“三联疗法”治疗幽门螺杆菌阳性十二指肠溃疡30例临床观察

目前普遍认为，幽门螺杆菌（Ｈｐ）是消化性溃疡的主要致病菌，是消化性溃疡复发的主要因素，对Ｈｐ感染的消化性溃疡行根除Ｈｐ治疗已成共识。我们自１９９３年－１９９８年６月采用铋剂为核心的“三联疗法”对胃镜室确诊的活动性十二指肠溃疡的住院病人３０例进行治疗，...     

雷尼替丁三联疗法对幽门螺杆菌阳性十二指肠溃疡的近期及远…

对８２例幽门螺杆菌阳性的十二指肠溃疡用雷尼替丁，羟氨苄青霉素和甲硝唑三联疗法２周，追踪１年，并与１４５例铋剂三联疗法病例对照。结果治疗组溃疡愈合率８７．８％，ＨＰ根除率８９．０％，对照组两参数为９２．４％和８５．７％（Ｐ均〉０．０５）。     

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     

瑞倍三联疗法治疗十二指肠球部溃疡及根除幽门螺杆菌的临床观察

目的 观察枸橼酸铋雷尼替丁(Ranitidine Bismuth Citrate，RBC瑞倍)为主的4周三联疗法的十二指肠球部溃疡治愈率及出门螺杆菌(Helicohbacter Pyliri，HP)根除疗效及安全性。方法将80例十二指肠球部溃疡及HP阳性患者随机分为瑞倍治疗组(A组)与奥美拉唑三联疗法组(B组)，疗程为4周。用C14呼气实验检测HP根除效果，并于疗程结束后1个月复查胃镜，评价溃疡愈合率。结果 两组HP根除率分别为：A组：95．0％，B组87．5％，溃疡治愈率为：A组：97．5％，B组：95．0％。结论 以瑞倍为主的三联疗法的溃疡治愈率和HP根除率与奥美拉唑组相似。     

克拉霉素三联疗法治疗幽门螺杆菌阳性十二指肠溃疡

根除幽门螺杆菌(Hp)可治愈溃疡病已成共识。克拉霉素加PPI和另一抗生素的一周三联疗法已成为欧、美和亚太地区专家共识报告的推荐方案并提出了规范组方。但目前国内报告尚缺。为此,广州市多家教学医院联合进行了前瞻性的临床观察。     

克拉霉素三联疗法治疗幽门螺杆菌阳性十二指肠溃疡

根除幽门螺杆菌 (Ｈｐ)感染以治愈溃疡病 ,预防复发已成共识。最近 ,欧美及亚太地区专家共识报告均推荐克拉霉素、质子泵抑制剂及抗生素的三联 7ｄ疗法 ,并对抗生素的种类和剂量作筛选 ,提出两个规范组方[1] 。为此广州地区 6家医院对这两个组方进行前瞻、多中心临床研究。材料和方法一、病例和分组从 1998年 12月到 1999年 4月 ,到协作组 6家医院就诊 ,内镜确诊为Ｈｐ阳性十二指肠溃疡的门诊病人 ,年龄为18～ 80岁 ,性别不限 ,溃疡长径 >3ｍｍ ,数目 1个 ,无并发症 ,无严重伴随疾病 ,无长期用药史者。 75例随机分入Ａ、Ｂ两组 ,两组具可比…     

兰索拉唑三联疗法治疗幽门螺杆菌阳性十二指肠球溃疡38例

根除幽门螺杆菌（HP）,预防复发已成为共识。兰索拉唑是新型的质子泵抑制剂,主要药理作用是通过特异性的抑制胃壁细胞的H^＋／K^＋-ATP酶,抑制胃酸分泌,临床上主要用于治疗消化性溃疡、返流性食管炎等与酸相关性疾病。我们采用兰索拉唑三联疗法治疗十二指肠球溃疡38例。现将结果报道如下。     

二联疗法治疗幽门螺杆菌阳性十二指肠溃疡

消化性溃疡复发率很高，根除幽门螺杆菌(HP)的治疗，可使溃疡复发大为降低。铋剂加二种抗生素三联疗法，根除HP效果虽好，但副反应屡有报道。本文用胶态枸橼酸铋(CBS)加呋喃唑酮(二联疗法)，对照CBS治疗HP阳性十二指肠溃疡，旨在探讨二联疗法的疗效及副反应。     

