3种根除幽门螺杆菌方案的疗效比较

目的：评价三联疗法、四联疗法和序贯疗法根除幽门螺杆菌（Hp）的疗效。方法：将经胃镜检查确诊为慢性胃炎和消化性溃疡且Hp阳性的240例患者以随机抽样法分为3组,三联疗法组（雷贝拉唑＋阿莫西林＋克拉霉素）、四联疗法组（雷贝拉唑＋阿莫西林＋克拉霉素＋胶体果胶铋）和序贯疗法组（前5 d使用雷贝拉唑＋阿莫西林,后5 d使用雷贝拉唑＋克拉霉素＋甲硝唑）,治疗结束停药4周后行14C-尿素呼气试验复查,比较3组Hp根除率。结果：（1）三联疗法组、四联疗法组和序贯疗法组按意向治疗（ITT）分析其Hp根除率分别为73.75%、92.5%和81.25%,3组按方案治疗（PP）分析其Hp根除率分别为77.63%、93.67%和83.33%,2种分析方法比较,四联疗法组Hp根除率优于三联疗法组和序贯疗法组,差异有统计学意义（P〈0.05）;三联疗法组与序贯疗法组Hp根除率差异无统计学意义（P〉0.05）。（2）三联疗法组、四联疗法组和序贯疗法组成本-效果比按ITT分析分别为1.75、1.57和1.79,按PP分析分别为1.67、1.55和1.65。结论：根除Hp四联疗法是一种高效、安全、经济的治疗方案。

Eradication Efficacy of Three Therapeutic Regimens for Helicobacter Pylori

OBJECTIVE：To evaluate the eradication efficacy of triple therapy, quadruple therapy and sequential therapy for helicobacter pylori （Hp）. METHODS： 240 patients with Hp infection who had diagnosed by gastroscopy as having chronic gastritis and peptic ulcer were randomly assigned to the triple therapy group （rabeprazole ＋ amoxicillin ＋ clarithromycin）, quadruple therapy group （rabeprazole ＋ amoxicillin ＋ clarithromycin ＋ colloidal bismuth pectin） or sequential therapy group （rabepazole ＋ amoxicillin for the first 5 days, followed by rabepazole ＋ clarithromycin ＋ metronidazole for second 5 days）. After drug withdrawal of 4 weeks, 14 C-urea breath test was performed to compare the Hp eradication rate among the 3 groups. RESULTS：（ 1 ）Intention-to-treat （ITT） analysis revealed eradication rates of 73.75% , 92.5% and 81.25% , respectively in triple therapy group, quadruple therapy group and sequential therapy; per-protocol （PP） analysis revealed Hp eradication rates of 77.63%, 93.67% and 83.33%, respectively; comparedby the ITT analysis and PP analysis, quadruple therapy was better than both triple therapy and sequential therapy in terms of Hp eradication rate and the differences were significant （ P 〈 0. 05 ）, yet no significant difference was noted between triple therapy and sequential therapy. （2） ITF analysis revealed cost-effectiveness ratios ofl. 75, 1.57 and 1.79, respectively in triple therapy, quadruple therapy and sequential therapy groups; PP analysis revealed cost- effectiveness ratios of 1.67, 1.55 and 1.65, respectively. CONCLUSION ： The quadruple therapy was proved to be an effective, safe and economical regimen for Hp eradication.