宏娜 梁辰飞 张亮 HAN Qiang;CHENG Yanli;LIU Xiuqing;WANG Yali;DONG Jialu;PANG Mengyao;ZHANG Hongna;LIANG Chenfei;ZHANG Liang(Department of Gastroenterology,the First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院消化内科,北京100016

出　　处：《胃肠病学和肝病学杂志》2024年第5期513-517,共5页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的评价含米诺环素、克拉霉素的铋剂四联方案在青霉素过敏的幽门螺杆菌(Helicobacter pylori,H.pylori)感染初治患者中应用的根除疗效、依从性及安全性等情况。方法回顾性分析2022年9月至2023年7月于清华大学第一附属医院就诊的H.pylori感染初治且青霉素过敏的219例患者的临床资料,其中RMiCB组(69例)为雷贝拉唑+米诺环素+克拉霉素+复方铝酸铋颗粒方案;RMeCB组(71例)为雷贝拉唑+甲硝唑+克拉霉素+复方铝酸铋颗粒方案;RLCB组(79例)为雷贝拉唑+左氧氟沙星+克拉霉素+复方铝酸铋颗粒方案,疗程均为14 d,电话随访患者用药安全性、依从性及H.pylori根除情况。结果三组患者的基线资料差异无统计学意义(P>0.05)。RMiCB组、RMeCB组、RLCB组患者H.pylori根除率根据意向性分析(intention-to-treat analysis,ITT)分别为86.9%(60/69)、60.5%(43/71)、62.0%(49/79),符合方案分析(per-protocol analysis,PP)分别为90.9%(60/66)、66.2%(43/65)、68.1%(49/72)。按照PP分析,RMiCB组患者H.pylori根除率高于RMeCB、RLCB组,差异有统计学意义(χ^(2)=13.428,P=0.001),RMeCB、RLCB组H.pylori根除率差异无统计学意义(χ^(2)=0.056,P=0.857)。RMiCB组、RMeCB组、RLCB组患者药物不良反应发生率分别为13.0%(9/69)、16.9%(12/71)、16.5%(13/79),差异无统计学意义(χ^(2)=0.479,P=0.797)。结论含米诺环素、克拉霉素的铋剂四联方案在青霉素过敏的H.pylori感染初治患者中根除效果较好,且具有较高的依从性,可考虑作为一线治疗的备选方案。Objective To evaluate the eradication efficacy,compliance and safety of the bismuth quadruple regimen containing Minocycline and Clarithromycin in the initial treatment of H.pylori infection among patients with penicillin allergy.Methods This study used a retrospective analysis to collect clinical data of 219 patients with H.pylori infection allergic to penicillin treated at the First Hospital of Tsinghua University from Sep.2022 to Jul.2023.Group RMiCB(69 cases)received a regimen of Rabeprazole,Minocycline,Clarithromycin and compound bismuth aluminate granules.Group RMeCB(71 cases)received the regimen of Rabeprazole,Metronidazole,Clarithromycin and compound bismuth aluminate granules.Group RLCB(79 cases)was treated with a regimen of Rabeprazole,Levofloxacin,Clarithromycin and compound bismuth aluminate granules.The treatment courses were all 14 days,and telephone follow-up was conducted to assess patient safety,compliance and H.pylori eradication.Results There was no significant difference in baseline data among the three groups(P>0.05).According to the intention-to-treat analysis(ITT),the H.pylori eradication rates were 86.9%(60/69)in group RMiCB,60.5%(43/71)in group RMeCB,and 62.0%(49/79)in group RLCB;the per-protocol analysis(PP)showed that the rates were 90.9%(60/66)in group RMiCB,66.2%(43/65)in group RMeCB,and 68.1%(49/72)in group RLCB.According to the PP analysis,the H.pylori eradication rate in group RMiCB was higher than that in group RMeCB and group RLCB,with a statistically significant difference(χ^(2)=13.428,P=0.001),while there was no statistical difference in the H.pylori eradication rates between group RMeCB and group RLCB(χ^(2)=0.056,P=0.857).The incidence of drug adverse reactions was 13.0%(9/69)in group RMiCB,16.9%(12/71)in group RMeCB,and 16.5%(13/79)in group RLCB,with no significant difference(χ^(2)=0.479,P=0.797).Conclusion The quadruple therapy regimen containing Bismuth,Minocycline,and Clarithromycin is effective in eradicating H.pylori infection among patients with penicillin allergy in

关 键 词：幽门螺杆菌 米诺环素 铋剂四联方案 青霉素过敏 根除治疗 

分 类 号：R378[医药卫生—病原生物学]