10日序贯疗法治疗幽门螺杆菌感染39例

目的: 比较埃索美拉唑、阿莫西林、克拉霉素、替硝唑组成的10日序贯疗法与标准三联疗法根除幽门螺杆菌( H pylori)的疗效.方法: 将我院经胃镜检查确诊为慢性胃炎和消化性溃疡且H pylori阳性的患者79例随机分为2组, 治疗组(39例)方案: 前5 d, 埃索美拉唑20 mg+阿莫西林1000 mg, 每日2次; 后5 d, 埃索美拉唑20 mg+克拉霉素500 mg+替硝唑500mg, 每日2次. 对照组(40例)标准三联疗法: 埃索美拉唑20 mg+克拉霉素500 mg+阿莫西林1000 mg, 每日2次, 疗程7 d. 所有患者停药4wk后复查13C呼气试验, 判断H pylori根除率.结果: 治疗组H pylori根除率为94.87%, 对照组77.50%, 2组比较差异具有统计学意义(χ2 =4.97, P<0.05), 且序贯疗法并未增加患者的经济负担. 2种方案不良方应的发生率无明显差异(χ2 = 0.05, P>0.05).结论: 10日序贯疗法治疗H pylori感染明显优于7日标准三联疗法, 是一种安全、经济、有效的方案选择.     

序贯疗法治疗幽门螺杆菌阳性消化性溃疡的临床观察

[目的]对比研究序贯疗法与三联疗法治疗幽门螺杆菌（Hp）阳性消化性溃疡的疗效。[方法]将100例幽门螺杆菌阳性消化性溃疡患者随机分成序贯疗法组与三联疗法组,每组50例,治疗10d后比较2组的疗效。[结果]2组治疗前后及复查结果比较差异均有统计学意义（P〈0.05）;治疗后,序贯疗法组Hp根除率高于三联疗法组,差异有统计学意义（P〈0.05）。[结论]从不良反应、患者的经济承担能力及依从性等方面比较,序贯疗法治疗幽门螺杆菌阳性消化性溃疡优于三联疗法。     

10天序贯疗法与标准三联疗法治疗幽门螺杆菌感染荟萃分析

目的系统地评价10天序贯疗法能否获得比标准三联疗法更高的H．pylori根除率，以及两种方案之间发生副反应的差异。方法利用中英文检索词检索相关电子数据库，根据纳入标准入选了比较10天序贯疗法与标准三联疗法的幽门螺杆菌根除率的随机临床试验。提取患者基本资料、研究质量、H．pylori根除率和副作用的发生率等相关数据。针对于10天序贯疗法和7天或10天标准三联疗法的H．pylori根除率和副作用的发生率，计算相应的RR和95％可信区间。运用漏斗图评价出版偏倚。结果Meta分析纳入了10项随机对照研究，共2855例患者。10天序贯疗法明显优于7天或10天标准三联疗法，总的H．pylori根除率分别为93．5％、75．9％和79．4％，RR为1．23（95％CI=1．19—1．28）和1．16（95％CI：1．10—1．23）。无论是溃疡性消化不良患者还是非溃疡性消化不良患者，10天序贯疗法都能获得更高的H．pylori根除率，RR分别为1．16（95％CI=1．10—1．23）和1．26（95％CI=1．19—1．33）；针对克拉霉素耐药患者，10天序贯疗法的有效H．pylori根除率也高于标准三联疗法（75．9％vs32．7％），RR为2．18（95％CI=1．43—3．34）。然而两种方案副作用的发生率无明显差别（RR=1．00，95％CI=0．97—1．03）。结论10天序贯疗法明显优于7天或10天标准三联疗法,副作用无明显增加。     

