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。     

以埃索美拉唑为基础的三联疗法治疗幽门螺杆菌阳性十二指肠球部溃疡的疗效分析

目的 研究埃索美拉唑+阿莫西林+左氧氟沙星的三联疗法对幽门螺杆菌(Hp)阳性十二指肠球部溃疡(Du)的疗效.方法 实验组58例,埃索美拉唑+阿莫西林+左氧氟沙星三联疗法,治疗1周,其中28例疗程结束,余30例继续单用埃索美拉唑3周,疗程4周.对照组50例,埃索美拉唑+阿莫两林+甲硝唑二联疗法,治疗1周,其中24例疗程结束,余26例继续单用埃索美拉唑3周,疗程4周.结果 实验组和对照组比较,不论是1周疗程,还是4周疗程,两组患者的症状缓解率、溃疡愈合率均无显著性差异,但幽门螺杆菌(Hp)根除率实验组均明显高于对照组;两组患者中1周疗程和4周疗程比较,两种疗程的症状缓解率、溃疡愈合率、Hp根除率均无显著性差异.结论 埃索美拉唑+阿莫西林+左氧氟沙星的三联1周疗法治疗Hp阳性的DU,可获得满意的临床疗效和Hp根除率.     

以埃索美拉唑为基础的三联疗法治疗幽门螺杆菌阳性十二指肠球部溃疡疗效分析

目的研究埃索美拉唑＋阿莫西林＋左氧氟沙星三联疗法对幽门螺杆菌（Hp）阳性十二指肠球部溃疡（DU）的疗效。方法实验组58例,埃索美拉唑＋阿莫西林＋左氧氟沙星三联疗法,治疗1周,其中28例疗程结束,余30例继续单用埃索美拉唑3周,疗程4周。对照组50例,埃索美拉唑＋阿莫西林＋甲硝唑三联疗法,治疗1周,其中24例疗程结束,余26例继续单用埃索美拉唑3周,疗程4周。结果实验组的1周疗程4和周疗程与对照组比较,症状缓解率、溃疡愈合率均无显著性差异,但实验组Hp清除率均高于对照组,两组患者中1周疗程和4周疗程比较,两种疗程的症状缓解率、溃疡愈合率、Hp清除率均无显著性差异。结论埃索美拉唑＋阿莫西林＋左氧氟沙星的三联1周疗法治疗Hp阳性的DU,可获得满意的临床疗效和Hp清除率。     

埃索美拉唑三联疗法治疗十二指肠球部溃疡疗效分析

将90例胃幽门螺杆菌(Hp)阳性的十二指肠球部溃疡患者随机分成两组,分别给予埃索美拉唑(治疗组)和奥美拉唑(对照组)为主的三联疗法。于用药1、2、3、7d观察临床症状的改善情况;疗程结束4周后,观察两组溃疡愈合率Hp根除率。结果治疗组溃疡愈合率为91.8%(45/49),Hp根除率为83.7%(41/49),对照组分别为87.8%(36/41)、80.5%(33/41),两组溃疡愈合率和Hp根除率比较无显著差异(P>0.05);治疗组第1、2天临床症状缓解率分别为38.8%、63.3%,高于对照组的14.6%、36.6%(P<0.05);不良反应发生率分别为6.1%和7.3%。表明埃索美拉唑能有效清除Hp,缓解症状,促使溃疡愈合。     

埃索美拉唑在十二指肠球部溃疡中根除幽门螺杆菌和愈合溃疡的疗效

幽门螺杆菌 (Ｈｐ)感染是消化性溃疡最重要的致病因子 ,成功根除Ｈｐ能显著降低溃疡复发率 ,因此众多治疗指南均主张Ｈｐ相关的消化性溃疡应作根除治疗。溃疡的持续愈合通常需将 1种抗酸分泌药物与 2种抗生素联合使用 ,在现有的抗酸分泌药物中 ,奥美拉唑是使用最广泛的一种质子泵抑制剂 (ＰＰＩ)。当与阿莫西林和克拉霉素联用时 ,根除率稳定在 90 %左右。与其他ＰＰＩ相似 ,奥美拉唑是苯并咪唑类化合物 ,以外消旋混合剂形式存在。埃索美拉唑是在酸相关性疾病治疗中 ,第一个发展为光学异构体形式的ＰＰＩ。胃食管反流病(ＧＥＲＤ)的早期临床…     

