多西环素配伍阿莫西林四联方案根除幽门螺旋杆菌的疗效观察

目的 观察不同药物四联方案根除幽门螺旋杆菌（Helicobacter pylori，Hp）的疗效。方法 选取初次和补救治疗的Hp感染患者各180例，单盲随机分成4组，分别为初治试验组（阿莫西林胶囊+多西环素胶囊）、初治对照组（阿莫西林胶囊+克拉霉素片）、补救治疗试验组（阿莫西林胶囊+多西环素胶囊）、补救治疗对照组（阿莫西林胶囊+左氧氟沙星片），各组均联合埃索美拉唑肠溶片、胶体果胶铋胶囊，每天2次，疗程14 d。疗程结束4周后复查¹³C呼气试验，观察Hp根除率、不良反应、成本-效果比（cost-effectiveness ratio，C/E），并做6，12个月随访，观察Hp复发率。结果 在Hp初治组中，试验组和对照组Hp根除率和复发率比较无统计学意义，但试验组C/E较低。在Hp补救治疗组中，试验组Hp根除率较高，疗效较好，与补救治疗对照组相比，差异有统计学意义（P<0.05），C/E较低，复发率较低，差异无统计学意义。各组不良反应比较，初治试验组、补救治疗试验组、补救治疗对照组的不良反应发生率较低，与初治对照组相比差异有统计学意义（P<0.01）。结论 多西环素配伍阿莫西林四联方案根除Hp近远期疗效较好，成本较低。

Efficacy of Quadruple Regimen Combination of Doxycycline and Amoxicillin for Helicobacter Pylori Eradication

OBJECTIVE To observe the curative effect of Helicobacter pylori(Hp) eradication with different drug quadruple regimen. METHODS Patients with Hp infection for initial and remedial treatment(180 cases respectively) were randomly divided into four groups, initial treatment group(treated with amoxicillin capsule+doxycycline capsule), initial treatment control group(treated with amoxicillin capsule+clarithromycin tablet), remedial treatment test group(treated with amoxicillin capsule+doxycycline capsule), remedial treatment control group(treated with amoxicillin capsule+levofloxacin tablet), each group were combined with esomeprazole enteric coated tablets, colloidal bismuth pectin capsule, twice a day, treat for 14 d. After 4 weeks of treatment, ¹³C breath test was reexamined, Hp eradication rate, adverse reactions, cost-effectiveness ratio(C/E) were observed, and Hp recurrence rate was observed after 6 or 12 months of follow-up. RESULTS In the Hp initial treatment group, there was no significant difference in the eradication rate and recurrence rate between initial treatment test group and control group, but the C/E of initial treatment test group was lower. In the Hp remedial treatment group, the Hp eradication rate of remedial treatment test group was higher than that of remedial treatment control group, and the curative effect was better, the difference was statistically significant(P<0.05), the C/E was lower, and the recurrence rate was lower, the difference was not statistically significant. In comparison of adverse reactions in each group, the incidence of adverse reactions in initial treatment test group, remedial treatment test group and remedial treatment control group was lower than initial treatment control group, the difference was statistically significant(P<0.01). CONCLUSION The quadruple regimen combination of doxycycline and amoxicillin has a better short-term and long-term effect and lower cost in eradicating Hp.