10天序贯疗法根除42例幽门螺杆菌临床观察

目的 比较10 d序贯疗法与传统三联疗法根治幽门螺杆菌(Hp)的疗效与安伞性.方法 选取85例1月内14C尿素呼气试验阳性或者胃镜Hp实验阳性病例,随机分为两组:治疗组前5 d予奥美拉唑、阿莫西林,后5 d予奥美拉唑、替硝唑、克拉霉素治疗;对照组予奥美拉唑加阿莫西林、克拉霉素治疗10 d.疗程结束1月后行14C尿素呼气试验检测.结果 1月后疗程结束时,治疗组总有效率97.6%,对照组总有效率73.3%,两组疗效比较有非常显著性差异(P<0.01);治疗组14C尿素呼气试验转阴率为95.2%,对照组转阴率为76.7%,两组Hp转阴率比较具有显著性差异(P<0.05).结论 10 d序贯疗法治疗Hp的根治率较传统三联疗法高,且副作用少,易耐受,安全可靠.     

含左氧氟沙星的四联药物10日序贯疗法根除幽门螺杆菌疗效观察

目的 观察雷贝拉唑、克拉霉素、左氧氟沙星、阿莫西林(四联药物)10日序贯疗法根除幽门螺旋杆菌(HP)的疗效及安全性.方法 将经胃镜确诊的消化性溃疡和慢性胃炎伴胃黏膜萎缩或糜烂且幽门螺杆菌阳性的80例成人患者随机分成治疗组和对照组各40例.治疗组前5d口服雷贝拉唑10 mg、阿莫西林1 000 mg,2次/d;后5d口服雷贝拉唑10 mg、克拉霉素500 mg,2次/d;左氧氟沙星500 mg,1次/d.对照组采用传统的三联疗法(雷贝拉唑10 mg、阿莫西林1 000mg、克拉霉素500 mg,2次/d,共10 d).结果 治疗组及对照组HP根除率分别为92.5％(37/40)、75％(30/40),P＜O.05;不良反应发生率分别为7.5％、10％,两组相比差异无统计学意义.结论 四联药物10日序贯疗法对成人HP的根除率明显优于传统三联疗法,且较为安全.     

序贯疗法根除幽门螺杆菌感染

序贯疗法是目前欧洲MaastrichtⅣ共识意见中推荐的幽门螺杆菌(Hp)感染的一线经验性根除方案之一,其根除率、耐受性及安全性均较令人满意,但国内缺乏相关研究及应用经验。此文对目前国际上应用序贯疗法根除Hp感染的相关研究作一综述。     

10天序贯疗法治疗幽门螺杆菌阳性消化性溃疡的疗效分析

幽门螺旋杆菌（Hp）感染是消化性溃疡的重要病因,根除Hp能够治愈消化性溃疡且减少溃疡复发率。Hp根除的经典一线方案根除率逐渐下降。寻找便宜、高效、副作用小的方案十分重要。我们比较了序贯疗法和7天以及14天三联疗法治疗幽门螺杆菌阳性消化性溃疡的疗效,为临床上选择根除Hp方案的提供帮助。     

中国序贯疗法与三联疗法治疗幽门螺杆菌感染荟萃分析

目的:系统评价中国序贯疗法与三联疗法治疗幽门螺杆菌(H pylon)感染的疗效及不良反应的差异.方法:利用中文数据库,根据纳入标准入选中国序贯疗法与三联疗法根除H pylori的随机对照临床试验.提取患者的基本资料、研究质量、Hpylori根除率和不良反应发生率等相关数据.比较序贯疗法和7日或10日三联疗法的Hpylori根除率和不良反应发生率,计算相对危险度(Relative risk,RR)和95%CI.运用漏斗图评价出版偏倚.结果:纳入了9项随机对照研究.共835例患者.序贯疗法、7日及1 0日三联疗法的总H pylori根除率分别为92.0%、73.7%和84.5%(P=0.002).序贯疗法分别与7日或10日三联疗法比较.RR分别为1.23(95%CI:1.14-1.33)和1.12(95%CI:1.02-1.23).不良反应发生率无明显差异.结论:中国根除Hpylon使用序贯疗法明显优于7日和10日三联疗法,不良反应发生率无差异.     

