抗幽门螺杆菌治疗探讨

幽门螺杆菌(Hp)为革兰阴性菌，早在1874年在胃内发现螺形菌，直到1983年从人体胃粘膜中分离培养出该细菌后，引起人们重视。世界范围内50％～70％的成年人有Hp感染，我国约有60％～80％之间。经近20多年研究，已有大量的资料表明Hp感染与慢性胃炎、消化性溃疡、胃癌的发生有关，所以Hp的治疗具有重要的临床意义。     

比较以阿莫西林和呋喃唑酮为基础的抗幽门螺杆菌四联和三联方案

目的比较以阿莫西林和呋喃唑酮为基础的四联、三联疗法根除幽门螺杆菌(H.pylori)的临床疗效。方法对符合条件的816例H.pylori阳性的慢性胃炎、十二指肠球部炎及消化性溃疡患者,根据治疗方案的随机选择分组如下:(1)质子泵抑制剂(PPI)+枸橼酸铋钾+阿莫西林+呋喃唑酮(含PPI四联组);(2)枸橼酸铋雷尼替丁(RBC)+阿莫西林+呋喃唑酮(含RBC三联组);(3)PPI+阿莫西林+呋喃唑酮(含PPI三联组);(4)枸橼酸铋钾+阿莫西林+呋喃唑酮(含枸橼酸铋钾三联组)。疗程结束4周后,复查快速尿素酶试验或13C呼气试验评判H.pylori根除情况。结果 (1)含PPI四联组与其他各组的H.pylori根除率比较均有显著性差异(P<0.05);(2)将上述每组患者按照接受H.pylori根除治疗的时间(2004年-2006年、2007年-2009年、2010年-2012年)分为3个时间段,在相同治疗方案下比较H.pylori根除率。结果显示同一治疗组的H.pylori根除率在不同时间段无显著差异(P>0.05)。结论含PPI四联疗法H.pylori根除率高,无与治疗相关的严重不良反应,在传统的一线含PPI三联疗法根除率H.pylori逐年下降的状况下,为克服原发耐药和避免继发耐药产生,值得进一步探讨作为根除H.pylori一线治疗选择方案的可能性。     

枸橼酸铋雷尼替丁、阿莫西林和阿奇霉素三联疗法根除幽门螺杆菌感染68例疗效观察

幽门螺杆菌(Hp)感染后能导致胃炎和消化性溃疡病的发生,人类胃黏膜上的Hp持续存在可增加胃癌和胃淋巴瘤发生的危险,根除Hp是防治这些疾病的重要措施之一.枸橼酸铋雷尼替丁(RBC)与2种抗生素结合的三联疗法已被推荐为根除Hp治疗的一线方案.我们自2005年1月～2006年4月采用枸橼酸铋雷尼替丁 阿奇霉素 阿莫西林三联疗法治疗有Hp感染的消化性溃疡患者68例.现将结果 报道如下.     

克拉霉素为基础的三联方案根除幽门螺杆菌的疗效研究

克拉霉素是根除幽门螺杆菌（Hpylori）感染的有效药物,以克拉霉素为基础的三联方案根除Hpylori在临床上广泛应用。目的：评估克拉霉素为基础的三联方案根除日．pylori的疗效。方法：133例Hpylori感染患者随机分为3组,A组：埃索美拉唑20mgbid＋克拉霉素0．5gbid＋阿莫西林1gbid,疗程7d;B组：埃索美拉唑20mgbid＋克拉霉素0．5gbid＋左氧氟沙星0．5gqd,疗程7d;C组：埃索美拉唑20mgbid＋克拉霉素0．5gbid＋呋喃唑酮0．1gtid,疗程7d。治疗结束后4～8周复查”C-尿素呼气试验和快速尿素酶试验以评估根除疗效。结果：128例患者按方案完成治疗。A、B、C组按意向治疗（11-r）分析日．pylori根除率分别为84．4％、77．3％、75．0％,按方案（PP）分析分别为88．4％、79,1％、78．6％。A组的11Tr和PP根除率高于B组和C组,但差异无统计学意义（P〉0．05）。结论：克拉霉素联合质子泵抑制剂（PPI）和阿莫西林7d疗法仍为有效的Hpylori感染根除方案。     

规范幽门螺杆菌感染的诊断和治疗

从1982年幽门螺杆菌(Hp)的发现至今,彻底改变了很多胃十二指肠疾病的基本理论.经过20多年的深入研究和广泛的临床实践,在很多重要问题上已达成了国际上的共识.本期刊登的"幽门螺杆菌若干临床方面的共识意见(2003*安徽桐城)"是中华医学会消化病学分会组织有关专家,根据国际有关的最新共识并结合我国的实际情况,对2000年发表的"幽门螺杆菌若干问题的共识意见"[1]进行修订后的新版本,对规范我国Hp感染的诊断和治疗具有重要的临床指导价值.     

根除幽门螺杆菌三联疗法临床观察

目的　观察以质子泵抑制剂 (PPI)、克拉霉素为中心的三联疗法治疗幽门螺杆菌 (HP)阳性十二指肠溃疡的疗效 ,比较甲硝唑和痢特灵的疗效及副作用 ,筛选理想的三联疗法。方法　胃镜确诊十二指肠溃疡并经病理组织学及 14 C-尿素呼吸试验证实 HP感染者 184例 ,随机分成 2组 ,A组用洛塞克、克拉霉素及甲硝唑 ,B组用洛塞克、克拉霉素及痢特灵 ,每日 2次 ,连续 7d,停药 4周后复查胃镜观察溃疡愈合程度 ,同时经 14 C-尿素呼吸试验及胃镜证实 HP根除情况。结果　溃疡总愈合率 :A组 91.4 % (85 / 93) ,B组 93.4 % (85 / 91) ,2种疗法比较差异无显著意义 (P >0 .0 5 ) ;HP根除率 :A组 90 .3% (84 / 93) ,B组 93.4 % (85 / 91) ,2种疗法比较差异无显著意义 (P >0 .0 5 ) ;轻度不良反应 :A组 16 .1% (15 / 93) ,B组 4 .4 % (4/ 91) ,B组反应明显轻于 A组 (P <0 .0 5 )。结论　 2组三联疗法根除 HP及治疗十二指肠溃疡均有良好疗效 ;痢特灵具有抗 HP作用强、无耐药性、价格低廉、副作用少等优点 ,可替代甲硝唑配伍于洛塞克、克拉霉素的三联疗法中 ,是一种理想的适合国情的根除 HP方案     

以果胶铋为主的四联疗法根除幽门螺杆菌的疗效观察

近年来 ,幽门螺杆菌 (Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ,ＨＰ)感染是慢性胃炎、消化性溃疡重要的致病因子之一 ,已得到人们的共识。根据ＨＰ感染是消除症状、预防复发的重要治疗环节 ,故寻求一种安全有效、价格便宜的治疗方案甚为重要。我们采用前瞻、随机对照方法研究以果胶铋为核心的四联疗法对ＨＰ的清除效果及其不良反应并与奥美拉唑为核心的三联疗法进行比较 ,现报告如下。1　材料和方法1.1　病例选择标准　 (1)临床上有上腹不适、返酸、隐痛症状 ,病程在 2周以上 ;(2 )胃镜证实有消化性溃疡或慢性糜烂性胃窦炎 ;(3)胃粘膜活检组…     

影响幽门螺杆菌根除与复发的因素

质子泵抑制剂（PPI）被用于幽门螺杆菌（Hp）的治疗是因为此类药物对抗生素作用于微生物有极大影响。在胃内胃酸能够降解抗生素，而用于治疗Hp的抗生素对酸的敏感性不同。甲硝唑（Metronidazole）在pH2和pH7的胃酸中非常稳定。其半衰期超过800h。阿莫西林（Amoxicillin）虽然在低pH胃酸中不稳定，但其半衰期在pH=2时仍然能够维持15h。相反，克拉霉素（clarithromycin）对酸特别敏感，在pH=2时半衰期〈1h，因此PPI的使用在防止克拉霉素被酸降解方面发挥重要作用。抗生素依靠脂质弥散通过细胞，即药物溶解于细胞膜的脂质中通过浓度梯度转运。药物离子化也发挥作用，非离子化的药物容易通过细胞膜，而多极化分子越过则较为困难。甲硝唑主要以非离子化形式存在于血浆，因此随着胃酸的分泌越过胃的黏膜进入胃液就比较容易。奥美拉唑通过减少酸的分泌从而降低甲硝唑在胃内的浓度．但可以通过减少胃液量从而增加阿莫西林的浓度。     

枸橼酸铋雷尼替丁短程三联根除幽门螺杆菌临床观察

根除幽门螺杆菌 (Hp)是防治消化性溃疡、慢性胃炎等Hp相关性疾病的重要措施。在临床实践中 ,临床医师期求根除Hp方案的高效、安全、价廉、短程和服用简便。本文以枸橼酸铋雷尼替丁 (RBC ,R)为主 ,联用克拉霉素 (C)和呋喃唑酮 (F)的三联低剂量 7天方案 ,观察其根除Hp的疗效 ,同时与新的质子泵抑制剂潘妥洛克 (Pantoloc ,P)为主联用C和F的三联短程方案根除Hp的疗效作比较。对象与方法1.对象 :为 2 0 0 1年 1月～ 2 0 0 2年 2月经胃镜证实为十二指肠球部溃疡 (DU)和慢性胃炎 (CG)、快速尿素酶试验阳性的门诊成年患者 ,排除伴有严重合并…     

One-week dual therapy with ranitidine bismuth citrate and clarithromycin for the treatment of Helicobacter pylori infection in Brazilian patients with peptic ulcer

AIM: To assess the efficacy and safety of ranitidine bismuth citrate plus clarithromycin given for 1 wk in Brazilian patients with peptic ulcer. METHODS: One hundred and twenty patients with peptic ulcer were randomized in two treatment groups: (1)1-wk regimen consisting of ranitidine bismuth citrate 400 mg b.i.d. with clarithromycin 500 mg b.i.d. or (2) 2-wk regimen of the same treatment. Eradication of the infection was considered when both the histologic examination and the urease test were negative for the infection 3 mo after treatment. RESULTS: By intention to treat analysis, Helicobacter pylori (H pylori) was eradicated in 73% and 76% of patients, respectively treated for 1 or 2 wk (P>0.05). By per protocol analysis, the eradication rates were 80% and 83%, respectively, in patients treated for 1 or 2 wk (P>0.05). Nine patients (8.2%) reported minor side effects. CONCLUSION: One-week therapy with ranitidine bismuth citrate and clarithromycin is safe, well tolerated and effective for treatment of H pylori infection, and appears to be comparable to the 2-wk regimen in terms of efficacy.x     

First-line eradication of H pylori infection in Europe： A metaanalysis based on congress abstracts, 1997-2004

INTRODUCTIONNumerous treatment regimens have been tested for their efficacy in curing H pylori infection worldwide[1-3]. Meta-analysis has become a frequently used method for re-solving such uncertainties and obtaining sound data in evidence-based medicin…     

Trends in the eradication rates of Helicobacter pylori infection for eleven years

