四黄调胃汤治疗幽门螺杆菌阳性消化性溃疡

幽门螺杆菌（ＨＰ）与消化性溃疡的发生密切相关［１］,为提高ＨＰ的根除率,自１９９７年１月～１９９８年１０月我们对ＨＰ感染与脾虚的相互关系及脾虚与胃肠道粘膜屏障的关系进行初步探讨,并用中药四黄调胃汤加抗生素联合治疗脾虚型ＨＰ阳性消化性溃疡,取得了一定疗效,现报告如下。１　资料与方法１．１　临床资料：观察对象为我院门诊患者,采用日本ＯＬＹＭＰＵＳＥＦ１３０胃镜检查、尿素酶试验、１３Ｃ呼气试验检查,按文献［１～４］标准确诊的中医脾虚证消化性溃疡患者６２例,其中胃溃疡１２例,十二指肠溃疡４８例,复合性溃…     

雷贝拉唑三联疗法治疗幽门螺杆菌相关性消化性溃疡的疗效观察

雷贝拉唑能迅速、持久地抑制胃酸分泌 ,临床疗效显著。我院自 2 0 0 1年 8月～ 2 0 0 2年 6月 ,应用雷贝拉唑联合羟氨苄青霉素和克拉霉素三联治疗幽门螺杆菌 (Hp)相关性消化性溃疡 ,并与奥美拉唑为主的三联疗法对比 ,观察其疗效。一、材料与方法1.病例选择 :①入选标准 :年龄 18～ 70岁 ;1周内经胃镜证实为胃或十二指肠溃疡 ;Hp阳性。②排除标准 :严重其他脏器疾病、妊娠、药物过敏、胃、十二指肠手术史、溃疡严重并发症、肿瘤、服用非甾体类或激素类药物及试验前 1周内服用过抗Hp药物者。入选病例共 115例 ,男 71例 ,女 4 4例 ,平均年龄 …     

三九胃泰四联疗法治疗消化性溃疡及根除幽门螺杆菌的临床研究

目的 为探讨三九胃泰对消化性溃疡的治疗作用和根除幽门螺杆菌的效果，南方医院和北京医科大学第一附属医院同时进行随机对照临床研究。方法 132例消化性溃疡病人随机分为三组，治疗组(A组)三九胃泰2．5g 雷尼替丁150mg 阿莫西林500mg 甲硝唑400mg，bid；对照组1(B组)铋剂220mg 雷尼替丁150mg 阿莫西林500mg 甲硝唑400mg，bid；对照组2(C组)雷尼替丁150mg 阿莫西林500mg 甲硝唑400mg，bid。以上药物服2周后停用抗生素，余药服满6周疗程结束，第7周复查胃镜和(或)呼气试验。其中A组78例，B组3l例，C组23例。结果 三组病人症状缓解率相似，A、B、C组溃疡愈合率分为85．1％，83．9％，82．6％(无显著差异)，溃疡S2期获得率分别为64．0％、61．5％或43．5％，(A、B组均高于C组)。Hp根除率分别为74．2％、73．3和52．6％。三组均无明显副反应发生。结论 雷尼替丁三联疗法加用三九胃泰治疗消化性溃疡，可使S期获得率增加。同时幽门螺杆菌根除率上升，其效果与加用铋剂效果相近，临床观察无明显副作用。     

三药联用治疗儿童幽门螺杆菌相关性慢性胃炎、消化性溃疡疗效观察

1999年12月至2002年1月．我们联用胶体次枸橼酸铋(CBS)、黄连素、庆大霉素颗粒治疗儿童幽门螺杆菌(HP)相关性慢性胃炎、消化性溃疡，疗效满意。现报告如下。     

幽门螺杆菌分型与消化性溃疡出血关系及四联根除疗效观察

近 2 0年来 ,已有大量关于幽门螺杆菌 ( Hp)的研究。通过免疫印迹试验 ,可检测出细胞毒素相关蛋白 A( cag A)和空泡毒素相关蛋白 A( vac A)抗体的情况 ,从而将 Hp分为 型及 型[1] , 型 cag A及 va-c A蛋白均阳性 , 型则均阴性。本文研究两型 Hp感染与消化性溃疡出血有无相关性及四联根除疗效。1　资料与方法1 .1　临床资料 :1 999年 1月～ 2 0 0 2年 9月我院门诊及住院患者 30 3例 ,随机分为两组 :消化性溃疡非出血组 ( A组 ) 1 2 7例 ,其中男 89例 ,女 38例 ,年龄38.2岁 ;消化性溃疡出血组 ( B组 ) 1 76例 ,其中男1 2 4例 ,女 5 2例…     

