含左氧氟沙星三联疗法根除幽门螺杆菌的临床研究

目的观察含左氧氟沙星三联疗法与常规四联疗法根除幽门螺杆菌（Hp）的临床疗效差异,并分析不良反应的差异。方法 260例既往未接受过根除治疗的Hp感染患者,按照分层随机分为A、B组两组,每组130例,A组为泮托拉唑＋克拉霉素干混悬剂＋左氧氟沙星治疗组,B组为泮托拉唑＋胃三联（枸橼酸铋钾＋克拉霉素＋替硝唑）治疗组,各组疗程均为1周,疗程结束4周后行14C-尿素呼气试验判断效果,结果阴性者判断为Hp根除,观察临床疗效及不良反应差异。结果 A组Hp根除103例,根除率83.1%（103/124）,B组Hp根除107例,根除率87.7%（107/122）,差异无显著性（P〉0.05）;A组发生不良反应4例,发生率3.2%（4/126）,B组发生不良反应13例,发生率10.4%（13/125）,差异有显著性（P〈0.05）。结论含左氧氟沙星三联疗法具有与常规四联疗法相似的根除Hp疗效,而且可以降低治疗中的不良反应发生率,依从性更好,可作为根除Hp感染的一线方案。     

新序贯疗法与传统三联疗法根除幽门螺杆菌的疗效比较

目的比较由泮托拉唑、阿莫西林、左氧氟沙星、呋喃唑酮组成的新序贯疗法与传统三联疗法根除幽门螺杆菌（Hp）的疗效与安全性。方法将经胃镜检查确诊的慢性胃炎和消化性溃疡且Hp阳性的患者90例随机分为两组：观察组（48例）采用新序贯疗法：前5 d口服泮托拉唑胶囊40 mg＋阿莫林胶囊1000 mg,每日2次口服,后5 d改为泮托拉唑40 mg＋左氧氟沙星200 mg＋呋喃唑酮100 mg,每日2次口服,疗程结束后再行泮托拉唑40 mg,每日1次口服7 d;对照组（42例）采用经典三联疗法：泮托拉唑40 mg＋阿莫林胶囊1000 mg＋左氧氟沙星200 mg,每日2次,口服7 d,疗程结束后,再给予泮托拉唑40 mg,每日1次,口服10 d。所有患者在治疗前、停药4周后各检查1次快速尿素酶试验和组织学Giemsa染色。结果观察组患者Hp根除率（95.8%）显著高于对照组（78.6%）（χ2=6.2214,P〈0.05）;两组不良反应发生率比较差异无统计学意义（P〉0.05）。结论以泮托拉唑、阿莫西林、左氧氟沙星、呋喃唑酮组成的10 d新序贯疗法Hp根除率高于传统三联疗法,且不良反应并无增加,安全可靠。     

奥美拉唑三联疗法根除幽门螺杆菌疗效观察

目的探讨奥美拉唑＋克拉霉素＋阿莫西林三联疗法根除幽门螺杆菌（Hp）感染的疗效。方法选择86例Hp阳性消化性溃疡患者,将其分为治疗组和对照组,均给予奥美拉唑加两种抗生素1周三联治疗。治疗组：口服奥关拉唑（20mg／次）＋克拉霉素（500mg／次）＋阿莫西林1000mg／次）;对照组：口服奥美拉唑（20mg／次）＋甲硝唑片（400mg／次）＋阿莫西林（1000mg／次）,均为2次／d,疗程为1周,一月后进行Hp检测。结果治疗组Hp根除率90．7％,对照组Hp根除率86．0％,两组根除率无统计学差异（P〉0．05）;治疗组不良反应发生率为14．0％,对照组为16．3％,两组比较无显著性差异（P〉0．05）。结论两组方案均能有效缓解消化性溃疡症状和根除Hp,但奥美拉唑＋克拉霉素＋阿莫西林三联疗法对Hp根除率相对较高,且不良反应相对较轻,值得临床推广应用。     

三联疗法根除幽门螺杆菌感染临床观察

目的 探讨枸橼酸铋雷尼替丁、左氧氟沙星、阿莫西林三联一周疗法,根除幽门螺杆菌(Hp)的疗效及安全性.方法 选择100例Hp阳性的慢性胃炎和消化性溃疡患者,随机分为两组,治疗组采用枸橼酸铋雷尼替丁350mg、左氧氟沙星200mg、阿莫西林1000mg,均为每日2次(早、晚),疗程1周.对照组采用奥美拉唑20mg、克拉霉唑500mg、阿莫西林1000mg,均为每日2次(早、晚),疗程1周,4周后复查Hp.结果 治疗组Hp根除率92%,对照组Hp根除率82%,差异无统计学意义(P＞0.05).结论 枸橼酸铋雷尼替丁、左氧氟沙星、阿莫西林三联疗法Hp根除率高,副作用少而轻,患者依从性好,值得临床推广使用.     

