序贯疗法与标准三联疗法根除幽门螺杆菌疗效随机对照研究

目的比较国产质子泵抑制剂（PPI）、阿莫西林、克拉霉素、替硝唑组成的序贯疗法与标准三联疗法根除幽门螺杆菌（Hp）的疗效、不良反应、药物费用。方法将经胃镜检查确诊为有明显异常的慢性胃炎、慢性胃炎伴消化不良症状和消化性溃疡且Hp阳性的患者86例随机分组，试验组（45例）方案为前5d兰索拉唑、阿莫西林，后5d兰索拉唑、克拉霉素、替硝唑；对照组（41例）三联疗法为兰索拉唑、阿莫西林、克拉霉素，疗程10d。结果试验组Hp根除率按意图治疗分析和按试验方案分析分别为88．89％（40／45，95％CI76．00％-96．00％）和93．33％（42／45，95％CI82．00％-98．00％）；对照组为78．05％（32／41，95％CI78．04％～90．72％）和85．37％（35／41，95％CI85．37％～96．19％）。两组比较差异有统计学意义（P〈0．05）。试验组有2例（4．44％），对照组有6例（14．63％）自诉服药后有不良反应。试验组的药物费用比对照组低廉。结论以国产兰索拉唑、阿莫西林、克拉霉素、替硝唑组成的10d序贯疗法治疗Hp感染，具有疗效高、不良反应低、相对价廉的特点。

Randomized control study on the effect of sequential therapy and standard triple therapy on eradication of Helicobacter pylori

Objective To evaluate the effect, adverse reaction and cost of sequential therapy （including lansoprazole, amoxicillin, clarithromyein and tinidazole）and standard triple therapy （including lansoprazole, amoxicillin and clarithromycin）for eradication of t4elicobaeter pylori （Hp）. Methods Eighty-six patients with Hp positive peptic ulcer and chronic gastritis were randomized into two groups. Study group （45 cases） were treated with lansoprazole plus amoxicillin at first 5 days, lansoprazole, clarithromyein and tinidazole at the second 5 days. Control group（41 cases） were treated with lansoprazole, amoxicillin and clarithromyein for 10 days. Results The eradication rates of Hp in study group were 88.89 % （40/45, 95% CI 76.00%-96.00% ）and 93.33 %（42/45, 95%CI 82.00%-98.00% ）, and those in control group were 78.05 % （ 32/41, 95% CI 78.04%-90.72% ） and 85.37% （ 35/41, 95% CI 85.37%-96.19% ）with intention-to-treat and perprotocol analysis respectively. The differences between two groups were significant （P 〈 0.05 ）. The incidence rate of adverse reaction was 4.44% （2/45） in study group and 14.63% （6/41） in control group respectively. The cost in study group was cheaper than that in control group. Conclusion Ten days sequential therapy is higher in eradication rate of Hp, welltolerated and cheaper.