铝碳酸镁、兰索拉唑、阿莫西林、呋喃唑酮四联疗法治疗幽门螺杆菌相关性胃溃疡的效果及安全性评价

目的观察铝碳酸镁、兰索拉唑、阿莫西林、呋喃唑酮四联疗法治疗幽门螺杆菌相关性胃溃疡的效果及安全性。方法2016年3月至2017年12月开滦总医院林西医院消化科收治的符合纳入标准的幽门螺杆菌相关性胃溃疡患者120例作为观察对象。采用随机数字表法将其分为观察组和对照组,每组60例。对照组给予兰索拉唑+阿莫西林+呋喃唑酮三联治疗。观察组在此基础上加用铝碳酸镁。比较两组患者治疗后的临床疗效,幽门螺杆菌清除率,胃液血管内皮生长因子(vascular endothelial growth factor,VEGF)和表皮细胞生长因子(epidermal growth factor,EGF)水平的差异,以及治疗期间患者的不良反应。结果观察组临床总有效率95.0%(57/60)显著优于对照组的83.3%(50/60),两组比较差异有统计学意义(χ^2=4.23,P<0.05)。两组患者综合症状评分均随治疗时间的推移显著下降[观察组治疗前(9.6±2.2)分、治疗2周(5.5±1.5)分、治疗4周(4.3±1.2)分、治疗6周(3.1±0.8)分,对照组治疗前(9.4±2.5)分、治疗2周(7.2±1.3)分、治疗4周(6.6±1.4)分、治疗6周(4.5±1.0)分],且观察组综合症状评分下降幅度显著大于对照组,差异有统计学意义(F组间=23.54,P<0.05;F组内=87.62,P<0.05;F交互=8.47,P<0.05)。两组患者治疗后胃液VEGF水平显著升高,观察组(429.4±128.5)ng/L显著高于对照组(380.3±137.2)ng/L(t=2.02,P<0.05)。两组患者治疗后胃液EGF水平显著升高,观察组(658.1±164.0)ng/L显著高于对照组(583.5±135.1)ng/L(t=2.72,P<0.05)。两组患者不良反应发生率[观察组6.7%(4/60)、对照组8.3%(5/60)]比较,差异无统计学意义(χ^2=0.12,P>0.05)。结论铝碳酸镁、兰索拉唑、阿莫西林、呋喃唑酮四联方案治疗幽门螺杆菌相关性胃溃疡能够明显改善患者的临床症状,促进溃疡黏膜的再生。     

兰索拉唑联合铝碳酸镁治疗消化性溃疡的长期疗效分析

目的：探讨溃疡愈合质量对消化性溃疡复发的影响。方法：将68例十二指肠球部溃疡合并幽门螺杆菌(H．Pylori)感染患者随机分为：试验组38例,对照组30例。2组均先给予标准3联疗法根除H．Pylori,1周后试验组,兰索拉唑30mg每日2次,联合铝碳酸镁(商品名,达喜)1000mg每日3次;对照组,兰索拉唑30mg每日2次;继续治疗4周。停药4周后观察内镜下溃疡愈合率、胃粘膜组织学改变;随访1年内溃疡复发情况。结果：停药4周后内镜下溃疡愈合率分别为,试验组94．7%,对照组80．0%,两者比较无显著性差异(P＞0．05)。组织学观察显示粘膜层厚度、腺体密度和腺管形态恢复,试验组显著优于对照组(P＜0．05);1年内溃疡复发率,试验组2．8%,对照组25．0%,两者比较有显著性差异(P＜0．05)。结论：兰索拉唑联用铝碳酸镁能提高溃疡愈合质量,减少溃疡复发,显著优于单用兰索拉唑。     

兰索拉唑、羟氨苄青霉素、替硝唑联合根除幽门螺杆菌的疗效观察

目的评价兰索拉唑（达克普隆）、羟氨苄青霉素、替硝唑三联疗法对幽门螺杆菌（Ｈｐ）相关性消化性溃疡的疗效。方法将８７例Ｈｐ阳性的十二指肠和（或）胃溃疡患者随机分为２组：第１组４３例,每次口服兰索拉唑３０ｍｇ、羟氨苄青霉素１０００ｍｇ、替硝唑５００ｍｇ,均每日２次,２周为一疗程;第２组４４例,给药方式同第１组,只是疗程缩短为１周,疗程结束后继续每日口服兰索拉唑３０ｍｇ,持续１周。疗程结束达４周时复查胃镜及Ｈｐ。３５例Ｈｐ根除后６个月行１４Ｃ－尿素呼气试验（ＵＢＴ）。结果第１组有３例因过敏性皮疹而退出观察,４０例用于统计学分析。第１组和第２组的Ｈｐ根除率分别为９００％和８１８％,十二指肠溃疡和胃溃疡的愈合率分别为９２５％和８８６％。６个月的Ｈｐ再感染率为８６％。结论第１组Ｈｐ根除率和溃疡愈合率均略高于第２组,两组相比差异无显著性（Ｐ＞００５）。两组均有较理想的溃疡愈合率和Ｈｐ根除率。     

Comparative study of omeprazole, lansoprazole, pantoprazole and esomeprazole for symptom relief in patients with reflux esophagitis

AIM： To clarify whether there is any difference in the symptom relief in patients with reflux esophagitis following the administration of four Proton pump inhibitors （PPIs）. METHODS： Two hundred and seventy-four patients with erosive reflux esophagitis were randomized to receive 8 wk of 20 mg omeprazole （n = 68）, 30 mg of lansoprazole （n = 69）, 40 mg of pantoprazole （n = 69）, 40 mg of esomeprazole （n = 68） once a day in the morning. Daily changes in heartburn and acid reflux symptoms in the first 7 d of administration were assessed using a six-point scale （0： none; 1： mild; 2： mild-moderate; 3： moderate; 4： moderate-severe; 5： severe）. RESULTS： The mean heartburn score in patients treated with esomeprazole more rapidly decreased than those receiving other PPI. Complete resolution of heartburn was also more rapid in patients treated with esomeprazole for 5 d compared with omeprazole （P = 0.0018, P = 0.0098, P = 0.0027, P = 0.0137, P = 0.0069, respectively）, lansoprazole （P = 0.0020, P = 0.0046, P = 0.0037, P = 0.0016, P = 0.0076, respectively）, and pantoprazole （P = 0.0006, P = 0.0005, P = 0.0009, P = 0.0031, P = 0.0119, respectively）. There were no significant differences between the four groups in the rate of endoscopic healing of reflux esophagitis at week 8. CONCLUSION： Esomeprazole may be more effective than omeprazole, lansoprazole, and pantoprazole for the rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis.