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盐酸小蘖碱抗幽门螺杆菌的实验及临床研究
引用本文:郭丽坤,王志荣,林永辉. 盐酸小蘖碱抗幽门螺杆菌的实验及临床研究[J]. 河南中医, 2017, 37(8). DOI: 10.16367/j.issn.1003-5028.2017.08.0520
作者姓名:郭丽坤  王志荣  林永辉
作者单位:上海中医药大学附属曙光医院,上海,201203
摘    要:目的:研究盐酸小蘖碱在体外的抗幽门螺杆菌(Helicobacter pylori,Hp)作用以及盐酸小蘖碱联合治疗Hp感染的临床疗效,为临床应用提供理论依据。方法:(1)胃镜下取25例快速尿素酶阳性患者的胃黏膜进行Hp临床株的分离纯化,连同12908、43504两例Hp标准株作为研究对象,将盐酸小蘖碱分为250μg、100μg、50μg、25μg四个浓度梯度组,以15μg标准克拉霉素纸片作为阳性对照,用纸片法进行体外药敏实验,比较平均抑菌圈直径及抗Hp有效率。(2)212例临床诊断为Hp感染的患者,随机分为4组:A组:PPI加克拉霉素加盐酸小蘖碱;B组:PPI加阿莫西林加盐酸小蘖碱;C组:PPI加阿莫西林加克拉霉素;D组:PPI加克拉霉素加甲硝唑。口服药物剂量:奥美拉唑20 mg·次~(-1)(其他PPI使用等效剂量),盐酸小蘖碱0.4 g·次~(-1),克拉霉素0.5 g·次~(-1),阿莫西林1.0 g·次~(-1),甲硝唑0.4 g·次~(-1),均2次·d~(-1)口服,连续服用7 d。抗Hp治疗停药4周后复查14 C呼气实验。比较Hp根除率、不良反应发生率。结果:(1)各浓度梯度组的盐酸小蘖碱抑菌圈直径均小于克拉霉素组,比较有统计学意义(P0.01)。盐酸小蘖碱250μg、100μg、50μg、25μg组与克拉霉素15μg组抗Hp有效率为92.59%(25/27)、85.19%(23/27)、44.44%(12/27)、44.44%(12/27)、88.89%(24/27),5组抗Hp有效率比较有统计学意义(P0.01),组间两两比较,克拉霉素15μg组与盐酸小蘖碱250μg、100μg组,盐酸小蘖碱250μg组与盐酸小蘖碱100μg组抗Hp有效率比较无统计学意义(P0.05)。(2)A组、B组、C组、D组Hp根除率分别为:70.37%(38/54)、61.22%(30/49)、68.63%(35/51)、65.52%(38/58),各组间根除率比较无统计学意义(P0.05);A组、B组、C组、D组不良反应发生率分别为9.12%、0.31%、2.87%、6.10%(P0.01);不良反应发生率组间比较:各组间差别均有统计学意义(P0.05)。结论:(1)盐酸小蘖碱在体外有良好的抗Hp作用;(2)临床应用PPI加盐酸小蘖碱加克拉霉素或阿莫西林组成三联方案的Hp根除率与对照组标准方案PPI加克拉霉素加甲硝唑或阿莫西林无明显差异;PPI加盐酸小蘖碱加阿莫西林组不良反应最少;含克拉霉素治疗组不良反应明显高于其他组。

关 键 词:幽门螺杆菌  盐酸小蘖碱  药敏实验

Experimental Study of Berberine Against Helicobacter Pylori and Clinical Research of Combined Therapy for Helicobacter Pylori with Berberine
GUO Li-kun,WANG Zhi-rong,LIN Yong-hui. Experimental Study of Berberine Against Helicobacter Pylori and Clinical Research of Combined Therapy for Helicobacter Pylori with Berberine[J]. Henan Traditional Chinese Medicine, 2017, 37(8). DOI: 10.16367/j.issn.1003-5028.2017.08.0520
Authors:GUO Li-kun  WANG Zhi-rong  LIN Yong-hui
Abstract:Objective:To study the effects of Berberine against Helicobacter pylori(Hp) in vitro and its clinical effects on Hp infection to provide theoretical basis for the clinical application.Methods:Step1:The clinical strains of Hp in the gastric mucosa of 25 patients with positive results of rapid urease test were conducted separation and purification.Two cases of 12908 and 43504 Hp standard strain were the study objects.Berberine were divided into four concentration gradients of 250 ug,100 ug,50 ug and 25 ug,and the 15 ug standard Clarithromycin paper was as the positive control.The paper stripmethod was applied to perform susceptibility testing in vitro.The diameter ofaverage inhibition zone and anti-Hp effective rates were compared.Step 2:The 212 patients diagnosed as Hp infection were randomized into four groups;group A:PPI + Clarithromycin + Berberine;group B:PPI + Amoxicillin + Berberine;group C:PPI + Amoxicillin + Clarithromycin;group D:PPI + Clarithromycin + Metronidazol.The dosage of oral medication:Omeprazole of 20mg once (others with same dosage of PPI),Berberine of 0.4g once,Clarithromycin of 0.5g once,Amoxicillin of 1.0g once,Metronidazol of 0.4g once,twice a day with oral administration for successive 7 days.Four weeks after the withdrawal of anti-Hp drug,14 C expiration test was conducted.The eradication rate of Hp and occurrence rate of adverse reactions were compared between the two groups.Results:1.The Berberine inhibition zone diameter of each concentration gradient was lower than that in Clarithromycin group;the difference had statisitical significance (P < 0.01).The antiHp effective rates of Berberine groups of 50ug,100ug,50ug and 25ug and the anti-Hp effective rate of Clarithromycin group of 15ug were respectively 92.59% (25/27),85.19% (23/27),44.44% (12/27),44.44% (12/27) and 88.89% (24/27).The differences between the five groups had statistical significance (P < 0.01).The comparison between every two groups indicated the differences of the anti-Hp effective rates between Clarithromycin group of 15ug and Berberine groups of 15ug,250ug and 100ug,between Berberine group of 250ug and Berberine group of 100ug had no statistical significance (P > 0.05).The Hp eradication rates of group A,group B,group C and group D were respectively 70.37% (38/54),61.22% (30/49),68.63% (35/51) and 65.52% (38/58);the differences had no statistical significance (P > 0.05).The occurrence rates of adverse reactions in group A,group B,group C and group D were respectively 9.12%,0.31%,2.87% and 6.10% (P <0.01).The differences of occurrence rates between every two groups had statistical significance (P < 0.05).Conclusion:1.Berberine has good anti-Hp effects in vitro;2.There is no obvious difference of the eradication rates of Hp between the clinical application of PPI + Berberine + Clarithromycin or Amoxicillin and clinical application of control standard program of PPI + Clarithromycin + Metronidazole or Amoxicillin.The adverse reaction rate of group PPI + Berberine + Amoxicillin is the least.The adverse reaction rate of groups including Clarithromycin is markedly higher than that of other groups.
Keywords:Helicobacter pylori (Hp)  Berberine  susceptibility testing
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