序贯疗法和三联疗法联合益生茵根除幽门螺杆菌感染的临床对照研究

背景：近年来，幽门螺杆菌（Hp）对抗菌药物耐药的问题日益突出，研究者正不断尝试调整根除治疗方案以提高根除率。目的：评估序贯疗法和三联疗法联合益生菌根除Hp感染的疗效和安全性。方法：纳入有消化不良症状、RUT和“C-UBT均阳性且既往未接受过Hp根除治疗的患者，进入不同组别。序贯疗法组（A组，n=127）：前5d雷贝拉唑10mgbid＋阿莫西林1．0gbid，后5d雷贝拉唑10mgbid＋克拉霉素500mgbid＋替硝唑400mgbid；三联疗法＋益生菌组（B组，n=117）：（雷贝拉唑10mgbid＋阿莫西林1．0gbid＋克拉霉素500mgbid）×7d，三联活菌胶囊3粒tid×14d；标准三联疗法组（C组，n=106）：PPI和抗菌药物的剂量、用法、疗程同B组，但不加用益生菌。疗程结束后4周复查“C-UBT，同时评估症状改善和溃疡愈合情况。治疗期间观察不良反应发生情况。结果：A、B两组Hp根除率（ITT分析：82．7％、78．6％对63．2％；PP分析：83．3％、79．3％对65．0％）和症状缓解率（82．7％、84．6％对65．1％）均显著高于C组（P〈0．05），A、B组问差异无统计学意义。三种方案的消化性溃疡痊愈率无明显差异（72．7％、67．6％和45．5％，P〉0．05）。B组不良反应发生率显著低于A、C两组（4．3％对15．0％和20．8％，P〈0．05）。结论：与标准三联疗法相比，序贯疗法和三联疗法联合益生菌能明显提高Hp根除率，其中三联疗法联合益生菌安全性更高，可能更适用于临床。

Sequential Therapy and Triple Therapy Combined with Probiotics for Eradication of Helicobacter pylori Infection: A Controlled Clinical Study

Background： Resistance of Helicobacter pylori （Hp） to antibiotics is becoming a serious problem in recent years. Various regimens have been tested for improving the eradication rate. Aims ： To assess the efficacy and safety of sequential therapy and triple therapy combined with probiotics for eradication of Hp infection. Methods： Patients with dyspeptic symptoms, proved to be positive for Hp infection by RUT and t4 C-UBT and naive to eradication therapy were enrolled and allocated into three groups. In group A （n = 127 ）, patients received 10-day sequential therapy （rabeprazole 10 mg bid and amoxicillin 1.0 g bid for the first 5 days, rabeprazole 10 mg bid, clarithromycin 500 mg bid and tinidazole 400 mg bid for the next 5 days） ; in group B （ n = 117）, patients received triple therapy （ rabeprazole 10 mg bid, amoxicillin 1.0 g bid and clarithromycin 500 mg bid for 7 days） combined with probiotics （Bifid Lriple Viable 3 caps. tid for 14 days） ; and in group C （n = 106） , only standard triple therapy was given. 14 C-UBT was re-examined 4 weeks after treatment, the clinical symptoms and ulcer healing were also assessed. Adverse reactions were observed during the treatment course. Results： Eradication rates were significantly higher in group A and group B than in group C on both IT＇F analysis （ 82.7% and 78.6% vs. 63.2%, P 〈 0.05） and PP analysis （83.3% and 79.3% vs. 65.0%, P 〈 0.05）, and so did the symptoms relieve rates （82.7% and 84.6% vs. 65.1%, P 〈0.05） ; no statistical differences were seen between group A and group B. Ulcer healing rates were similar in peptic ulcer patients between the three groups （72.7% , 67.6% and 45.5% , P 〉 0.05）. Adverse reaction rate was significantly lower in group B than in groups A and C （4.3% vs. 15.0% and 20.8% , P 〈 0.05 ）. Conclusions： When compared with standard triple therapy, both sequential therapy and triple therapy combined with probiotics provide excellent eradication rate for Hp infection. Triple therapy combined with probiotics is safer than sequential therapy, it might be recommended for clinical use.