埃索美拉唑为基础的三联疗法治疗十二指肠溃疡的临床观察

目的：评估埃索美拉唑(耐信)与克拉霉素和阿莫西林三联治疗十二指肠溃疡的愈合情况、幽门螺杆菌(Hp)的根除情况、消化道症状的缓解及其安全性和耐受性。方法：符合纳入标准的十二指肠溃疡病人分配到治疗组(耐信与克拉霉素和阿莫西林)和对照组(奥美拉唑与克拉霉素和阿莫西林)，疗程1周，治疗结束后随访4周进行评估。结果：共纳入40例病人，每组20例，无一例失访。治疗组18例溃疡为斑痕期(S期)，2例为愈合期(H期)；对照组17例溃疡为S期，3例为H期。治疗组19例Hp根除，对照组18例Hp根除。治疗1周后所有病人的消化道症状均缓解。除少数病人有轻微的消化道不适，但能耐受，无其他不良反应。结论：含耐信的1周三联治疗能有效地根除十二指肠溃疡病人的Hp感染、治愈十二指肠溃疡，其总体疗效与以奥美拉唑为基础的三联治疗方案相接近，且病人的耐受性良好。     

Triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse: Comparison of 1 week and 2 week regimens and recrudescence rates over 12 months

Abstract The aim of this study is to assess the relationship between Helicobacter pylori and the relapse of duodenal ulcer, and also to evaluate the differences in efficacy and side effects between 1 week and 2 week triple therapy. Sixty-two patients with active duodenal ulcer, which healed within 8 weeks of nizatidine treatment, were randomly allocated to one of two groups. Group 1 ( n = 29) received no drugs, Group II ( n = 33) received triple threapy for 1 week (IIa, n = 16) or 2 weeks (IIb, n = 17). Eleven patients whose ulcer did not heal after an 8 week nizatidine treatment period were randomly assigned into Group IIa ( n = 5) and IIb ( n = 6). Seven patients whose ulcer recurred after discontinuation of nizatidine were allocated to receive 2 weeks of triple therapy. All patients received endoscopy 6 weeks after entry, and again at 3, 6 and 12 months unless both ulcer recurrence and H. pylori infection were found. The frequency of ulcer relapse 6 weeks after the active duodenal ulcer had healed was 83% (24/29) in Group I, 13% in Group IIa and 14% in Group IIb. The cumulative rate of recurrence was significantly higher in Group I than in Group II (90 vs 30% at 12 months, P < 0.01). Ulcer relapse was associated with persistence of H. pylori infection ( P < 0.0001). No statistical difference was found between the 1 week and 2 week regimens in ulcer relapse rate (30 vs 30% in 1 year), H. pylori eradication rate (86 vs 100%), incidence of side effects (48 vs 53%) or recrudescence rate (17 vs 23%). Our study suggests that a 1 week regimen and a 2 week regimen are equally effective in the eradication of H. pylori and reduction of ulcer recurrence in 1 year.     

治疗的依从性、年龄、性别对胃溃疡患者使用三联7天疗法根除幽门螺杆菌治疗的影响

目的研究胃溃疡患者使用三联7天疗法治疗幽门螺杆菌（Helicobacter pylori,H.pylori）感染的根除率,评估患者依从性、年龄、性别对于此类人群根除H.pylori治疗的影响。方法将经胃镜检查确诊为新发胃溃疡,并经活组织病理学检查明确有H.py-lori感染的1 075例患者纳入研究范围,所有入选患者均接受三联（洛赛克或耐信20 mg/次、2次/天,联合克拉霉素500 mg/次、2次/天,与阿莫西林1 000 mg/次、2次/天）7天疗法行根除H.pylori治疗,之后予以耐信或洛赛克20 mg/次、1次/天、治疗49天。所有入选患者系统治疗完成后6-8周复查胃镜。结果40-59岁与60岁以上人群的胃溃疡患者对治疗的依从性差异无显著性,而40岁以下人群对治疗的依从性较差（P〈0.05）。〈40岁、40-59岁和≥60岁胃溃疡患者的H.pylori根除率分别为61.0%、72.7%和81.9%。〈40岁与40-59岁和≥60岁患者的H.pylori根除率差异有统计学意义（P〈0.05）。不同性别胃溃疡患者的H.pylori根除率差异无显著性（P〉0.05）。结论使用三联7天疗法治疗胃溃疡患者的H.pylori感染,H.pylori的根除率较低,患者对治疗的依从性、年龄是影响胃溃疡患者H.pylori根除率的重要因素,而性别对此无影响。     

