含左氧氟沙星的三种方法根除幽门螺杆菌疗效比较

目的比较含左氧氟沙星的三联疗法、铋剂四联疗法及序贯疗法根治幽门螺杆菌（Hp）的疗效。方法115例Hp阳性患者按时间先后顺序随机分为3组：三联组38例，给予口服兰索拉唑胶囊30mg、阿莫西林克拉维酸钾片685．5mg、左氧氟沙星胶囊200mg，2次／d，治疗7d；四联组38例，予以口服兰索拉唑胶囊30mg、阿莫西林克拉维酸钾片685．5mg、左氧氟沙星胶囊200mg、胶体果胶铋胶囊200mg，2次／d，7d；序贯组39例，前5d口服兰索拉唑胶囊30mg、阿莫西林克拉维酸钾片685．5mg，后5d口服兰索拉唑胶囊30mg、克拉霉素片500mg、左氧氟沙星胶囊200mg，均2次／d。疗程结束后4周复查”C呼气试验检查，评估治疗结果及不良反应。结果三联组完成35例，失访2例，未能按要求服药1例；铋剂四联组完成36例，失访2例；序贯组完成37例，未能按要求服药2例。三联组成功根除29例，按符合方案（PP）分析根除率为82．9％（29／35），意向性治疗（ITT）分析根除率为76．3％（29／38）；铋剂四联组成功根除32例，PP根除率为88．9％（32／36），ITT根除率为84．2％（32／38）；序贯组成功根除34例，PP根除率为91．9％（34／37），ITT根除率为87．2％（34／39）。3组间Hp根除率差异无统计学意义（P〉0．05）。结论含左氧氟沙星的铋剂四联与序贯治疗均有较高的Hp根除率，但从安全性与疗效方面考虑，含左氧氟沙星的铋剂四联疗法可作为Hp初治的首选方案。

Analysis of the effect of triple, colloidal bismuth pectin quadruple and sequential therapies with levofloxacin on Helicobacter pylori infection

Objective To compare the effect of triple, colloidal bismuth pectin quadruple and sequential therapies with levofloxacin on Helicobacter pylori （Hp） infection. Methods All 115 Hp positive patients were ran- domly allocated to three groups. The patients in triple therapy group received a 7-day triple therapy （ lansoprazole capsules 30 mg bid, amoxicillin and clavulanate potassium tablets 685.5 mg bid, levofloxacin capsule 200 mg bid）. Quadruple therapy group received a 7-day colloidal bismuth pectin quadruple therapy （ lansoprazole capsules 30 mg bid, colloidal bismuth pectin 200 mg bid, amoxicillin and clavulanate potassium tablets 685.5 mg bid, levofloxacin capsule 200 mg bid）. Sequential therapy group received a 10-day sequential therapy （lansoprazole capsules 30 mg bid, amoxicillin and clavulanate potassium tablets 685.5 mg bid for the first 5 days; lansoprazole capsules 30 mg bid, clarithromycin 500 mg bid and colloidal bismuth pectin 200 mg bid for the remaining 5 days）. We assessed the effect of the eradication of Hp by 14C-urea breath test after finishing of Hp therapy at least four weeks later, and ad- verse reactions were analysed. Results According to intention-to-treat（ITr）, the eradication rates in triple therapy group, quadruple group, sequential therapy group were 76.3% （29/38）, 84.2% （32/38） and 87.2% （34/39） ; according to per-protocol（ PP）, the eradication rates in triple therapy group, quadruple group, sequential therapy group were 82.9% （29/35）, 88.9% （32/36）, 91.9% （34/37）. There were no significant differences among three groups （ P 〉 0.05 ）. Conclusion Quadruple group and sequential therapy group of levofloxacin both have higher Hp eradication rates, but taking the security and the curative effect into consideration, colloidal bismuth pectin quadrup- le therapy with levofloxacin can be used as the first choice of the eradication of Hp for the first treatment.