序贯与三联疗法根除幽门螺杆菌的临床应用比较

 目的 比较由雷贝拉唑联合阿莫西林、克拉霉素以及替硝唑组成的10 d序贯疗法与三联疗法根除幽门螺杆菌的疗效、依从性、安全性及经济学比较。方法 将幽门螺杆菌阳性的90例消化性溃疡患者随机分为以雷贝拉唑为基础的10 d序贯疗法组(n=45)和三联疗法组(n=45),治疗结束4周后复查¹⁴C-UBT,评估幽门螺杆菌根除情况,并对各方案进行成本-效果分析。结果 共85例患者按方案完成治疗。10 d序贯疗法组幽门螺杆菌根除率按意向治疗(ITT)和按方案(PP)分析均高于三联疗法组(ITT：91.1%对73.3％,P<0.05;PP：95.3％对78.6％,P<0.05);10 d序贯疗法组不良反应发生率(PP：14.0％对11.9％,P<0.05)与三联疗法组相似;成本-效果分析显示,序贯治疗组的成本-效果比值（C/E）低于对照组。结论 以雷贝拉唑为基础的10 d序贯疗法具有疗效高、可提高幽门螺杆菌根除率等优势。

Comparison of Sequential Therapy Versus Standard Triple-drug Therapy for Helicobacter pylori Eradication

Objective To compare the efficacy,compliance,safety and economics of standard triple therapy and 10-day sequential therapy consisting of rabeprazole,clarithromycin,amoxicillin and tinidazole for Helicobacter pylori eradication. METHODS A total of 90 pepticulcer patients who were Helicobacter pylori positive proved by ¹⁴C-urea breath test(¹⁴C-UBT) were randomly divided into two groups. Forty-five patients received rabeprazole-based 10-day sequential therapy and the other forty-five patients received rabeprazole-based 7-day standard triple therapy. ¹⁴C-UBT was carried out 4 weeks after a course of treatment to evaluate the eradication of Helicobacter pylori. The two regimens were evaluated by cost-effectiveness analysis. RESULTS Eighty-five patients completed the study. The Helicobacter pylori eradication rates by intention-to-treat(ITT) analysis and by per-protocol(PP) analysis in 10-day sequential therapy group were higher than those in 7-day standard triple therapy group(ITT: 91.1% vs. 73.3%,P<0.05; PP: 95.3% vs. 78.6%,P<0.05). The incidences of adverse reactions(PP: 14.0% vs. 11.9%,P<0.05) were similar in the two groups. The cost-effectiveness analysis showed that the C/E value of the 10-day sequential therapy were lower. CONCLUSION Rabeprazole-based 10-day sequential therapy is more effective for eradication of Helicobacter pylori.