四联疗法联合中医药对幽门螺杆菌的补救治疗

目的 对进行过根除幽门螺杆菌(H.pylori)治疗而失败的患者,应用含铋剂、质子泵抑制剂的四联疗法和中医药联合补救治疗并观察根除疗效.方法 120例H.pylori阳性患者随机分成两组,每组60例；对照组应用埃索美拉唑镁肠溶片20 mg,枸橼酸铋钾胶囊(商品名丽珠得乐)0.6g(相当于铋0.22 g),阿莫西林(珠海联邦制药股份有限公司)1000 mg,呋喃唑酮(商品名痢特灵,上海利生制药厂生产)100 mg,2次/d,共7d;而治疗组除应用对照组药物外,同时服用中药14 d,观察上腹痛、反酸、饱胀感、嗳气等症状缓解情况,并在补救治疗结束1个月后复查胃黏膜快速尿素酶试验和组织学染色或查14C-尿素呼气试验,观察其根除率.结果治疗组58例完成治疗,其中53例H.pylori转阴,根除率按意图治疗(ITT)和试验方案(PP)分析分别为88.33％ (53/60)和91.38％(53/58),对照组55例完成治疗,其中48例转阴,根除率按意图治疗(ITT)和试验方案(PP)分析分别为80.00％(48/60)和87.27％(48/55),两组间比较有显著性差异(P＜0.05).治疗后两组症状缓解率分别为94.83％(治疗组)和83.64％(对照组),两组间比较有显著性差异(P＜0.05).结论 对H.pylori根除治疗失败的患者,应用四联疗法和中医药联合补救疗法不仅能获得较高的H.pylori根除率,对临床症状的改善也有良好作用,且副反应较小,值得临床推广.

Quadruple regimen combined with traditional Chinese medicine on the remedial treatment of Helicobacter pylori

Objective To compare the efficacy and tolerability of rescue therapy for eradicating Helicobacter pylori(H.pylori) with quadruple regimen and traditional Chinese medicine and western medicine combination therapy after treatment failure of triple regimen.Methods 120 patients with H.pylori infection were divided randomly into control group and experimental group.Patients in control group received Bismuth Potassium Citrate Capsules 0.6 g,Esomeprazole Magnesium Enteric-coated Tablets 20 mg,Amocillim 1 000 mg,Furazolidone 100 mg bid for 7 days and experimental group received the same medicine add traditional Chinese medicine for 14 days.The efficacy of the clinical symptoms was observed,at least 4 weeks after completion of the therapy,the 14C-urea breath test(UBT) was performed to evaluate the success of H.pylori eradication.Results 58 patients in experimental group and 55 patients in control group finished the treatment.By intention-to-treat(TTI) analysis and per-protocol(PP)analysis,the H.pylori eradication rates of experimental group were 88.33%(53/60)and 91.38%(53/58),and those of the control group were 80.00%(48/60)and 87.27%(48/55),there was significant difference between two groups(P<0.05).The effective rates of symptoms in experimental group and control group were 94.83%(55/58) and 83.64%(46/55)(P<0.05).Conclusion Quadruple regimen combined with traditional Chinese medicine as rescue therapy has a high H.pylori eradicating rate for treatment failure of triple regimen.