莫西沙星三联疗法根除幽门螺杆菌疗效观察

目的观察以莫西沙星、阿莫西林、埃索美拉唑三联疗法根除幽门螺杆菌感染的临床疗效和耐受性。方法选择幽门螺杆菌感染患者66例,随机分为观察组34例,对照组32例。观察组采用莫西沙星(每次400 mg,1次/天)、阿莫西林(每次1 000 mg,2次/天)、埃索美拉唑(每次20 mg,2次/天),治疗7 d后继续用埃索美拉唑,每次20 mg,1次/天,连用4周。对照组采用克拉霉素(每次500 mg,2次/天)、阿莫西林(每次1 000 mg,2次/天)、埃索美拉唑(每次20 mg,2次/天),治疗7 d后继续用埃索美拉唑每次20 mg,1次/天,连用4周。疗程结束后行14C尿素酶呼气试验检测幽门螺杆菌,对比两组幽门螺杆菌根除率,并评价耐受性。结果观察组幽门螺杆菌根除率为91.2%,对照组为75.0%,两组差异有统计学意义(P<0.05)。结论莫西沙星三联疗法对幽门螺杆菌的根除率明显优于克拉霉素三联疗法。     

含左氧氟沙星三联疗法根除幽门螺杆菌的临床观察

目的:进一步探讨左氧氟沙星在根除幽门螺杆菌治疗中的有效性和安全性。方法:治疗组给予枸橼酸铋雷尼替丁400mg、左氧氟沙星200mg、阿莫西林1000mg,每天2次,疗程10d;对照组给予枸橼酸铋雷尼替丁400mg、克拉霉素0.5g、阿莫西林1000mg,每天2次,疗程10d。停药4周后复查C14呼气试验。结果:治疗组根除55例,根除率91.67%;对照组根除52例,根除率86.67%;两组比较无统计学差异(P>0.05)。两组患者不良反应轻微,于停药后均消失,总体安全性好。结论:以枸橼酸铋雷尼替丁为基础的含左氧氟沙星三联方案根除幽门螺杆菌10d疗法根除率达91.67%,且不良反应轻微,同时10d疗程费用比对照组低廉,容易被患者接受,值得临床推广。     

雷贝拉唑与克拉霉素和阿莫西林联用对根除幽门螺杆菌感染的近期疗效

目的：观察雷贝拉唑、克拉霉素、阿莫西林合用对根除幽门螺杆菌（HP）的近期疗效。方法：62例HP阳性的十二指肠球部溃疡病人，随机分2组，治疗组采用雷贝拉唑10mg，第一周每日2次，第2-4周每日1次；阿莫西林1．0每日2次共1周；克拉霉素0．5mg每日2次共1周。对照组采用枸橼酸铋钾220mg每日2次共4周，抗生素使用同治疗组。疗程结束后，复查胃镜观察HP清除及十二指肠溃疡的愈合情况。结果：HP根除率为：治疗组24／26（92．3％），对照组21／25（84％）。结论：雷贝拉唑组能明显缓解十二指肠溃疡的症状，对溃疡有较高的愈合率及HP清除率。     

两种10天序贯疗法与标准三联疗法根除幽门螺杆菌的临床研究

随着幽门螺杆菌耐药菌株的增加,一些以往幽门螺杆菌根除率高的方案疗效逐渐下降.本次研究以质子泵抑制剂三联7 d标准疗法作为对照,评价两种10 d序贯疗法作为幽门螺杆菌根除治疗一线方案的疗效和安全性.现报道如下.     