10天序贯疗法和传统三联疗法根除幽门螺杆菌的疗效比较

[目的]比较10d序贯疗法与传统三联疗法根除幽门螺杆菌（Hp）的疗效。[方法]选取78例^14C-尿素呼气试验阳性病例,随机分为2组：治疗组（39例）前5天予埃索美拉唑、阿莫西林,后5天予埃索美拉唑、克拉霉素、替硝唑治疗;对照组（39例）予埃索美拉唑、克拉霉素、阿莫西林治疗10d。疗程结束1个月后行^14C-尿素呼气试验检测。[结果]治疗组^14C-尿素呼气试验检测阴性者37例,阳性者2例,根除率为94．87％;对照组^14C-尿素呼气试验检测阴性者32例,阳性者7例,根除率为82．05oA,2组Hp根除率比较差异有统计学意义（P〈0．05）,2组不良反应比较差异无统计学意义。[结论]10d序贯疗法治疗Hp感染的根除率较传统三联疗法高。     

序贯疗法补救根除幽门螺杆菌感染的疗效观察

目的比较序贯疗法与传统四联疗法对幽门螺杆菌(H.pylori)根除失败后补救治疗的临床疗效。方法选取胃镜下H.pylori快速尿素酶试验或14C尿素呼气试验阳性的患者,经我国标准H.pylori一线三联根除方案治疗7天,停药4周后检测H.pylori,结果仍为阳性者判定为H.pylori根治失败,即进行H.pylori的补救根除治疗,共68例患者入选。随机分为两组:治疗组予以序贯疗法:前5天口服埃索美拉唑20mg和阿莫西林1000mg,2次/d,后5天口服埃索美拉唑20mg、克拉霉素500mg和甲硝唑400mg,2次/d;对照组予以传统四联疗法:口服埃索美拉唑20mg、阿莫西林1000mg、呋喃唑酮100mg和胶体果胶铋100mg,2次/d,疗程7天。疗程结束后4周行14C尿素呼气试验检测H.pylori。结果疗程结束后4周,治疗组H.pylori根除率为93.9%,对照组H.pylori根除率为73.3%,两组H.pylori根除率比较有显著性差异(P0.05)。结论序贯疗法对H.pylori的根除率高于传统四联疗法,可作为有效的H.pylori补救根除治疗方案。     

8d与10d序贯疗法根除幽门螺杆菌的疗效比较

目的:比较雷贝拉唑、阿莫西林、克拉霉素、奥硝唑组成的8d与10d序贯疗法根除幽门螺杆菌(H.pylori)的疗效.方法:将经胃镜检查确诊为慢性胃炎和消化性溃疡,且H.pylori阳性的217例患者随机分为2组,8d组(n=104)方案:前4d,雷贝拉唑+阿莫西林;后4d,雷贝拉唑+克拉霉素+奥硝唑.10d组(n=113)方案:前5d,雷贝拉唑+阿莫西林;后5d,雷贝拉唑+克拉霉素+奥硝唑.根除治疗后复查14C-尿素呼气试验,比较两组H.pylori根除率.结果:8d组和10d组H.pyloriITT根除率分别为89.3%和91.2%,PP根除率分别为92.0%和93.7%.两种分析方法比较两组的根除率差异均无统计学意义(P>0.05),但8d序贯疗法降低了成本-效果比,减轻了患者的经济负担.两种方案症状缓解率及不良反应发生率的差异无统计学意义(P>0.05).结论:8d序贯疗法可以获得较高的H.pylori根除率和症状缓解率,且经济、安全,是一种可供选择的一线治疗方案.     

Helicobacter pylori eradication with either 7-day or 10-day triple therapies, and with a 10-day sequential regimen.

