雷贝拉唑联合左氧氟沙星、奥硝唑治疗幽门螺杆菌相关性消化性溃疡的效果  

Effect of the combination of rabeprazole,levofloxacin and ornidazole in treating Helicobacter pylori-related peptic ulcers

作　　者：高振伟 苏卫仙 刘倩[1] 赵俊精[1] 张文艺 GAO Zhenwei;SU Weixian;LIU Qian;ZHAO Junjing;ZHANG Wenyi(Department of Digestion,Langfang People’s Hospital,Langfang 065000,China;Department of Laboratory,Langfang Hospital Traditional Chinese Medicine,Langfang 065000,China)

机构地区：[1]廊坊市人民医院消化科,廊坊065000 [2]廊坊市中医医院检验科,廊坊065000

出　　处：《西北药学杂志》2025年第2期153-161,共9页Northwest Pharmaceutical Journal

基　　金：河北省医学科学研究课题计划项目(编号:20221596)。

摘　　要：目的探究雷贝拉唑联合左氧氟沙星、奥硝唑治疗幽门螺杆菌(Helicobacter pylori,HP)相关性消化性溃疡的效果。方法选取2021年7月至2023年12月收治的HP相关性消化性溃疡患者80例作为研究对象,用随机信封法分为A组(传统三联疗法,即奥美拉唑、阿莫西林和克拉霉素联合使用)和B组(雷贝拉唑、左氧氟沙星、奥硝唑联合使用),每组40例。比较2组的疗效、消化道黏膜损伤情况[胃黏膜损伤Lanza评分法(modified Lanza score,MLS)]、HP根除率、炎症因子水平[干扰素γ(interferon-γ,IFN-γ)、白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]、成本效益、不良反应和治疗后3个月的复发率,用二元Logistic回归模型分析影响HP相关性消化性溃疡患者HP根除情况的因素。结果B组的治疗总有效率为95.00%,高于A组的77.50%(P<0.05);B组的HP根除率为92.50%,高于A组的75.00%(P<0.05);2组患者中HP根除共67例,根据患者HP根除情况分为根除组(n=67)和未根除组(n=13),2组患者在治疗依从性、对阿莫西林/左氧氟沙星耐药以及CYP2C19基因多态性方面比较差异均有统计学意义(P<0.05);回归分析结果显示,治疗依从性不佳、对阿莫西林/左氧氟沙星耐药、强代谢型CYP2C19基因多态性均为HP相关性消化性溃疡患者HP未根除的危险因素(P<0.05);治疗后,2组的MLS评分及血清IL-6、TNF-α、INF-γ水平均降低,且B组均低于A组(P<0.05);A组的总治疗费用为274.40元,CER为3.67元/%,B组为164.66元,CER为1.78元/%,HP根除率每增高1%,B组较A组少支付6.27元;A组的不良反应发生率为10.00%,B组为12.50%,2组比较差异无统计学用意义(P>0.05);A组的复发率为20.00%,B组的复发率为5.00%,2组比较差异有统计学意义(P<0.05)。结论雷贝拉唑联合左氧氟沙星、奥硝唑治疗HP相关性消化性溃疡的疗效显著,可有效改善患者的消化道黏膜损伤情况,提高HP根除率,降低患者的炎症因�Objective To investigate the effect of rabeprazole combined with levofloxacin and ornidazole in the treatment of Helicobacter pylori(HP)-related peptic ulcers.Methods From July 2021 to December 2023,80 patients with HP-related peptic ulcers were selected as study subjects,and were divided into group A(traditional triple therapy,i.e.,combination of omeprazole,amoxicillin and clarithromycin)and group B(combination of rabeprazole,levofloxacin and ornidazole)by random envelope method,with 40 cases in each group.The efficacy,gastrointestinal mucosal damage[modified Lanza score(MLS)],HP eradication rate,levels of inflammatory factors[interferon-γ(IFN-γ),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)],costeffectiveness,adverse reactions,and recurrence rate at 3 months after treatment were compared between the 2 groups.Binary logistic regression model was used to analyze the factors affecting HP eradication in patients with HP-related peptic ulcers.Results The total effective rate of treatment(95.00%)in group B was higher than in group A(77.50%),P<0.05.The HP eradication rate(92.50%)in group B was higher than in group A(75.00%),P<0.05.A total of 67 cases of HP eradication were found in the 2 groups.According to the eradication of HP,the patients were divided into eradication group(n=67)and non-eradication group(n=13).There were statistical differences in treatment compliance,drugresistance to amoxicillin/levofloxacin and CYP2C19 gene polymorphism between the 2 groups(P<0.05).Regression analysis showed that poor treatment compliance,drug resistance to amoxicillin/levofloxacin,and strong metabolizer CYP2C19 gene polymorphism were risk factors for HP non-eradication in patients with HP-related peptic ulcers(P<0.05).After treatment,the MLS score and serum levels of IL-6,TNF-α,and INF-γ in both groups were reduced,and the score and levels were lower in group B than those in group A(P<0.05).The total cost in group A was 274.40 yuan,with a cost-effective ratio(CER)of 3.67 yuan/%,while the total cost in group B was

关 键 词：雷贝拉唑 左氧氟沙星 奥硝唑 消化性溃疡 幽门螺杆菌根除率 炎性因子 

分 类 号：R975[医药卫生—药品]