克拉霉素、阿莫西林、奥美拉唑三联疗法根除幽门螺杆菌的临床研究——附32例报告

１资料与方法１．１病例选择 入选对象符合以下条件：①年龄１８岁至６５岁的门诊患者;②选前３日内经内镜检查证实为活动性十二指肠球部溃疡（ＤＵ）,溃疡长径超过 ３ ｍｍ;③尿素酶法、细菌培养及改良姬姆萨（Ｇｉｅｍｓａ）染色检测幽门螺杆菌（Ｈｐ）至少二项阳性;④试验前４８小时停服一切抗溃疡药,试验前１个月内未服过抗生素、皮质激素、非甾体消炎药、铋剂、质子泵抑制药;⑤自愿受试。有下列情况之一者,不列入受试对象：①霜斑样溃疡;②复合性溃疡;③溃疡数超过３个或以上;④有特殊原因的溃疡,如胃泌素瘤;⑤曾做过胃或…     

三联疗法根除幽门螺杆菌临床观察

目的：探讨枸橼酸铋雷尼替丁加左氧氟沙星加呋喃唑酮三联1周疗法根除幽门螺杆菌的疗效及安全性。方法：选择110例符合条件的幽门螺杆菌阳性慢性胃炎和消化性溃疡患者，随机分为两组。治疗组采用枸橼酸铋雷尼替丁（350mg，2次／d）加左氧氟沙星（200mg，2次／d）加呋喃唑酮（100mg，2次／d），治疗7d；溃疡患者继用枸橼酸铋雷尼替丁350mg，2次／d，3周。对照组采用奥美拉唑（20mg，2次／d）加阿莫西林（1．0g，2次／d）加甲硝唑（400mg，2次／d），治疗7d；溃疡患者继用奥美拉唑20mg，1次／d，3周。疗程结束后4周及8周复查Hp，观察幽门螺杆菌根除率、症状缓解率、溃疡愈合率及不良反应等。结果：治疗组和对照组的症状缓解率、幽门螺杆菌根除率、溃疡治愈率、不良反应发生率分别为91．8％、81．6％、90，5％、32．7％和94．0％、86．0％、95．0％、28．0％，差异无统计学意义（P〉0．05）。治疗组与对照组每例根除幽门螺杆菌费用分别为100．10元、274．68元，治疗组根除幽门螺杆菌期望成本比对照组低196．77元。结论：幽门螺杆菌加左氧氟沙星加呋喃唑酮三联1周疗法是根除幽门螺杆菌的理想方案，可作为根除幽门螺杆菌一线治疗的选择。     

益生菌联合三联疗法根除幽门螺杆菌疗效研究

目的 评价复方嗜酸乳杆菌片与布拉酵母菌(Saccharomyces boulardii,S.Boulardii)散剂联合三联疗法根除幽门螺杆菌(Helicobacter pylori,H.pylori)的有效性和安全性.方法 H.pylori阳性患者240例随机分为3组,A组:埃索美拉唑20 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,口服每日2次,疗程10天;B组:在A组三联10天基础上,加用复方嗜酸乳杆菌片1 000 mg,口服每日3次,总疗程14天;C组:在A组三联10天基础上,加用S.Boulardii散剂500mg,口服每日2次,总疗程14天.治疗期间观察患者不良反应发生情况,疗程结束4周后观察H.pylori根除率.结果 A、B、C组H.pylori根除率按意向性(ITT)分析分别为62.5％、76.2％、83.8％,按方案(PP)分析分别为64.1％、79.2％、85.9％,B组、C组PP根除率明显高于A组(P＜0.05),C组ITT和PP根除率与B组比较差异无统计学意义(P＞0.05).不良反应发生率方面,B、C组明显低于A组(19.5％、7.7％ vs 34.6％,P＜0.05),C组明显低于B组(P＜0.05).B、C组对药物的耐受程度明显高于A组(P＜0.05),B组与C组差异无统计学意义(P＞0.05).结论 复方嗜酸乳杆菌片或S,Boulardii散剂联合三联疗法均可提高H.pylori根除率,后者安全性优于前者.     

Supplementing vitamins C and E to standard triple therapy for the eradication of Helicobacter pylori