BACKGROUND: Helicobacter pylori eradication rates achieved by standard seven-day triple therapies are decreasing in several countries, while a novel 10-day sequential regimen has achieved a very high success rate. A longer 10-day triple therapy, similar to the sequential regimen, was tested to see whether it could achieve a better infection cure rate. METHODS: Patients with nonulcer dyspepsia and H pylori infection were randomly assigned to one of the following three therapies: esomeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1 g for seven days or 10 days, or a 10-day sequential regimen including esomeprazole 20 mg plus amoxycillin 1 g for five days and esomeprazole 20 mg, clarithromycin 500 mg and tinidazole 500 mg for the remaining five days. All drugs were given twice daily. H pylori eradication was checked four to six weeks after treatment by using a 13C-urea breath test. RESULTS: Overall, 213 patients were enrolled. H pylori eradication was achieved in 75.7% and 77.9%, in 81.7% and 84.1%, and in 94.4% and 97.1% of patients following seven-day or 10-day triple therapy and the 10-day sequential regimen, at intention-to-treat and per protocol analyses, respectively. The eradication rate following the sequential regimen was higher than either seven-day (P=0.002) or 10-day triple therapy (P=0.02), while no significant difference emerged between the latter two regimens (P=0.6). CONCLUSIONS: The 10-day sequential regimen was significantly more effective than both triple regimens, while 10-day triple therapy failed to significantly increase the H pylori eradication rate achieved by the standard seven-day regimen.     

亚洲人群中序贯疗法与三联疗法根除幽门螺旋杆菌临床疗效的Meta分析

目的评价在亚洲人群中序贯疗法与三联疗法根除幽门螺旋杆菌(Helicobacter pylori,H.pylori)临床疗效的差异。方法计算机检索中文数据库和外文数据库包括万方数据库、中国知网、维普数据库、中国生物医学文献数据库(CBM)、Medline/Pubmed、Embase、Wiley、Springer和Elsevier;手工检索《中华消化杂志》、《世界华人消化杂志》和会议记录。查找与此研究相关的临床随机对照试验(RCT)文献,采用Cochrane系统评价员手册5.0.2版推荐的方法纳入文献,并对其进行Meta分析。结果共纳入19篇临床随机对照(RCT)文献,纳入患者2 854例,其中采用序贯疗法的患者1 282例,采用三联疗法的患者1 572例。对19篇RCT研究进行Meta分析的结果显示:序贯疗法根除幽门螺旋杆菌(H.pylori)的疗效优于三联疗法,差异具有统计学意义(P0.05)。序贯疗法和三联疗法根除率的意向处理(ITT)分析分别为86.91%和73.47%(OR=2.43,95%CI:1.83~3.22,P0.05),序贯疗法与三联疗法根除率的试验方案(PP)分析分别为89.85%和77.32%(OR=2.51,95%CI:1.91~3.30,P0.05)。对于溃疡显效情况、疼痛缓解情况和不良反应发生情况等,由于条件所限未能进行Meta分析,仅进行了描述性分析。结论在亚洲人群中,序贯疗法较传统三联疗法具有较高的H.pylori根除率,为当前由于H.pylori抗生素耐药性提高而引起的三联疗法治疗成功率降低提供了一种新的选择,在临床上具有很好的应用前景。但目前相关RCT研究样本量少,且普遍质量较低。上述结论尚需要高质量、多中心、大样本量的随机双盲试验加以证实。     

Hybrid vs sequential therapy for eradication of Helicobacter pylori in Taiwan: a prospective randomized trial

