序贯与标准三联疗法治疗幽门螺杆菌阳性消化性溃疡的临床观察

目的比较序贯与标准三联疗法根除幽门螺杆菌(Hp)以及治疗Hp阳性消化性溃疡的临床疗效,探讨影响根除Hp的因素。方法将经胃镜确诊为消化性溃疡(A期)且Hp阳性的患者90例按随机数字表达分为3组,序贯疗法A组(30例):前5d埃索美拉唑20mg,2次/d+阿莫西林1.0,2次/d,后5d埃索美拉唑镁肠溶片20mg,2次/d+克拉霉素0.5g,2次/d+替硝唑0.5g,2次/d;序贯疗法B组(30例):前5d埃索美拉唑镁肠溶片40mg,2次/d+阿莫西林1.0g,2次/d,后5d埃索美拉唑镁肠溶片40mg,2次/d+克拉霉素0.5g,2次/d+替硝唑0.5g,2次/d;标准三联疗法C组(30例):埃索美拉唑镁肠溶片20mg,2次/d+阿莫西林1.0g,2次/d+克拉霉素0.5g,2次/d,疗程10d。用药结束后至少4周复查14C-尿素呼气试验(14C-UBT),观察3组Hp根除率,同时通过问卷调查和电话随访记录患者症状缓解情况、药物不良反应,并对各组进行成本-效果分析,用Logistic回归分析方法筛选出影响HP根除结果的相关因素。结果①A、B、C3组Hp根除率分别为83%、87%和60%,C组与A、B2组间差异均有统计学意义(P<0.05)。②3组临床症状评分于治疗后均呈明显缓解趋势,差异无统计学意义;3组不良反应发生率差异无统计学意义(P>0.05)。③成本-效果分析显示A组、B组成本效果比值(C/E)均低于C组。④影响Hp根除率的相关因素分析:与年龄、既往溃疡病史、治疗分组、溃疡的部位以及胃黏膜组织快速尿素酶试验(RUT)结果有关。结论①序贯疗法治疗Hp阳性的消化性溃疡具有较高的Hp根除率。A组成本效果比更高。②年龄愈长者、既往无溃疡病史及治疗前RUT为弱阳性的十二指肠溃疡患者Hp根除率高。

Effects of sequential regimen and standard triple therapy in peptic ulcer with Helicobacter pylori infection

Objective To compare the effects of sequential regimen and standard triple therapy for eradication of Helicobacter pylori （Hp） and to investigate the factors linked to the eradication of Hp. Methods Ninety consecutive patients with HP infection and gastroscopy-diagnosed stage A peptic ulcer were randomly assigned to three groups. Patients in group A （n=30） were treated with sequential regimen, namely, esomeprazole 20 mg plus amoxicillin 1.0 g for the first 5 days followed by esomeprazole 20 rag, clarithromycin 500 mg and tinidazole 500 mg for days 5-10. Patients in group B （n=30） received sequential regimen, namely, esomeprazole 40 mg plus amoxicillin 1.0 g for the first 5 days and followed by esomeprazole 40 nag, clarithromycin 500 mg and tinidazole 500 mg for days 5-10. Patients in group C （n=30） received standard triple regimen that was comprised of esomeprazole 20 rag, clarithromycin 500 mg and amoxicillin 1 g for 10 days. Reassessment of ^14C-urea breath test （^14C-UBT） was undertaken for comparison on the eradication of Hp at week 4 following accomplishment of the treatment. Amelioration of clinical symptoms and side- effects were determined by inquisition, questionnaire survey and telephone follow-up visits. This entailed subsequent analysis on the cost-effectiveness and factors affecting the rate of Hp eradication by Logistic regression analysis. Re- suits The rates of Hp eradication was 83%, 87% and 60% in groups A, B and C, respectively. Group C yielded a significantly higher rate of Hp eradication than groups A and B （both P〈0.05）. Compared with group C, groups A and B showed a reduced cost-effectiveness ratio. Multiple regression analysis demonstrated that the Hp eradication rate correlated to age, the past history of peptic ulcer, treatment allocation, the site of ulcers and gastric mucosa RUT re- suits. The lack of history of peptic ulcer, duodenal ulcer, treatment with sequential regimen, insignificant positivity of RUT prior to the treatment and of advanced age were associated with an increased eradication rate. Conclusion Se- quential regimen may result in a higher rate of Hp eradication. Group A was associated with the highest cost-effective- ness ratio. Of advanced age, an absence of previous peptic ulcer and insignificant positivity of RUT prior to the treat- ment are indicators of higher eradication rate of HP.