薏苡利浊清毒方联合奥美拉唑治疗幽门螺杆菌相关性十二指肠球部溃疡临床研究

[目的]研究薏苡利浊清毒方联合奥美拉唑治疗幽门螺杆菌（Helicobacter pylori,Hp）相关性十二指肠球部溃疡（DU）的临床疗效。[方法]将符合纳入标准的120例患者随机分为3组,治疗组用薏苡利浊清毒方联合奥美拉唑20 mg,2次/d,对照1组用三联杀菌药物1周后单独予奥美拉唑20 mg,2次/d,对照2组单纯服用薏苡利浊清毒方,2次/d,均治疗4周后观察各组胃镜、Hp根除率、证侯疗效等,评价其效果。[结果]治疗组、对照1组DU愈合率均优于对照2组（P〈0.05）,治疗组与对照1组间差异无统计学意义。治疗组对症状的缓解作用均优于对照1组和对照2组（P〈0.05）。[结论]薏苡利浊清毒方联合奥美拉唑治疗Hp相关性DU有较好疗效。     

Medical treatment of duodenal ulcer: Acid inhibition or Helicobacter pylori eradication?

To ascertain whether acid inhibition or Helicobacter pylori (HP) colonization is the decisive factor in the healing of duodenal ulcer, we treated 54 patients with famotidine and carried out long-term follow-up. Helicobacter pylori colonization was found in 70.4% of patients before treatment. There were no differences in the pre-treatment characteristics between patients with HP positive or HP negative ulcers. The 4-week and 8-week healing rates after famotidine treatment were 72.5% and 82.4% respectively. No difference in HP colonization was found between patients with ulcer healed and those with ulcer not healed (78.4% vs 64.3% at 4th week and 77.3% vs 71.4% at 8th week, P greater than 0.05). In patients with ulcer healed at 4th week, the intragastric pH was raised significantly and the antral acute inflammation was less severe than those with ulcer not healed. Ulcer recurrence was found in 76.9% of patients within 1 year, but there was no difference in ulcer recurrence between the patients with positive or negative HP colonization at the time of ulcer healing. Our results suggest that duodenal ulcer healing and recurrence are closely related to acid inhibition rather than to HP colonization.     

Effect of Helicobacter pylori eradicated therapy on water gastric emptying in patients with active duodenal ulcer

BACKGROUND AND AIMS: It remains debatable if duodenal ulcer (DU) or Helicobacter pylori infection has a definite impact on human gastric emptying (GE). We explored the nature of water GE in active DU patients before and after ulcer healing and the influence of H. pylori eradication on GE. METHODS: A home made applied potential tomography (APT) was used to measure liquid GE. Twelve electrodes were placed in a circular array around the upper abdomen of studied subjects. After drinking 500 mL of ion-free water, paired electrodes injected electrical current and the remaining 10 electrodes recorded signals, one-by-one in a rotating order. Based on tomographical calculation, the serial changes of averaged signals from altered resistivities were constructed to display GE. Initially, 64 H. pylori infected active DU patients were enrolled. After APT measurement, one-week triple therapy (omeprazole, amoxicillin and clarithromycin) was dispensed. Patients were asked back to determine ulcer/H. pylori status and GE on a scheduled date 3 months later. Finally, 58 patients finished the trial with valid and readable GE data obtained. RESULTS: The ulcer healing and H. pylori eradicated rates were 91.4% and 82.8%, respectively. In general, liquid GE was prolonged in all DU patients at follow up. Of 48 eradicated patients, 35.4% manifested either enhanced or delayed GE before treatment, whereas only five (10.4%) had abnormal GE after treatment (P < 0.0001). In contrast, this characteristically normalized GE was not found in non-eradicated patients. CONCLUSIONS: Water GE of active DU patients ranges from enhanced to delayed, while an effective H. pylori triple therapy is useful not only for healing ulcers, but also for restoring abnormal GE.     