AIM: To evaluate the trends in the eradication rate of Helicobacter pylori (H. pylori) over the past 11 years in a single center.METHODS: This retrospective study covered the period from January 2000 to December 2010. We evaluated 5746 patients diagnosed with gastric ulcers (GU), duodenal ulcers (DU), GU + DU, or nonpeptic ulcers associated with an H. pylori infection. We treated them annually with the 2 wk standard first-line triple regimen, proton pump inhibitor (PPI) + amoxicilin + clarithromycin (PAC; PPI, clarithromycin 500 mg, and amoxicillin 1 g, all twice a day). The follow-up test was performed at least 4 wk after the completion of the 2 wk standard H. pylori eradication using the PAC regimen. We also assessed the eradication rates of 1 wk second-line therapy with a quadruple standard regimen (PPI b.i.d., tripotassium dicitrate bismuthate 300 mg q.i.d., metronidazole 500 mg t.i.d., and tetracycline 500 mg q.i.d.) after the failure of the first-line therapy. Statistical analysis was performed with 95%CI for the differences in the annual eradication rates.RESULTS: A total of 5746 patients [2333 males (58.8%), 1636 females (41.2%); mean age of males vs females 51.31 ± 13.1 years vs 52.76 ± 13.6 years, P < 0.05, total mean age 51.9 ± 13.3 years (mean ± SD)] were investigated. Among these patients, 1674 patients were excluded: 35 patients refused treatment; 18 patients ceased H. pylori eradication due to side effects; 1211 patients had inappropriate indications for H. pylori eradication, having undergone stomach cancer operation or chemotherapy; and 410 patients did not undergo the follow-up. We also excluded 103 patients who wanted to stop eradication treatment after only 1 wk due to poor compliance or the side effects mentioned above. Finally, we evaluated the annual eradication success rates in a total of 3969 patients who received 2 wk first-line PAC therapy. The endoscopic and clinical findings in patients who received the 2 wk PAC were as follows: gastric ulcer in 855 (21.5%); duodenal ulcer in 878 (22.1%); gastric and duodenal ulcer in 124 (3.1%), erosive, atrophic gastritis and functional dyspepsia in 2055 (51.8%); and other findings (e.g., MALToma, patients who wanted to receive the therapy even though they had no abnormal endoscopic finding) in 57 (0.5%). The overall eradication rate of the 2 wk standard first-line triple regimen was 86.5%. The annual eradication rates from 2000 to 2010 were 86.7%, 85.4%, 86.5%, 83.3%, 89.9%, 90.5%, 88.4%, 84.5%, 89.1%, 85.8%, and 88.3%, sequentially (P = 0.06). No definite evidence of a significant change in the eradication rate was seen during the past eleven years. The eradication rates of second-line therapy were 88.9%, 82.4%, 85%, 83.9%, 77.3%, 85.7%, 84.4%, 87.3%, 83.3%, 88.9%, and 84% (P = 0.77). The overall eradication rate of 1 wk quadruple second-line therapy was 84.7%. There was no significant difference in the eradication rate according to the H. pylori associated diseases.CONCLUSION: This study showed that there was no trend change in the H. pylori eradication rate over the most recent 11 years in our institution.     

The efficacy and safety of different bismuth agents in Helicobacter pylori first-line eradication: A multicenter,randomized, controlled clinical trial

Background:The aim of this study was to evaluate the efficacy and safety of bismuth pectin capsules and bismuth pectin granules in the first-line quadruple treatment of Helicobacter pylori (H. pylori).Methods:This study was a multicenter, randomized, open-labelled controlled clinical trial. Patients with a H. pylori infection were randomized into 4 groups (1:1:1:1) and treated with a 14-day bismuth-containing quadruple therapy. The 4 groups received either bismuth potassium citrate capsules (220 mg), colloidal bismuth pectin capsules (200 mg), bismuth pectin granules (150 mg), or bismuth pectin granules (300 mg). The primary outcome was the eradication rate of H. pylori. The secondary outcomes included symptom improvement, patient compliance, and incidence of adverse events. This study was registered at ClinicalTrials.gov (NCT04209933).Result(s):A total of 240 patients were included in this study, and 211 patients completed the follow-up. An intention-to-treat analysis showed that the H. pylori eradication rates of the 4 groups were 73.3%, 76.7%, 75.0%, and 71.7%, respectively. The per-protocol analysis showed that the H. pylori eradication rates of the 4 groups were 86.3%, 82.1%, 83.3%, and 86.0%. There was no significant difference among the 4 groups in the H. pylori eradication rate (P > .05). There were also no significant differences in the symptom improvement rate, overall adverse reaction rate, or patient compliance among the 4 groups.Conclusion(s):Bismuth pectin capsules and bismuth pectin granules had similar efficacy and safety for H. pylori eradication compared to bismuth potassium citrate. These data suggest that bismuth pectin can be an alternative to bismuth potassium citrate to eradicate H. pylori when using bismuth-containing quadruple therapy.     

