幽门螺杆菌阳性功能性消化不良的治疗选择

目的：探讨根除幽门螺杆菌（HP）、改善胃动力及抗焦虑药对HP阳性功能性消化不良（FD）症状的效果。方法：HP阳性的FD160例随机的分为3个治疗组：胶体次枸橼酸铋（B）合并呋喃唑酮（F）及羟氨苄青霉素（A）三联疗法（BFA方案,60例）、西沙必利（CIS,60例）和多虑平（DXP,40例）,对其疗效作前瞻性随机对照研究。结果：CIS总有效率显著高于BFA（P＜0．05）,DXP总有效率介于两者之间。临床类型中,CIS对运动障碍型FD疗效优于BFA（P＜0．01）;而对溃疡型FD,BFA比CIS效果更佳（P＜0．05）;伴有焦虑、多疑、多梦及严重失眠的女性FD,DXP常常收到良好的效果,并优于BFA或CIS（P＜0．05）。不同年龄、性别及病程对疗效亦产生一定的影响。结论：HP阳性FD没有必要常规行根除HP治疗,但对溃疡型FD尤其病程较长者,根除HP治疗对改善FD症状有较好的效果。改善胃动力更适合于运动障碍型、年龄较小及病程较短的FD患者。上述治疗无效,尤其病程较长且同时伴有神经衰弱征候群的女性FD患者,推荐给予抗焦虑药治疗。

Therapeutic Study on Helicobacter Pylori Positive Functional Dysplasia

Purpose: To investigate the effect of three therapies on symptoms of function dysplasia (FD) with HP positive, eradication of HP, improving dysmotility or anti anxiety. Methods: 160 cases FD with HP infection proved by urease test, warthen starry staining and culture (at least two out of three are positive) were randomly allocated into three groups: bismuth based triple therapy containing furazolidone and amoxine (BFA method, 60cases), Cisapride (CIS 60cases) and doxepine (DXP, 40 cases). Prospective and compared study was done to estimate their effect by t test, ridit analysis, Chi square test and Logistic regression analysis. Results: Total effective rate of CIS (70%) was significantly higher than that of BFA (40%)(P<0.05). Total effective rate of DXP was between that of CIS and BFA. In the subgroup of clinical pattens, the effect of BFA (86.67%) on ulcer like dysplasia was significantly increased compared with that of CIS(46.15%)(P<0.05), whereas the effect of CIS (94.29%) on dysmotility like dysplasia was much better than that of BFA (24.2%)(P<0.01). In addition, DXP was often good candidate for the female patients accompanied with anxiety, suspicious, lots of dream and severe insomnia. There were quite different effects between three groups due to age, sex and duration of disease. Conclusions: It is not necessory to eradicate HP as a routine therapeutic approach on FD with HP positive, however, it might be more efficacious to eradicate HP in ulcer like dysplasia. Prokinetic therapy probably would get a clinically significant benefit, especially in dysmotility like FD with HP positive. Anti anxiety drugs such as DXP have an unexpected effect on the patients with crack up.