Follow-up survey of a large-scale multicenter,double-blind study of triple therapy with lansoprazole,amoxicillin, and clarithromycin for eradication of Helicobacter pylori in Japanese peptic ulcer patients

Background: To evaluate histopathological changes and effects on inhibition of ulcer recurrence, a follow-up survey was performed in Japanese patients with Helicobacter pylori-positive active peptic ulcers. These patients had previously participated in a large-scale multicenter trial of triple therapy with lansoprazole (LPZ)/amoxicillin (AMPC)/clarithromycin (CAM) for eradication of H. pylori. Methods: Patients who had been treated with LPZ only or a combination of LPZ, AMPC, and CAM for a period of 7 days and in whom ulcer healing had been confirmed after treatment were grouped according to successful or failed eradication of H. pylori. They were examined endoscopically to determine whether ulcers had recurred. The updated Sydney system was applied to study histological changes after H. pylori eradication therapy, compared with baseline. Results: Twelve months after treatment for H. pylori eradication, gastric ulcers had recurred in 11.4% of those with successful H. pylori eradication and in 64.5% of those with unsuccessful H. pylori eradication. Duodenal ulcers had recurred in 6.8% of patients for whom H. pylori eradication was successful and in 85.3% of patients in whom eradication failed. These findings proved that H. pylori eradication significantly reduced ulcer recurrence (P < 0.0001 for both types of ulcers). Histopathological findings of inflammation and activity grade in both gastric and duodenal ulcers were more favorable in patients with successful eradication than in those with unsuccessful eradication. Conclusions: H. pylori eradication significantly inhibited ulcer recurrence in Japanese peptic ulcer patients. Histopathological findings were also improved with regard to inflammation and activity (neutrophils) in patients in whom H. pylori eradication was successful. Received: May 13, 2002 / Accepted: September 6, 2002 Reprint requests to: M. Asaka Editorial on page 410     

序贯疗法和标准三联疗法根除幽门螺杆菌的疗效比较

目的:观察10d序贯疗法治疗幽门螺杆菌(Helicobacter pylori,H.pylori)的疗效及不良反应,与14d三联标准疗法比较H.pylori根除情况及经济学上有无优越性.方法:将103例经胃镜检查确诊为慢性胃炎或消化性溃疡且H.pylori阳性的患者随机分为两组,治疗组(10d序贯疗法)52例,前5d埃索美拉唑、阿莫西林,后5d埃索美拉唑、克拉霉素、替硝唑.对照组(14d标准三联疗法)51例,埃索美拉唑、阿莫西林、克拉霉素14d.所有患者停药4wk后复查13C呼气试验或胃镜检查,判断H.pylori根除情况.结果:治疗组H.pylori根除率为90.4%,与对照组(90.2%)比较无统计学差异(P=1.000);两组不良反应发生率分别为12/52(23.1%)、18/51(35.3%),两组比较无统计学差异(P=0.172);治疗组费用为380.6元,较对照组(677.88元)明显减低.结论:10d序贯疗法的H.pylori根除率不低于标准14d三联疗法,2组不良反应发生率相似,但10d序贯疗法根除H.pylori的效价比更高.     

Helicobacter pylori eradication improves gastric histology and decreases serum gastrin, pepsinogen I and pepsinogen II levels in patients with duodenal ulcer

Background and Aim: The aim of this study was to assess the gastric histopathology and serum gastrin‐17 and pepsinogens profiles in patients with duodenal ulcer before and after Helicobacter pylori eradication in a population with a very high prevalence of H. pylori. At the same time we assessed the role of H. pylori density on these variables. Methods: Eighty Caucasian patients with H. pylori–associated duodenal ulcer before treatment and 1 year after randomized eradication were studied. Among patients with unsuccessful eradication two groups were distinguished according to the data obtained after treatment: the group with negative rapid urease test and decreased bacterial density according to morphological score (partial elimination group); the group with positive rapid urease test and high bacterial density (failed eradication group). Results: One year after successful eradication, serum levels of gastrin‐17, pepsinogen I and pepsinogen II decreased. Similar changes of serum pepsinogen I and pepsinogen II levels were observed in patients with partial elimination of H. pylori infection. In the group with successful eradication, inflammation, activity, atrophy and number of lymphoid follicles in the antral mucosa fell. In the group with partial elimination, antral mucosa activity and H. pylori score reduced. Other morphological changes were statistically non‐significant. Conclusion: Patients with duodenal ulcer after successful eradication have improvement of morphological and functional characteristics of gastric mucosa.