根除幽门螺杆菌疗效与细胞色素氧化酶P450 2C19基因多态性的关系

目的 比较雷贝拉唑与奥美拉唑三联疗法根除幽门螺杆菌（Hp）的疗效与细胞色素氧化酶P4502 C19（CYP 2C19）基因多态性的关系。方法 采用随机、对照研究方法，将169例因消化不良症状接受常规胃镜检查确诊为慢性胃炎且Hp阳性的连续患者分人两组：雷贝拉唑三联疗法组（RAC组85例）和奥美拉唑三联疗法组（OAC组84例）。Hp诊断依靠组织病理学检查并参考快速尿素酶试验、血清Hp抗体检测结果。RAC组、OAC组均给予三联治疗：RAC组：雷贝拉唑10mg，OAC组：奥美拉唑20mg，两组均联用羟氨苄青霉素1000mg和克拉霉素500mg，全部药物每日2次，疗程7d。采用聚合酶链式反应结合限制性内切酶技术（PCR-RFLP），进行CYP 2C19基因型分析，治疗结束后第28天用^14C尿素呼气实验检测Hp根除疗效。结果 160例完成治疗方案，RAC组及OAC组的Hp根除率按PP分析及ITT分析均无统计学差异（P〉0．05）。根据CYP 2C19基因型分析，160例中，弱代谢型（PM）、中间代谢型（IM）及强代谢型（EM）的Hp根除率分别为95．5%（21／22）、85．9％（73／85）和67．9％（36／53）。PM型及IM型的Hp根除率均显著高于EM型（P〈0．05），而PM型与IM型间差异无统计学意义（P〉0．05）。RAC组中，各基因型的Hp根除率差异无统计学意义（P〉0．05）。OAC组中。IM型与EM型间（P〈0．01）及EM型与PM型间（P〈0．05）差异均有统计学意义。结论 雷贝拉唑与奥美拉唑两种三联疗法均能有效根除Hp。总疗效差异无统计学意义。雷贝拉唑三联疗法疗效较稳定，个体间差异小。PM型及IM型的Hp根除率均较EM型为高。     

Prolonged treatment duration is required for successful Helicobacter pylori eradication with proton pump inhibitor triple therapy in Canada

BACKGROUND:

Traditional seven-day proton pump inhibitor triple therapy for Helicobacter pylori eradication has recently shown disappointing results outside of Canada. Prolonging therapy may be associated with poorer compliance and, hence, may not have a better outcome in a real-world setting.

OBJECTIVE:

To compare the outcomes of seven- and 14-day triple therapy for first-line treatment of H pylori infection in an effectiveness setting in Canada.

METHODS:

A total of 314 consecutive treatment-naive, adult H pylori-infected patients were allocated to either a seven- or 14-day triple therapy regimen, with a subgroup of 172 consecutive patients quasi-randomized to treatment according to date of visit. Eradication was confirmed using either urea breath test or gastric biopsies. Analysis was by intention to treat.