奥美拉唑、呋喃唑酮、阿莫西林三联疗法治疗幽门螺杆菌相关性消化性溃疡的疗效观察

目的观察奥美拉唑、呋喃唑酮、阿莫西林三联疗法对消化性溃疡（PU）的治疗效果及幽门螺杆菌（Hp）的根除效果。方法对64例幽门螺杆菌阳性的消化性溃疡患者，随机分为治疗组及对照组。治疗组33例，给予奥美拉唑20mg，每日1次，呋喃唑酮100mg，每日2次；阿莫西林1000mg，每日2次，饭前服用1周；对照组31例，给予奥美拉唑20mg，每日2次，克拉霉素500mg，每日2次，阿莫西林1000mg，每日2次，饭前服用1周；停药4周后复查胃镜。结果治疗组与对照组Hp根除率分别为90．9％、93．5％，差异无显著性（P〉0．05）；溃疡愈合率分别为93．9％、96．8％，差异无显著性（P〉0．05）。结论奥美拉唑、呋喃唑酮、阿莫西林三联疗法具有疗程短、疗效高，依从性好、费用低，值得基层医院推广应用。     

胃康宁治疗幽门螺杆菌相关性消化性溃疡临床研究

[目的]观察胃康宁治疗幽门螺杆菌（Hp）相关性消化性溃疡临床疗效，并从中医理论和临床方面进行初步探讨。[方法]将100例Hp相关性消化性溃疡患者随机分为治疗组和对照组，分别给予胃康宁和奥抗三联治疗，疗程4周，观察主要症状的改善、溃疡愈合率、Hp根除率及不良反应。[结果]在改善主要症状方面治疗组优于对照组（P〈0．05）；在溃疡愈合率、Hp根除率方面两组差异无统计学意义。治疗组不良反应率1．7％，对照组32．5％，两组差异有统计学意义。[结论]胃康宁治疗Hp相关性消化性溃疡有较好的疗效。     

中西医结合疗法治疗幽门螺杆菌阳性消化性溃疡的远期疗效观察

目的：探讨中药、中西医结合疗法治疗幽门螺杆菌（Hp）阳性消化性溃疡的远期疗效。方法：将Hp阳性消化性溃疡用中药方剂（益胃片）、西药三联（丽珠得乐加甲硝唑加羟氨苄青霉素）、中西医结合疗法（益胃片加西药组用药）治疗根除Hp后,分别随访3年,共94例,观察Hp和溃疡的复发率,并进行比较。结果：西药组Hp和溃疡复发率均为26．67％;中药组Hp复发率为9．38％,溃疡复发率为12．50％;中西医结合组Hp复发率和溃疡的复发率均为6．25％。中西医结合组与西药组比较,差异有显著性意义（P＜0．05）。结论：中药方剂益胃片和中西医结合疗法治疗Hp阳性消化性溃疡既有很好的Hp根除率,又有很好的溃疡愈合率,Hp和溃疡的复发率也很低,不失为一种较好的治疗Hp阳性消化性溃疡的有效方法。     

Occurrence and Progression of Gastritis in Patients Operated on for Peptic Ulcer

A group of 31 patients, operated on for gastric or duodenal ulcer, had sequential gastric biopsies. Before the operation 47% of the duodenal ulcer patients and 71.4% of the gastric ulcer patients had different forms of gastritis. A year after the operation 72.5% of the duodenal ulcer patients and all patients with gastric ulcer had gastritis. The gastritis process had progressed in 67.7% of the whole group. Maximal acid output after Histalog^R stimulation was, on an average, 24.1 mEq/h before operation and 7.7 mEq/h, on an average, 9 months after operation. The occurrence of gastritis was correlated both pre- and postoperatively with low maximal acid output values. The slowest progression of gastritis was seen in duodenal ulcer patients with vagotomy and pyloroplasty as the operative procedure. A significant proportion of the patients developed antibodies to parietal cells, but the low titres and transient occurrence indicated that antibody production was not the cause of the gastritic process.     

溃疡散治疗消化性溃疡的临床观察

目的：观察自拟溃疡散治疗消化性溃疡的临床疗效。方法：应用溃疡散治疗消化性溃疡107例,与西药泰胃美片治疗的54例作比较。服药30d后判定近期疗效。停药半年后观察溃疡的复发情况。结果：治疗组总有效率为94．39％,治愈率为86．91％,对照组分别为92．59％和83．33％。经X^2检验两组近期疗效比较差异无显著性意义（P＞0．05）。停药半年后治疗组溃疡复发率为6．45％,对照组为26．67％,两者比较差异有显著性意义（P＜0．05）。结论：溃疡散治疗消化性溃疡的近期疗效与泰胃美片相似,而遏制溃疡复发则优于泰胃美片。     

金不换冲剂治疗幽门螺杆菌相关性胃炎的疗效研究

目的 :观察金不换冲剂治疗幽门螺杆菌 (Hp)相关性胃炎的疗效。方法 :选择 16 6例 Hp相关性胃炎患者并分为两组 ,金不换治疗组 112例 ,西药对照组 5 4例 ,进行两组疗效对比。观察金不换冲剂对体外 Hp的影响。结果 :金不换治疗组 Hp治愈率与对照组比较差异无显著性意义 (P >0 .0 5 ) ,且能显著改善临床症状 (P <0 .0 5 ) ;对不同中医证型患者均有疗效 (P >0 .0 5 )。金不换冲剂体外具有抑制 Hp生长的作用。结论 :金不换冲剂是治疗 Hp相关性胃炎较理想的单味中成药。     

Peptic Ulcer Occurrence in Follow-Up of Chronic Gastritis in Patients with Treated and Not Eradicated CagA-Positive Helicobacter pylori Infection

The aim of the present prospective investigation was to study 49 dyspeptic Helicobacter pylori (HP)-positive (HP⁺) or -negative (HP^–), CagA⁺ and CagA^– patients with a normal pattern or pure chronic gastritis at initial histology as well as normal features or hyperemic gastropathy at initial endoscopy in a two-year follow up. All the HP⁺ patients were treated with omeprazole 20 mg twice a day plus amoxicillin 1 g twice a day for two weeks. No substantial change was seen in gastritis in CagA⁺ patients in whom the infection was not eradicated, and, in contrast, a progressive improvement in 13/14 successfully treated patients was found. At endoscopy, a progressive change to a normal picture was seen in 8 and no change in 6 of 14 patients whose HP infection was eradicated, in contrast a worsening in the 9 HP⁺ patients who were still infected was observed. In particular, peptic lesions arose in 6 of 21 CagA⁺ patients in whom the infection was not eradicated. In conclusions, the lack of change in chronic gastritis at histology and the progressive worsening of endoscopic hyperemic gastropathy (with peptic lesions arising in 28,6%) when HP⁺ CagA⁺ infection is not eradicated, unlike the progressive improvement of the anatomoclinical condition in the patients whose infection was eradicated, draws attention to the relevance of eradicating HP in CagA⁺ patients even when no peptic lesion is found at initial endoscopy.     

经内镜中西医结合治疗消化性溃疡临床研究

目的:观察经内镜中西医结合治疗消化性溃疡(PU)的临床疗效,寻找一种安全、快速有效的治疗方法.方法:160例PU患者随机分为两组,各80例,治疗组采用经内镜中西医结合治疗;对照组采用法莫替丁治疗,于2周及4周后经胃镜复查,观察两组患者溃疡愈合情况,并于1年后进行随访,观察复发率.结果:治疗组溃疡愈合明显高于对照组(P＜0.01),复发率显著低于对照组(P＜0.01).结论:经内镜中西医结合治疗PU溃疡愈合快,愈合质量高,复发率低.     

红藤蒲贝煎治疗消化性溃疡疗效分析

红藤蒲贝煎由《景岳全书》中连翘金贝煎化裁组成，具有清热解毒、活血化瘀、理气止痛、制酸敛疡等作用。应用红藤蒲口煎治疗消化性溃疡54例，同时与用呋硫硝胺治疗消化性溃疡30例进行对照。结果，在改善临床症状，促使幽门螺杆菌根除以及降低溃疡复发率等方面。治疗组疗效均明显优于对照组。     

溃疡宁治疗和维持治疗消化性溃疡的临床研究

用中药溃疡宁对70例消化性溃疡患者进行治疗及维持治疗，并与雷尼替丁及灭滴灵联用组对照，结果两组经过4～8周的治疗后，溃疡愈合率相似（P＞0．05）；而幽门螺杆菌的清除率治疗组明显优于对照组（P＜0．01）；维持治疗1年内消化性溃疡的复发率治疗组显著低于对照组（P＜0．05）。结果提示溃疡宁是治疗和维持治疗消化性溃疡的有效药物。     

