10d序贯疗法对根除幽门螺杆菌疗效的随访研究

背景:幽门螺杆菌(H.pylori)与慢性胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织(MALT)淋巴瘤密切相关,但标准三联疗法的根除率逐年下降。目的:比较10 d序贯疗法和三联疗法根除H.pylori的疗效。方法:将经快速尿素酶试验(RUT)和~(14)C-尿素呼气试验(UBT)证实为H.pylori阳性的106例消化性溃疡、慢性糜烂性胃炎和萎缩性胃炎患者随机分为以雷贝拉唑为基础的10 d序贯疗法组(n=56)和三联疗法组(n=50)。治疗结束4周后复查RUT和,~(14)C-UBT,评估H.pylori根除情况;随访1年后再复查~(14)C-UBT评估H.pylori复发情况。结果:共93例患者按方案完成治疗。10 d序贯疗法组H.pylori根除率按意向治疗(ITT)和按方案(PP)分析均显著高于三联疗法组(ITF:89.3%对62.0%,P0.01;PP:94.3%对77.5%,P0.05);10 d序贯疗法组不良反应发生率(7.1%对30.0%,P0.01)和随访1年后的H.pylori复发率(6.0%对25.8%,P0.01)均显著低于三联疗法组。结论:以雷贝拉唑为基础的10 d序贯疗法可明显提高H.pylori根除率,提高患者的依从性,减少不良反应的发生。

Follow-up Study of 10-day Sequential Therapy on Eradication of Helicobacter pylori

Helicobacter pylori （H. pylori） is closely related with chronic gastritis, peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue （MALT） lymphoma. However, the efficacy of standard triple therapy is decreasing in recent years. Aims： To compare the efficacy of H. pylori eradication with 10-day sequential therapy and standard triple therapy. Methods： A total of 106 patients with peptic ulcer, chronic erosive gastritis and atrophic gastritis who were H. pylori positive proved by rapid urease test （RUT） and 14C-urea breath test （14C-UBT） were randomly divided into two groups. Fifty-six patients were administered with rabeprazole-based 10-day sequential therapy and 50 patients received rabeprazole-based 10-day standard triple therapy. RUT and 14C-UBT were reexamined 4 weeks after a course of treatment to evaluate the eradication of H. pylori. The recurrence of H. pylori was assessed by 14C-UBT one-year after eradication treatment of H. pylori. Results： Ninety-three patients completed the study. The H. pylori eradication rates by intention-to-treat （ITT） analysis and by per protocol （PP） analysis in 10-day sequential therapy group were significantly higher than those in 10-day standard triple therapy group （ITT： 89.3% vs. 62.0%, P〈0.01; PP： 94.3% vs. 77.5%, P〈0.05）. The incidence of adverse reactions （7.1% vs. 30.0%, P〈0.01） and recurrence rate of H. pylori after one-year follow-up （6.0% vs.25.8%, P〈0.01） in 10-day sequential therapy group were significantly lower than those in 10-day triple therapy group. Conclusions： In the present study, rabeprazole-based 10-day sequential therapy has achieved a high eradication rate of H. pylori with good patient compliance and less adverse reactions.