埃索美拉唑镁治疗幽门螺杆菌阳性胃十二指肠炎的临床疗效及安全性

目的探讨埃索美拉唑镁治疗幽门螺杆菌(HP)阳性胃十二指肠炎的临床疗效及安全性。方法 54例HP阳性胃十二指肠炎患者随机分为对照组及试验组各27例;对照组给予克拉霉素缓释片0.5 g+阿莫西林克拉维酸钾片562.5 mg+奥美拉唑肠溶片20 mg,2次/d,口服;试验组给予克拉霉素缓释片0.5 g+阿莫西林克拉维酸钾片562.5 mg+埃索美拉唑镁肠溶片20 mg,2次/d,口服。比较两组患者治疗前后血清胃蛋白酶原(PG)Ⅰ、PGⅡ、PGⅠ/PGⅡ水平、治疗有效率及安全性。结果治疗后,与对照组比较,试验组患者血清PGⅠ、PGⅡ水平较低,PGⅠ/PGⅡ水平较高,差异显著(P<0.05)。试验组的治疗有效率显著高于对照组(P<0.05)。两组患者不良反应发生率无明显差异(P>0.05)。结论埃索美拉唑镁能显著降低HP阳性胃十二指肠炎患者血清胃PGⅠ、PGⅡ水平,提高PGⅠ/PGⅡ水平,有效根除HP。     

埃索美拉唑与奥美拉唑治疗胃溃疡的临床分析

目的对比埃索美拉唑与奥美拉唑治疗胃溃疡的疗效。方法将经胃镜证实的胃溃疡病人随机分为埃索美拉唑组（治疗组60例）与奥美拉唑组（对照组58例）。治疗组应用埃索美拉唑40mg,对照组用奥美拉唑20Ing均睡前服,治疗3周、6周后均复查胃镜,观察溃疡愈合情况。结果治疗3周后治疗组和对照组病人胃镜下胃溃疡的愈合率、显效率、有效率分别是36．7％和17．2％、75．0％和43．1％、95．0％和72．4％,治疗组疗效明显高于对照组,两组差异具有统计学意义（P〈0．05）;治疗6周后治疗组和对照组病人胃镜下胃溃疡的愈合率、显效率、有效率分别是40．0％和37．9％、86．7％和81．0％、98．3％和96．6％,两组比较差异无统计学意义（P〉0．05）。结论埃索美拉唑与奥美拉唑治疗胃溃疡的愈合率、显效率、有效率相当,但埃索美拉唑起效快,治疗时间短,不良反应少,值得在临床上广泛应用。     

埃索美拉唑治疗Hp阳性十二指肠球后溃疡的疗效

我们院近2年应用埃索美拉唑联合克拉霉素及阿莫西林治疗Hp阳性球后溃疡48例，并以国产奥美拉唑肠溶片对照，观察上腹疼痛等临床症状改善及溃疡愈合情况等，现总结分析报告如下。     

埃索美拉唑对十二指肠球溃疡合并幽门螺杆菌感染的治疗

目的:观察埃索美拉唑加利复星、克拉霉素治疗十二指肠溃疡合并幽门螺杆菌(H Pylori) 感染的临床疗效．方法:将64例幽门螺杆菌阳性的十二指肠球溃疡患者随机分为治疗组(n=32)和对照组(n= 32)．治疗组口服埃索美拉唑、利复星、克拉霉素．对照组口服法莫替丁、利复星、克拉霉素．各组疗程结束后复查胃镜,观察溃疡愈合率、H pylori清除率和临床症状的改善情况．结果:治疗组和对照组镜下溃疡愈合率分别为32例(100％)和26例(81．3％)(P<0．01);H pylori根除率分别为90．6％和71．9％(P<0．01); 治疗组显效32例,总有效率100％;对照组显效率20例(62．5％),有效8例(25％),总有效率 87．5％．治疗组显效率和总有效率显著高于对照组(P<0．01)．两组均无明显不良反应．结论:埃索美拉唑缓解临床症状快,有效促进溃疡愈合,与抗生素联合应用提高H pylroi清除率．     

以埃索美拉唑和奥美拉唑为基础的三联疗法根除幽门螺杆菌疗效的荟萃分析

目的对以埃索美拉唑和奥美拉唑为基础的1周三联疗法根治幽门螺杆菌的疗效进行系统性分析。方法联机检索从Medline数据库(2000年~2005年)、维普(2000~2005年)、万方数据库(2000~2005年)中检索埃索美拉唑与奥美拉唑为基础的三联疗法对根治幽门螺杆菌疗效的随机对照临床试验。对各项研究中疗效的比值比(OR)进行荟萃分析,采用Mantel-Haesul方法。结果共有7项研究符合入选标准。荟萃结果表明以埃索美拉唑为基础的1周标准三联疗法对幽门螺杆菌的根治疗效和以奥美拉唑为基础的标准三联疗法疗效相似[OR(95%CI):1·2746(0·8835,1·8388)]。结论埃索美拉唑作为奥美拉唑的光学异构体,以其为基础的1周三联疗法能有效地根治幽门螺杆菌,疗效相似于奥美拉唑。     