AIM: To evaluate the efficacy of sequential vs hybrid therapy in patients with Helicobacter pylori(H. pylori) infection.METHODS: From March 2013 to May 2014,one hundred and seventy-five H. pylori infected patients who had not been treated for H. pylori before wererandomized to receive either sequential therapy(rabeprazole 20 mg and amoxicillin 1 g twice daily for 5 d,followed by rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg twice daily for 5 d) or hybrid therapy(rabeprazole 20 mg and amoxicillin 1 g for 7 d,followed by rabeprazole 20 mg,amoxicillin 1 g,clarithromycin 500 mg and metronidazole 500 mg twice daily for 7 d). H. pylori status was confirmed by positive results of both rapid urease test and histology examination or a positive result of culture. Eradication efficacy was assessed by follow-up endoscopy with rapid urease test and histological examination 8 wk after the end of anti-H. pylori therapy,or 13C-urea breath test at least 4 wk after completion of treatment. The primary outcome was H. pylori eradication by intension-to-treat(ITT) and per-protocol(PP) analyses.RESULTS: One hundred and sixty-seven patients(83 patients in the sequential group and 84 patients in the hybrid group) completed the study. The compliance rates were 97.6% and 97.7% for the two groups,respectively. The eradication rate was 78.2% for the sequential group and 92% for the hybrid group by ITT analysis(P = 0.01). The eradication rate was 81.9% for the sequential group and 96.4% for the hybrid group by PP analysis(P = 0.01). Univariate analysis for the clinical and bacterial factors did not identify any risk factors associated with treatment failure. Severe adverse events were observed in 2.3% of patients in the sequential group and 2.4% of those in the hybrid group.CONCLUSION: Due to a grade A( 95%) success rate for H. pylori eradication by PP analysis,similar compliance and adverse events,hybrid therapy seems to be an appropriate eradication regimen in Taiwan.     

Comparison of sequential and 7-, 10-, 14-d triple therapy for Helicobacter pylori infection

AIM: To compare the effectiveness of sequential therapy for Helicobacter pylori (H. pylori) infection with that of triple therapy of varying durations.METHODS: The 460 patients enrolled in this study had H. pylori-associated gastritis or a gastric or duodenal ulcer. After screening, H. pylori-infected patients were randomly assigned to receive either conventional triple therapy for 7, 10 or 14 d, or a new 10-d sequential therapy. Each of the 4 treatment groups included 115 patients. The outcomes of eradication therapy were assessed 4 wk after treatment by the urea breath test and histology.RESULTS: The overall eradication rate was 81.0%, and eradication rates were 75.7% for 7-d conventional triple therapy, 81.9% for 10-d conventional triple therapy, 84.4% for 14-d conventional triple therapy, and 82.0% for 10-d sequential therapy. Neither intention-to-treat analysis nor per protocol analysis showed significant differences in eradication rates using sequential therapy or the standard triple therapy (P = 0.416 and P = 0.405, respectively).CONCLUSION: There are no significant differences between 10-d sequential eradication therapy for H. pylori and any duration of standard triple treatment in Korean patients.     

培菲康辅助序贯疗法根除幽门螺杆菌的临床观察

目的比较序贯疗法联合培菲康与序贯疗法治疗幽门螺杆菌（Hp）阳性十二指肠溃疡的疗效与安全性。方法选取84例经胃镜检测证实为Hp阳性十二指肠溃疡病例,随机分为治疗组与对照组,两组均前5d予雷贝拉唑、阿莫西林,后5d予雷贝拉唑、替硝唑、克拉霉素治疗。随后两组均进行雷贝拉唑巩固治疗4周,治疗组全程均辅加培菲康,疗程结束后均行复查。结果疗程结束时,治疗组溃疡愈合率95.12%,对照组93.02%（P〉0.05）;Hp根除率治疗组97.56%,明显高于对照组81.40%,且具有显著性差异（P〈0.05）;治疗组不良反应明显少于对照组（P〈0.05）。结论两组溃疡愈合率相当,但培菲康提高了序贯疗法的Hp根除率,且不良反应少,耐受好,安全。     

Hybrid therapy for Helicobacter pylori infection: A systemic review and meta-analysis

