铝碳酸镁咀嚼片联合奥美拉唑治疗活动性胃溃疡组织学愈合质量的评价

背景：随着质子泵抑制剂的广泛应用，以及根除幽门螺杆菌（H．pylori）感染作为治疗消化性溃疡的主要手段，极大地提高了消化性溃疡的临床愈合率，但复发的难题仍待解决。溃疡愈合质量，尤其是组织学愈合质量受到许多学者关注。目的：观察活动性胃溃疡患者应用铝碳酸镁咀嚼片联合奥美拉唑与单用奥美拉唑治疗前后胃黏膜组织学变化。比较两组患者组织学溃疡愈合质量。方法：88例经胃镜检查证实伴有H．pylori感染的活动性胃溃疡患者随机分成治疗组和对照组。治疗第1周，两组患者均予H．pylori根除三联疗法，治疗组同时加服铝碳酸镁咀嚼片；第2～6周，治疗组给予铝碳酸镁咀嚼片联合奥美拉唑胶囊，对照组仅用奥美拉唑胶囊治疗；第7～8周，治疗组继续给予铝碳酸镁咀嚼片，对照组则停药。8周疗程结束后，两组患者复查胃镜。内镜下取胃溃疡周围黏膜（相当于原取材点处）组织2～4块，重新观察两组患者治疗后的胃黏膜组织学变化，着重从炎性细胞浸润程度和黏膜形态结构两个方面观察胃黏膜组织学恢复情况。结果：治疗组胃黏膜腺体密度和腺管形态改善程度较对照组好，且有统计学差异（P值分别为0．0351和0．0176）。结论：治疗活动期胃溃疡患者在根除H．pylori感染＋抗溃疡治疗后的第8周时点上．同时加用兼有抗酸和吸附胆汁作用的胃黏膜保护剂——铝碳酸镁咀嚼片，能更好地恢复胃黏膜形态结构，增强溃疡愈合的组织学质量．并有可能降低溃疡的远期复发率。

Quality of Ulcer Healing in Patients with Active Gastric Ulcer Treated with Combined Hydrotalcite and Omeprazole

Background: Peptic ulcers healing can be accelerated by the use of proton-pump inhibitors and eradication ofinfection, however, sometimes its relapse remains a problem. The quality of ulcer histologic healing plays an important role in ulcer recurrence. Aims: To evaluate the quality of gastric ulcer histologic healing under Omeprazole treatment alone or in combination with hydrotalcite. Methods: Gastric biopsy specimens were obtained from 88 patients with active gastric ulcer and positiveinfection. All patients were randomized into study group and control group. At the 1st week, all patients were giveneradication regimen, and the study group was given additional hydrotalcite . From the 2nd to 6th week, the study group received Omeprazole and hydrotalcite, and the controlled group received Omeprazole only. From the 7 th to 8th week, the study group was given hydrotalcite, and the controlled group without any drug. After the eight-week treatment, two to four biopsy specimens were obtained from the same area near the ulcer as before. The histological changes of gastric mucosa were re-evaluated in both groups after treatment. The gastric mucosal recovery was noted, in paticular, the degree of inflammatory cell infiltration and morphological structure of mucosa. Results: Better mucosal recovery on the density and morphology of glandular structures were observed in the study group (P=0.0351 and P=0.0176, respectively) at the end of eight weeks. Conclusions: The combined therapy of hydrotalcite and Omeprazole can improve the histologic quality of ulcer healing, in particular the restoration of gastric mucosa in patients with active gastric ulcer.