Lansoprazole Capsules and Amoxicillin Oral Suspension in the Treatment of Peptic Ulcer Disease

Background: Lansoprazole is a potent antisecretory drug also possessing anti-Helicobacter pylori activity in vitro. It is a candidate drug for combination regimens with antibiotics for treating H. pylori infections. Methods: In a semiblind study, 65 patients with duodenal and/or gastric ulcer and pathologic ¹⁴C urea breath test results were treated with either 60 mg lansoprazole every morning only for 14 days or combined with 500 mg amoxicillin oral suspension four times daily between meals, given for 11 days. Endoscopy and breath test were repeated after 6 weeks and 6 months. Patients with unhealed ulcers were withdrawn. Results: Eradication of H. pylori infection was attained in 46% of patients receiving lansoprazole and amoxicillin but in no patient receiving lansoprazole alone. Ulcers healed significantly more often in those who were H. pylori-negative (18 of 19 (95%)) than in those who were H. pylori-positive (20 of 41 (49%)). Adverse events, particularly stomatitis/sore throat and diarrhea, occurred significantly more often when amoxicillin was combined with lansoprazole. Conclusions: Lansoprazole eradicated H. pylori infection only when combined with amoxicillin. Eradication rates in this study are hardly acceptable, and further studies are necessary to define optimal doses and duration of treatment. Using amoxicillin as an oral suspension may not be of any substantial benefit and may cause stomatitis and sore throat.     

Diagnosis and Treatment of Peptic Ulcer Disease

Peptic ulcer disease continues to be a source of significant morbidity and mortality worldwide. Approximately two-thirds of patients found to have peptic ulcer disease are asymptomatic. In symptomatic patients, the most common presenting symptom of peptic ulcer disease is epigastric pain, which may be associated with dyspepsia, bloating, abdominal fullness, nausea, or early satiety. Most cases of peptic ulcer disease are associated with Helicobacter pylori infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs), or both. In this review, we discuss the role of proton pump inhibitors in the management of peptic ulcer disease, highlight the latest guidelines about the diagnosis and management of H. pylori, and discuss the latest evidence in the management of complications related to peptic ulcer disease, including endoscopic intervention for peptic ulcer-related bleeding. Timely diagnosis and treatment of peptic ulcer disease and its sequelae are crucial in order to minimize associated morbidity and mortality, as is prevention of peptic ulcer disease among patients at high risk, including those infected with H. pylori and users of NSAIDs.     

雷尼替丁维持治疗对幽门螺杆菌相关性溃疡四联法治疗后意义的探讨

目的：观察以洛赛克为核心的两种四联疗法的幽门螺杆菌（HP）根除率和溃疡治愈率以及HP相关性胃十二指肠溃疡治愈后是否仍需应用抑酸剂维持治疗。方法：（1）196例病人（HP相关性胃炎40例,HP相关性溃疡156例）随机分两,分别给予洛赛克＋灭滴灵＋瑞贝克（庆大霉素混悬剂）＋四环素（A组）和洛赛克＋灭滴灵＋丽珠得乐＋四环素（B组）口服2周。十二指肠溃疡者继续应用洛赛克6周。胃溃疡和复合性溃疡者则继续用10周后查复查胃镜。（2）对溃疡愈合者将A与B两组各分为雷尼替丁维持组和对照组（AR^ 、AR^－、BR^ 、BR^－组）,对溃疡已愈合但HP未能根除者加用2周四联疗法后再用上述方法处理,1年后复查胃镜记录其溃疡愈合情况。结果：A组与B组的HP根除率分别为92．60％和92％和92．16（P≥0．05）,12周溃疡愈合率分别为90．54％和92．68％（P≥0．05）;AR^ 组与AR^－组组1年后溃疡持久事率分别为91．67％和58．06％（P≤0．01）,BR^ 组和BR^－组的溃疡持久愈合率分别为90．91％和53．13％（P≤0．001）,结论：（1）以洛赛克为核心的两种四联疗法均具有极高的HP根除率和极好的治疗溃疡作用。（2）HP相关性溃疡在HP根除和溃疡短期治愈后仍需用抑酸剂维持治疗。