What is known and Objective: Helicobacter pylori eradication rates of currently accepted triple therapy regimens vary between geographic locations and do not exceed 70–80%. Eradication rates are much lower in locations where uncontrolled antibiotic use is common such as Turkey. In the present study, we aimed to test whether supplementing vitamins C and E to standard triple therapy, including a proton pump inhibitor plus amoxicillin plus clarithromycin, increased the H. pylori eradication rate. Methods: Two hundred patients infected with H. pylori were randomized into two groups in an open‐label trial. In group A, patients (n = 160) were given standard triple therapy, including lansoprazole 30 mg BID plus amoxicillin 1000 mg BID plus clarithromycin 500 mg BID for 14 days, plus vitamin C 500 mg BID plus vitamin E 200 IU BID for 30 days. In group B, patients (n = 40) were given standard triple therapy for 14 days. The success of H. pylori eradication was defined as a negative ¹⁴C‐urea breath test result, 4–6 weeks after the completion of therapy. Comaprisons were by both intention‐to‐treat (ITT) and per‐protocol (PP) analysis. Results and Discussion: Two hundred patients (137 women, 63 men) were analysed using ITT analysis and 195 patients completed the study. In group A, H. pylori eradication was achieved in 132 of the 160 patients (82·5%) included in ITT analysis and 132 of the 157 patients (84%) included in PP analysis. In group B, H. pylori eradication was achieved in 18 of the 40 patients (45%) included in ITT analysis and 18 of the 38 patients (47·4%) included in PP analysis. Eradication rates were significantly higher in group A than in group B (P < 0·005). Eradication rates were not statistically significant between men and women in both groups. What is new and Conclusion: Adding vitamins C and E to standard triple therapy increases the eradication rate of H. pylori. Vitamins C and E may increase the eradication rate via increasing the effectiveness of the antibiotics by decreasing oxidative stress in the gastric mucosa and strengthening the immune system.     

以加替沙星为基础的三联疗法治疗幽门螺杆菌感染

目的分析以加替沙星、呋喃唑酮、兰索拉唑为基础的三联疗法作为一线治疗方案治疗幽门螺杆菌(Hp)感染的疗效。方法将200例Hp感染者,随机分为2组,每组100例。治疗组给予加替沙星、呋喃唑酮、兰索拉唑治疗,对照组给予克拉霉素、呋喃唑酮、兰索拉唑治疗,疗程均为7 d。停药4周后复查Hp,分析Hp的根除率、副反应发生率及成本/效果比(C/E)。结果治疗组、对照组Hp根除率分别为90.53%、81.52%,差异有统计学意义(P<0.05)。不良反应发生率治疗组为12.63%,对照组为20.65%,两组间差异有统计学意义(P<0.05)。治疗组与对照组成本/效果比(C/E)分别为1.48和2.71。结论以加替沙星为基础的三联疗法能有效、安全地根除Hp感染且费用较低。     

High-dose versus low-dose esomeprazole-based triple therapy for Helicobacter pylori infection

BACKGROUND: This prospective, randomized, controlled study was conducted to compare the efficacies of high-dose and low-dose esomeprazole-based triple therapies for Helicobacter pylori eradication in Taiwan. MATERIALS AND METHODS: From January 2004 to June 2006, 240 H. pylori-infected patients were randomly assigned to undergo high-dose (40 mg b.d.) or low-dose (40 mg o.d.) esomeprazole combined with clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for one week. Follow-up endoscopy was performed at eight weeks after the end of treatment to evaluate the response to therapy. RESULTS: Intention-to-treat analysis demonstrated no differences between eradication rates of high-dose and low-dose groups (92% vs. 90%, respectively, P > 0.05). Per-protocol analysis yielded comparable results (95% vs. 93%). Both groups exhibited similar frequencies of adverse events (13% vs. 11%) and drug compliance (96% vs. 93%). Multivariate analysis indicated that only good compliance (odds ratio: 10.3, 95% CI, 3.0-35.7) was an independent predictor of treatment success. CONCLUSIONS: This work demonstrates that low-dose esomeprazole-based triple therapy yields a similar eradication rate as high-dose esomeprazole-based therapy in Taiwan. Since the cost of the low-dose regime is lower than that of the high-dose regime, low-dose esomeprazole-based triple therapy can reasonably be recommended for the first-line eradication of H. pylori for Taiwanese and probably most Asians.     

幽门螺杆菌感染根治方案的对比研究

目的比较不同方案对幽门螺杆菌感染根除治疗的疗效。方法共180例幽门螺杆菌感染患者进行治疗,随机分为A、B、C组。A组(雷尼替丁+胶体果胶铋+阿莫西林+甲硝唑)、B组(泮托拉唑+胶体果胶铋+克拉霉素+甲硝唑)、C组(雷贝拉唑+胶体果胶铋+阿莫西林+呋喃唑酮)分别采用不同方案治疗,疗程7d,停药4周后检测幽门螺杆菌。结果 A、B、C组幽门螺杆菌根除率分别为65.00%、81.66%和91.66%(P0.01),药物不良反应发生率分别为21.66%、25.00%、26.66%(P0.05)。结论雷贝拉唑、胶体果胶铋、阿莫西林和呋喃唑酮四联短程疗法对幽门螺杆菌感染具有较好的根除疗效。     