RESULTS:

Eradication was achieved in a higher proportion of patients who underwent 14-day versus seven-day treatment regimens (overall: 85% versus 70% [P≤0.001]; subgroup: 83% versus 64% [P≤0.01]). Although successful eradication was also associated with older age and a diagnosis of ulcer disease, multivariate analysis revealed only longer treatment duration and lack of yogurt ingestion as independent predictors of successful eradication. There was a trend toward reduced success in the latter years of the study. Side effects were similar in both groups and were not prevented by yogurt ingestion.

CONCLUSIONS:

The currently recommended duration of proton pump inhibitor triple therapy in Canada should be increased from seven to 14 days, the latter having achieved an excellent result in this particular real-world setting. Yogurt added no benefit. Further study is required to compare 10-day with 14-day treatment regimens.     

Quadruple therapy for eradication of Helicobacter pylori

AIM:To investigate quadruple therapy with rabeprazole,amoxicillin,levofloxacin and furazolidone for the eradication of Helicobacter pylori (H.pylori) infection.METHODS:A total of 147 patients were divided into the experimental treatment group (n=78) and the standard triple treatment group (n=69).The experimental treatment group received rabeprazole 20 mg,amoxicillin 1.0 g,levofloxacin 0.2 g and furazolidone 0.1 g,twice daily.The standard triple treatment group received omeprazole 20 mg,amoxicillin 1.0 g and clarithromycin 0.5 g,twice daily.RESULTS:One month after treatment,the 13 C urea breath test was carried out to detect H.pylori.The eradication rate using per-protocol analysis was 94.3% in the experimental treatment group and 73% in the standard triple treatment group (P < 0.05),and using intention to test analysis,these figures were 86% and 67% in the two groups,respectively.Side effects were observed in 34 patients,and included mild dizziness,nausea,diarrhea and increased bowel movement.Eleven of the 34 patients needed no treatment for their side effects.CONCLUSION:Rabeprazole,amoxicillin,levofloxacinand furazolidone quadruple therapy is a safe method for the eradication of H.pylori with high efficacy and good tolerability.     

细胞色素P450 2C19基因多态性对埃索美拉唑三联疗法根除幽门螺杆菌疗效的影响

目的 前瞻性对比埃索美拉唑和奥美拉唑三联疗法根除幽门螺杆菌(Hp)的疗效,及细胞色素P450(CYP)2C19基因多态性对根除Hp疗效的影响.方法 240例Hp阳性消化性溃疡患者,随机分为EAC组(埃索美拉唑、阿莫西林和克拉霉素)和OAC组(奥美拉唑、阿莫西林和克拉霉素),每组120例,疗程7 d.继后埃索美拉唑或奥美拉唑巩固治疗3周.胃镜观察2周溃疡愈合情况,结束治疗4周后进行13C尿素呼气试验.利用聚合酶链反应(PCR)及限制片段长度多态性(RFLP)分析技术,测定所有患者的CYP2C19基因型,分为强代谢型(Ems)和弱代谢型(PMs),强代谢型包括纯合子(homEM)和杂合子(hetEM).结果 240例患者中225例完成疗效观察.Hp根除率按意向处理分析(ITT),EAC组为88.3%,OAC组为79.2%(P>0.05);按方案分析(PP)EAC组为91.4%,OAC组为87.2 oA(P>0.05).ITT分析显示,在CYP2C19 homEM基因型中,EAC和OAC组Hp根除率分别为91.9%和71.8%,两组间差异有统计学意义(P=0.037).PP分析显示,在homEM基因型中,EAC组和OAC组Hp根除率分别为97.1%和77.8%,两组间差异也有统计学意义(P=0.028).ITT分析显示,EAC组和OAC组2周溃疡愈合率分别为79.2%和69.2%(P>0.05);PP分析显示分别为81.9%和76.1%(P>0.05).EAC组和OAC组不良反应均较少(分别为3.3%和7.5%,P>0.05).结论 EAC方案Hp根除率较高,尤其在CYP2C19 homEM基因型患者,埃索美拉唑优于奥美拉唑.