含阿奇霉素的三联疗法对幽门螺杆菌阳性十二指肠球部溃疡的疗效

目的观察埃索美拉唑、阿莫西林、阿奇霉素治疗幽门螺杆菌（Hp）阳性十二指肠球部溃疡的疗效。方法治疗组1：埃索美拉唑20mgbid、阿莫西林1.0bid、阿奇霉素0.5qd（连续服用3d）,疗程1周;治疗组2：埃索美拉唑20mgbid、阿莫西林1.0bid、阿奇霉素0.5qd（连续服用3d）,疗程2周;对照组：埃索美拉唑20mgbid、阿莫西林1.0bid、克拉霉素0.25bid,疗程1周。4周后复查电子胃镜及13C尿素呼气试验。结果实验组1与实验组2比较,溃疡愈合率、Hp根除率、症状缓解率无显著性差异,但与对照组比较有显著性差异。结论埃索美拉唑、阿莫西林、阿奇霉素三联7d疗法治疗Hp阳性十二指肠球部溃疡可获得满意的临床疗效和Hp根除率。     

Omeprazole triple therapy versus omeprazole quadruple therapy for healing duodenal ulcer and eradication of Helicobacter pylori infection: a 24-month follow-up study

OBJECTIVE: To evaluate the efficacy of omeprazole triple therapy versus omeprazole quadruple therapy for Helicobacter pylori infection. DESIGN: Prospective, randomized, single-centre, investigator-blind study. SETTINGS: Departments of Gastroenterology and Histopathology, Evangelismos Hospital, Athens, Greece. METHODS: One hundred and forty-nine consecutive patients with active duodenal ulcer were randomized to receive omeprazole (20 mg b.d.), amoxicillin (1 g b.d.) and clarithromycin (0.5 g b.d.) (OAC, n = 78), or omeprazole (20 mg b.d.), colloidal bismuth subcitrate (120 mg q.i.d.), metronidazole (0.5 g t.i.d.) and tetracycline hydrochloride (0.5 g q.i.d.) (OBMT, n = 71) for 10 days. Patients' symptoms were scored, and compliance and treatment-related side effects were assessed. Endoscopy was performed before treatment and at 10-12 weeks and 12 months after treatment. H. pylori infection and its successful eradication were sought by histology, immunohistochemistry and campylobacter-like organisms (CLO) tests on multiple biopsies taken from the gastric antrum, corpus and fundus. Patients were re-evaluated clinically and underwent a C-urea breath test (UBT) at 21-24 months. Those with dyspepsia and/or recrudescence of H. pylori were re-endoscoped. RESULTS: Patient groups were comparable for age, sex, smoking, occasional use of nonsteroidal anti-inflammatory drugs (NSAIDs), and current or past bleeding episodes. Six and seven patients in the OAC and OBMT treatment groups, respectively, were lost to follow-up. Eight patients were non-compliant. Two ulcers in the OAC group and one in the OBMT group did not heal. By intention-to-treat (ITT) and per-protocol (PP) analyses, ulcer healing rates were 86% (67/78) and 97% (67/69), respectively, for the OAC group, and 82% (58/71) and 98% (58/59), respectively, for the OBMT group. H. pylori eradication at 10-12 weeks after treatment was 78% (61/78) and 88% (61/69) for OAC, and 65% (46/71) and 78% (46/59) for OBMT, by ITT and PP analyses, respectively (P > 0.1). Side effects were more common with OBMT. Relapse rates of H. pylori were 3% and 2% for the first and second years, respectively. Four H. pylori-negative patients developed reflux symptoms, but only two developed erosive oesophagitis between 12 and 24 months. CONCLUSIONS: OAC and OBMT were equally effective in healing active duodenal ulcers and eradicating H. pylori, but OAC should be used as a first-line treatment because of its better tolerance.     

