序貫療法治療幽門螺桿菌陽性胃潰瘍的臨床分析

1、序貫療法治療幽門螺桿菌陽性胃潰瘍的臨床分析    【摘要】目的比較序貫療法與傳統(tǒng)三聯(lián)療法治療幽門螺桿菌Hp陽性胃潰瘍的療效與安全性。方法選取84例經(jīng)胃鏡檢測證實(shí)為Hp陽性胃潰瘍病例，隨機(jī)分為兩組：治療組，前5d予雷貝拉唑、阿莫西林,后5d予雷貝拉唑、替硝唑、克拉霉素治療；對照組予雷貝拉唑、阿莫西林、克拉霉素治療10d。隨后兩組均進(jìn)行雷貝拉唑鞏固治療4周，療程結(jié)束后均行胃鏡復(fù)查檢測。結(jié)果療程結(jié)束時(shí),治療組潰瘍愈合率87.8%,對照組潰瘍愈合率86.05%，兩組愈合率比較無顯著性差異P0.05；治療組HP陰轉(zhuǎn)率為92.68%,對照組HP陰轉(zhuǎn)率為83.72%，

2、兩組HP陰轉(zhuǎn)率比較具有顯著性差異P【關(guān)鍵詞】10d序貫療法；三聯(lián)療法；幽門螺桿菌；胃潰瘍 Sequential therapies for Helicobacter pylori-positive gastric ulcer clinical analysis 【Abstract】Objective To compare sequential therapy with the traditional triple therapies for Helicobacter pylori Hp-positive gastric ulcer and security. Methods 84 cases

3、detected by endoscopy confirmed Hp-positive patients with gastric ulcer were randomly divided into two groups: the treatment group，before the therapy of the combination of rabeprazole, amoxicillin and rabeprazole for 5d,tinidazole, clarithromycin mixture therapy of 5d;control group, rabeprazole, Amo

4、xicillin,clarithromycin treatment of 10d. Both groups were followed for consolidation therapy of rabeprazole for 4 weeks after treatment underwent endoscopy review test. Results at the end of treatment, the treatment group 87.8% ulcer healing rate, ulcer healing rate of the control group was 86.05%,

5、 the healing rate between the two groups there was no significant difference P>0.05; treatment group HP negative conversion rate was 92.68%, control Group HP negative conversion rate was 83.72%, compared two groups of HP negative rate was significant difference P 【Keywords】10d sequential triple t

6、herapy for Helicobacter pylori in gastric ulcer treatment 幽門螺桿菌Helicobacter pylori, Hp是消化性潰瘍、胃癌、胃黏膜相關(guān)淋巴組織MALT淋巴瘤等疾病的重要致病因子, 對消化性潰瘍患者的治療必須根除Hp。目前，隨著細(xì)菌耐藥率的逐年升高, Hp根除的一線方案的Hp根除率也在下降, 已有文獻(xiàn)報(bào)道標(biāo)準(zhǔn)三聯(lián)療法Hp根除率已下降至66.6%1。因此,需要尋找一種更理想的Hp根除的一線方案。由意大利DeFrancesco et al2發(fā)現(xiàn)的根除Hp的新方案-序貫療法,可以取得更高的H pylor第一階段的阿莫西林治療能通過破壞

7、細(xì)胞壁而阻止克拉霉素流出通道的形成,故可能提高了第二階段克拉霉素的治療效果5。近年來克拉霉素的耐藥率較以前有明顯升高,達(dá)17 %44 % 6、7 ；2序貫療法適當(dāng)?shù)匮娱L了療程,使根除Hp治療更徹底;3種抗生素短期聯(lián)合應(yīng)用,達(dá)到了強(qiáng)強(qiáng)聯(lián)合抑制Hp,又能減少Hp耐藥機(jī)會(huì)。 本研究發(fā)現(xiàn)序貫療法較經(jīng)典三聯(lián)療法在胃潰瘍的根治Hp感染一線治療有較好的前景。我們的研究發(fā)現(xiàn)，雖在胃潰瘍治愈率方面無明顯差別，但Hp陰轉(zhuǎn)率達(dá)92.68，較傳統(tǒng)標(biāo)準(zhǔn)治療方案優(yōu)越，這與國外Zullo博士發(fā)表了有關(guān)序貫療法根除Hp的研究報(bào)告的98的Hp根除率8較接近，也與國內(nèi)趙大國等研究結(jié)果一致10，他們發(fā)現(xiàn)，前5d給奧美拉唑克拉霉素，

8、后5d給奧美拉唑阿莫西林呋喃唑酮的10d序貫療法治療Hp 感染的成人患者，Hp 根除率為90.7，與標(biāo)準(zhǔn)7d三聯(lián)療法（Hp根除率為71.4）比較，Hp根除率高，患者的耐受性和依從性好；與一項(xiàng)薈萃分析得出總的Hp根除率93.5相似9，他們還發(fā)現(xiàn)，針對克拉霉素耐藥患者Hp根除率也高，且兩種方案副作用的發(fā)生率無明顯差別。但我們發(fā)現(xiàn)序貫療法不良反應(yīng)明顯少于傳統(tǒng)標(biāo)準(zhǔn)治療方案。這可能與研究的對象、樣本量、抗生素種類、質(zhì)子泵抑制劑的差異等有關(guān)，有待進(jìn)步研究。 參考文獻(xiàn) 1Ojetti V, Migneco A, Zocco MA, Nista EC,Gasbarrini G, Gasbarrini A. B

9、eta-lactamase inhibitor enhances Helicobacter pylori eradication rate. J Intern Med 2004; 255: 125-129. 2 De Francesco V, Zullo A, Hassan C, Faleo D,Ierardi E, Panella C, Morini S.Two new treatment regimens for Helicobacter pylori eradication: a randomised study. Dig Liver Dis 2001; 33: 676-679. 3 潘

10、秀珍, 彭孝緯, 彭如潔. 幽門螺桿菌對抗生素耐藥研究進(jìn)展. 世界華人消化雜志 2008; 16: 806-813. 4 成虹, 胡伏蓮. “第三次全國幽門螺桿菌感染若干問題共識(shí)意見會(huì)議”紀(jì)要. 臨床藥物治療雜志 2007; 5:58-59. 5 Dino Vaira M D , Angelo Zullo M D , Nimish Vakil M D. Sequential therapy versus standard tripie-drug therapy for Helicobacter pylori eradication J.Annals of Internal Medicine,2

11、007,146 8:556-563. 6Perri F, Villani M R , Festa V , et al. Predictors of failure of Helicobacter pylori eradication with the standard Maastricht triple therapyJ.Aliment Pharmacol Ther,2001,15:1023-1029. 7 Savarino V, Zentilin P, Pivari M, et al.The impact of antibiotic resistance on the efficacy of

12、 three 7-day regimens against Helicobacter pyloriJ . Aliment Pharmacol Ther ,2000 ,14 :893 - 900. 8Zullo A，Rinaldi V，Winn S，et alA new highly effective shorttermtherapy schedule for Helicobacter pylori eradication JAliment Pharmacol Ther，2000，14（6）：715718 9童錦祿，冉志華，沈俊,等.10 天序貫療法與標(biāo)準(zhǔn)三聯(lián)療法治療幽門螺桿菌感染那薈萃分析J.胃腸病學(xué)和肝病學(xué)雜志，2008，17（2）：106109. 10趙大國，孫