双歧杆菌四联活菌片辅助含呋喃唑酮及四环素四联疗法补救根除幽门螺杆菌的疗程研究

目的探讨含呋喃唑酮、四环素的四联疗法在补救根除幽门螺杆菌(Helicobacter pylori,Hp)治疗中辅助应用不同疗程双歧杆菌四联活菌片对根除率及不良反应的影响。方法选取2016年12月至2019年5月于华北理工大学附属开滦总医院消化内科门诊就诊患者348例进行前瞻性研究,均为初次根除Hp失败的慢性胃炎患者,利用Excel随机分组方法分为A、B、C组,A组(116例)给予14 d艾普拉唑、果胶铋、呋喃唑酮、四环素方案治疗;B组(116例)在A组方案基础上同时服用14d双歧杆菌四联活菌片;C组(116例)在A组方案治疗第二周开始同时服用7 d双歧杆菌四联活菌片。根除治疗结束4周后复查14C-尿素呼气试验,比较3组的Hp根除率及不良反应发生率。结果3组按意向性治疗分析根除率分别为80.2%、84.5%和82.3%,按符合方案分析根除率分别为88.6%、90.7%和89.7%,3组两种分析方法比较,差异均无统计学意义(按意向性治疗分析:χ^2=0.755P=0.685,按符合方案分析:χ^2=0.271P=0.873);3组不良反应发生率分别为16.4%、6.3%和7.3%,差异有统计学意义(χ^2=7.561,P=0.023),且B组显著低于A组(χ^2=5.570,P=0.017),差异有统计学意义,但C组与A组比较差异无统计学意义(χ^2=4.362,P=0.037)。结论14 d双歧杆菌四联活菌片辅助含呋喃唑酮、四环素的四联疗法补救根除Hp可以显著降低不良反应,但双歧杆菌四联活菌片不能显著提高Hp根除率。

Study on the treatment course of Bifidobacterium combined with quadruple therapy including furazolidone and tetracycline for rescue eradication of Helicobacter pylori

Objective To explore the effect of the eradication rate and adverse reactions of different courses of Bifidobacterium combined with quadruple therapy containing furazolidone and tetracycline for rescue eradication of Helicobacter pylori.Methods From December 2016 to May 2019,348 patients with chronic gastritis who failed to eradicate Hp for the first time were selected from the outpatient department of digestive medicine of Kailuan General Hospital affiliated to North China University of Technology.Group A,B and C were randomly divided by Excel,Group A(116 patients):14-day quadruple therapy(Eprazole+colloidal bismuth pectin+furazolidone+tetracycline);group B(116 patients):Bifidobacterium was given 14 days on the basis of treatment in group A;group C(116 patients):7 days Bifidobacterium was given in the second week of treatment in group A 4 weeks after the end of eradication treatment,14 C urea breath test was reexamined,to compare the eradication rate and the incidence of adverse reactions.Results The eradication rates were 80.2%,84.5%and 82.3%respectively according to intention treatment.The eradication rates were 88.6%,90.7%and 89.7%,respectively according to perprotocol.There was no significant difference between the three groups(according to intention to treat analysis:χ^2=0.755,P=0.685;according to the perprotocol analysis:χ^2=0.271,P=0.873).The incidence of adverse reactions in three groups was 16.4%,6.3%and 7.3%respectively,the difference was statistically significant(χ^2=7.561,P=0.023).Group B was significantly lower than group A(χ^2=5.570,P=0.017),the difference was statistically significant,but there was no statistically significant difference between group C and group A(χ^2=4.362,P=0.037).Conclusion After 14 days of Bifidobacterium tetrad live tablet assisted with tetrad therapy containing furazolidone and tetracycline,the adverse reactions could be significantly reduced,but Bifidobacterium could not significantly improve the eradication rate.