序贯疗法与标准三联疗法根除幽门螺杆菌的疗效对比分析——附105例报告

目的：比较由泮托拉唑、阿莫西林、克拉霉素、替硝唑组成的10日序贯疗法与标准的7日三联疗法根除幽门螺杆菌（Hp）的疗效及安全性。方法：将105例消化性溃疡或慢性胃炎且Hp阳性成人患者随机分为两组。治疗组（53例）前5日应用泮托拉唑40mg、阿莫西林1000mg,每日2次口服,后5日用泮托拉唑40mg、克拉霉素500mg、替硝唑500mg,每日2次口服。对照组（52例）采用7日泮托拉唑40mg、阿莫西林1000mg、克拉霉素500mg,每日2次口服。停药4周后复查Hp。结果：治疗组Hp根除率为90.6%,对照组为71.2%,两组比较差异有统计学意义（P〈0.05）;不良反应发生率分别为18.9%和17.3%（P〉0.05）。结论：由泮托拉唑、阿莫西林、克拉霉素、替硝唑组成的10日序贯疗法治疗成人Hp感染的疗效优于标准7日三联疗法。     

阿奇霉素三联疗法根除幽门螺杆菌的疗效观察──附69例报告

目的:观察阿奇霉素三联疗法根除十二指肠球部溃疡病人的幽门螺杆菌(Hp)的临床疗效,对比阿奇霉素三联疗法一周与两周方案的疗效差别。方法:69例经胃镜检查证实为十二指肠球部溃疡并有Hp感染的病人,随机分为两组。A组(35例)口服奥美拉唑40mg每日1次,共2周;阿奇霉素500mg/d,仅疗程开始的头3日口服;阿莫西林500mg口服,每日4次,共2周。B组(34例)奥美拉唑与阿奇霉素的剂量和疗程同A组,阿莫西林500mg口服,每日3次,共1周。疗程结束后停用所有抗生素,4周后胃镜复查溃疡愈合情况,14C-尿素呼气试验复查Hp根除情况。结果:Hp根除率:A组和B组分别为89%(31/35)、85%(29/34),两组比较无显著性差异(P>0.05);溃疡愈合率:A组和B组分别为97%(28/29)、94%(29/31),两组比较无显著性差异(P>0.05);全部病人均完成治疗,仅2例出现恶心,1例轻度腹泻,总不良反应率为4%。结论:①阿奇霉素三联疗法具有Hp根除率高、安全性好、不良反应少及依从性好的优点;②阿奇霉素三联疗法一周方案与两周方案比较疗效相当;③阿奇霉素可作为根除Hp治疗方案中的一个新选择。     

Helicobacter pylori eradication: role of individual therapy constituents and therapy duration

Treatment of Helicobacter pylori ( H. pylori ) infection has become a key factor in the management of dyspepsia and is the treatment of choice for peptic ulcer disease. First-line eradication regimens combining a proton pump inhibitor (PPI) with clarithromycin and amoxicillin or metronidazole are considered most effective when given for a minimum period of 1 week. Eradication regimens of shorter duration have shown promising results but clinical experience remains limited. Pharmacological properties such as bioavailability and plasma concentrations of individual PPIs differ between individuals but it remains unclear whether these differences impact on the efficacy of eradication therapy and are influenced by renal or hepatic impairment. Bioavailability of PPIs also differs and is impacted on by factors including intragastric pH, metabolic pathways, potency on an mg-for-mg basis and intrinsic antibacterial activity. Several significant pharmacokinetic differences between the PPIs do not seem to influence overall H. pylori eradication rates for first-line triple therapy. However, comparison of factors including pharmacokinetics and treatment duration may prove important in achieving successful eradication with second- and third-line treatments. Based on the factors which influence therapy outcome, we suggest an algorithm for the use of H. pylori eradication therapies.     

头孢羟氨苄三联疗法对幽门螺杆菌阳性十二指肠球部溃疡30例的近期疗效

目的：观察头孢羟氨苄三联疗法根除幽门螺杆菌（Ｈｐ）的临床应用价值。方法;对３０例Ｈｐ阳性的十二指肠球部溃疡病人用头孢羟氨苄、奥美拉唑、甲硝唑三联疗法治疗２周并与２５例行阿莫西林、奥美拉唑、甲硝唑三联疗法的病人进行对照。