3种幽门螺杆菌根除方案和抗生素耐药对其根除率的影响

背景:目前推荐的根除幽门螺杆菌(H.pylori)的治疗方案因H.pylori对大环内酯类和硝基咪唑类抗生素的耐药性快速增加而不能令人满意。目的:评估以质子泵抑制剂(PPI)为基础或以H2受体拮抗剂(H2RA)加铋剂为基础的三联或四联疗法根除H.pylori的疗效和安全性,评估H.pylori的耐药性及其对根除率的影响。方法:120例H.pylori感染的愈合期十二指肠球部溃疡或非溃疡性消化不良患者随机分入3个治疗组,疗程7天。A组:奥美拉唑、克拉霉素和替硝唑;B组:法莫替丁、枸橼酸铋钾、克拉霉素和替硝唑;C组:法莫替丁、枸橼酸铋钾、呋喃唑酮和四环素。根除治疗前取胃窦黏膜活检组织行快速尿素酶试验、H.pylori培养和组织学检查评估H.pylori感染状态。治疗结束后4～6周,采用13C-尿素呼气试验评估H.pylori根除情况。琼脂扩散法药物敏感试验测定抗生素的最小抑菌浓度(MIC)。结果:所有患者均完成治疗和随访。A组、B组和C组的H.pylori根除率分别为80%(32/40)、85％(34/40)和90％(36/40),3组间无显著差异(P>0.05)。耐药菌株与敏感菌株的H.pylori根除率有显著差异。结论:以PPI为基础或以H2RA加铋剂为基础的三联或四联疗法对H.pylori具有较高的根除率。H.py-lori的耐药性是影响根除率的主要因素。

Three Regimens in Eradication of Helicobacter pylori and the Influences of Antibiotics Resistance on the Eradication Rates

Background: Current treatment regimens recommended for Helicobacter pylori (H. pylori) eradication are not satisfactory because of the rapid increase of resistances to macrolides and nitroimidazoles. Aims: To evaluate the efficacy and safety of proton pump inhibitor (PPI)-based or H2 receptor antagonist (H2RA) plus bismuth-based triple or quadruple regimens on H. pylori eradication, and to assess the prevalence of antibiotics-resistant H. pylori and its influences on eradication rates. Methods: A total of 120 H. pylori-positive patients with healed duodenal ulcer or non-ulcer dyspepsia were randomly enrolled to receive one of the three following 7-day regimens. Group A: omeprazole, clarithromycin and tinidazole; Group B: famotidine, colloidal bismuth subcitrate (CBS), clarithromycin and tinidazole; Group C: famotidine, CBS, furazolidone and tetracycline. H. pylori infection was assessed before eradication by rapid urease test, H. pylori culture and histology on biopsies taken from the antrum. Bacterial eradication was assessed by 13C-urea breath test 4~6 weeks after the therapy had ended. The minimal inhibitory concentration (MIC) of the antibiotics in the antimicrobial susceptibility testing was measured by agar dilution method. Results: All patients completed the treatment and follow-up. The eradication rates of H. pylori in group A, B and C were 80% (32/40), 85% (34/40) and 90% (36/40), respectively with no significant difference (P>0.05), but the eradication rates were significantly different between the resistant and sensitive strains of H. pylori infected. Conclusions: PPI-based or H2RA plus bismuth-based triple or quadruple regimens were proven to have high eradication rates of H. pylori, and antibiotics-resistance is the main factor which influences the eradication rate of H. pylori.