AIM: To compare the effectiveness of hybrid therapy with other recommended regimens using meta-analysis.METHODS: Bibliographical searches for randomized trials comparing hybrid and other therapies were performed in PubMed, the Cochrane Library and relevant congresses up to February 2015 using the following keywords (all fields and/or MeSH): (“Helicobacter pylori” or “H. pylori”) and (“hybrid therapy” or “sequential-concomitant therapy”). Meta-analyses were performed with Cochrane Review Manager 5.1. The random effect model proposed by DerSimonian and Laird and the Mantel-Haenszel method were used to estimate the pooled relative risk and 95%CI of the efficacy outcomes between hybrid therapy and other eradication therapies.RESULTS: Eight studies (2516 subjects) met entry criteria. The antimicrobial resistance in the study groups ranged from 6.9% to 23.5%. The mean cure rates of hybrid therapy by intention-to-treat (ITT) and per-protocol analyses were 88.5% (n = 1207; range: 80.0% to 97.4%) and 93.3% (n = 1109; range: 85.7% to 99.1%), respectively. Meta-analysis showed there was no significant difference in ITT eradication rate between hybrid and sequential therapy (relative risk: 1.01; 95%CI: 0.92-1.11). Subgroup analysis revealed hybrid therapy was more effective than sequential therapy in the non-Italian populations (95%CI: 1.01-1.18) and was only less effective in one, Italian population (95%CI: 0.83-0.98). There was no significant difference in eradication rate between hybrid therapy and concomitant therapy (95%CI: 0.93-1.02). No head-to-head comparisons of hybrid therapy and standard triple therapy or bismuth quadruple therapy were found. However, a multicenter, randomized trial showed that reverse hybrid therapy was superior to standard triple therapy (95.5% vs 88.6% ITT; P = 0.011).CONCLUSION: Hybrid therapy appears to be an effective, safe, and well-tolerated treatment for H. pylori infection in the era of increasing antibiotic resistance.     

序贯疗法和四联疗法对幽门螺杆菌初治失败患者的疗效评价

目的:评价含左氧氟沙星序贯疗法和含铋剂四联疗法治疗根除失败的幽门螺杆菌感染患者的疗效以及发生的不良反应.方法:将98例经传统标准三联疗法(7 d)根除幽门螺杆菌失败的患者,随机分成治疗组和对照组.治疗组(序贯疗法)方案为前5d雷贝拉唑+左氧氟沙星,后5d雷贝拉唑+克拉霉素+呋喃唑酮,疗程l0d.对照组(四联疗法)方案为...     

序贯疗法与三联疗法根除幽门螺杆菌的疗效及对反流性食管炎愈合率的影响

目的比较10天序贯疗法与10天标准三联疗法根除幽门螺杆菌（HP）的疗效,并观察根除HP对反流性食管炎愈合率的影响。方法将76例反流性食管炎合并HP感染的患者随机分为3组：序贯疗法治疗组32例,埃索美拉唑＋阿莫西林,每日2次,共用5天,随后5天用埃索美拉唑＋克拉霉素＋替硝唑,每日2次;三联疗法治疗组24例,埃索美拉唑＋克拉霉素＋阿莫西林,每日2次,疗程10天,两组抗HP疗程结束后继续给予埃索美拉唑,每日2次,总疗程8周;对照组20例：单用埃索美拉唑,每Et2次,疗程8周。疗程结束后复查胃镜,并行HP检测。结果序贯疗法与三联疗法对幽门螺杆菌的根除率分别为87．50％和58．33％,两组比较差异有统计学意义（P〈0．05）。HP根除患者和未根除患者食管炎治愈率分别为83．33％和91．18％,两者比较差异无统计学意义;3组食管炎的治愈率分别为87．50％、83．33％和90％,三者之间比较差异无统计学意义。结论在食管炎患者中,序贯疗法HP根除率明显优于三联疗法;根除幽门螺杆菌对反流性食管炎8周愈合率无明显影响。