三联疗法根除十二指肠溃疡病患者Hp感染效果及影响因素分析

目的研究十二指肠溃疡患者使用三联疗法治疗幽门螺杆菌（Hp）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Hp治疗的影响。方法新发十二指肠溃疡并明确有Hp感染的1038例患者均接受三联（洛赛克或耐信联合克拉霉素与阿莫西林）7d疗法行根除Hp治疗,之后予以耐信或洛赛克治疗35d。系统治疗完成后6—8周复查胃镜。结果十二指肠溃疡病患者Hp根除率为77．0％。40岁以下人群的治疗依从性较差,40岁以下与40岁以上患者的Hp根除率有统计学差异（P〈0．05）。不同性别十二指肠溃疡患者的Hp根除率无统计学差异（P〉0．05）。结论三联7d疗法对十二指肠溃疡病患者Hp的根除率较低,患者对治疗的依从性、年龄是影响十二指肠溃疡患者Hp根除率的重要因素。     

Comparison of three triple regimens with omeprazole or ranitidine bismuth citrate for Helicobacter pylori eradication

BACKGROUND: Regimens with ranitidine bismuth citrate (RBC) or omeprazole (O) are effective in eradicating Helicobacter pylori. This randomized, open, multicentre trial compares three different regimens with these drugs. METHODS: Consecutive H. pylori +ve outpatients were included. The alternative regimens were: 1) O 20 mg, clarithromycin (C) 250 mg and metronidazole (M) 500 mg (O.C.M), 2) RBC 400 mg, C 250 mg and M 500 mg (RBC.C.M), 3) RBC 400 mg, tetracycline (T) 1000 mg and M 500 mg [RBC.T.M]. All drugs were given twice daily for 7 days. H. pylori infection was assessed with H. pylori urea breath tests. RESULTS: 426 H. pylori +ve patients were included (mean age 58 years [range 18-88], male/female: 244/182). The eradication rates (intention to treat) in the O.C.M, RBC.C.M and RBC.T.M groups were 117/137 (85%), 141/146 (97%) and 117/143 (82%), respectively (P < 0.001, overall assessment). There were no significant differences in side effects between the alternatives. CONCLUSION: In this trial, RBC.C.M was the most effective one, it was well tolerated and compliance was satisfactory. RBC.T.M is an alternative to regimens with clarithromycin.     

Long-term follow-up and serologic assessment after triple therapy with omeprazole or lansoprazole of Helicobacter-associated duodenal ulcer

We assessed both the effectiveness of two Helicobacter pylori (Hp) eradication triple therapies and the usefulness of serology in the follow-up. Fifty patients with active or scarred duodenal ulcer were randomized to lansoprazole or omeprazole for 1 to 4 weeks, with clarithromycin 250 mg twice a day and tinidazole 500 mg twice a day for the first week. Endoscopies were scheduled before treatment, after 8 weeks, and after I year. H. pylori status was determined before therapy by rapid urease test and histology and during the follow-up by histology and culture. Serology was determined at baseline and at 6 and 12 months. The regimens were equally effective in inducing ulcer healing (95.8% vs. 87.5%) and eradicating Hp with no recurrences at 12 months. Among 44 patients eradicated, a significant reduction of immunoglobulin G (IgG) titer occurred at 6 (p < 0.0001) and 12 months (p < 0.0001). If a titer reduction of more than 30% was taken as an indicator for Hp eradication, the specificity of enzyme-linked immunosorbent assay was 75% at 6 and 95.4% at 12 months with a 100% sensitivity. Either lansoprazole or omeprazole combined with antibiotics are effective in eradicating Hp. Serology is useful for monitoring Hp eradication provided that an appropriate percent reduction in IgG titer is used after more then 6 months after therapy.     

两种短程小剂量三联疗法根除幽门螺杆菌的比较

目的比较两组短程小剂量三联方案(OTA奥美拉唑+替硝唑+阿莫西林;FFA法莫替丁+呋喃唑酮+阿莫西林)根除幽门螺杆菌感染的疗效.方法采用随机对照临床试验设计,经内镜检查、快速尿素酶试验和病理检查(MB染色)证实有Hp感染的患者132例.通过随机化方法分为2组,A组用OTA方案,B组用FFA方案,均治疗1周,随访6周.随访结束时行14C尿素呼气试验确定Hp根除情况.结果131例患者完成治疗及随访,两组的Hp根除率分别为84.8%和73.8%(P＞0.05).两组中胃炎患者的Hp根除率分别为89.2%和70.2%(P＜0.05),两组中溃疡患者的Hp根除率分别为79.3%和78.6%(P＞0.05).副作用发生率分别为15.2%、26.2%(P＞0.05),未发现严重副作用,所有患者均能耐受.A组药物费用明显高于B组(331.98元比77.26元).结论对Hp阳性的胃炎患者,应选价格较贵,但根除率高、副作用少的OTA方案;对Hp阳性的溃疡患者,可选价格低廉、疗效与OTA方案相当的FFA方案.