序贯疗法与三联疗法治疗幽门螺杆菌性消化性溃疡的疗效观察

目的探讨泮托拉唑、阿莫西林、克拉霉素、替硝唑组成的序贯疗法与7 d、14 d三联疗法治疗幽门螺杆菌性消化性溃疡的临床疗效及安全性。方法选择144例由胃镜及14C尿素呼气试验证实为幽门螺杆菌性消化性溃疡的患者,随机分为序贯组48例：1~5 d服用泮托拉唑＋阿莫西林,6~10 d口服泮托拉唑＋替硝唑＋克拉霉素治疗;7 d三联组47例：服用泮托拉唑＋阿莫西林＋克拉霉素,疗程7 d;14 d三联组49例：用药方法同服用7 d三联组,但疗程为14 d。比较三组患者治疗后1个月的Hp根除情况及用药后不良反应。结果治疗1个月后,序贯组患者与14 d三联组Hp根除率分别为93.6%与90.9%,明显较7 d三联组的73.9%高,差异有统计学意义（P〈0.05）,而序贯组患者与14 d三联组Hp根除率差异无统计学意义（P〉0.05）。序贯组治疗后不良反应发生率6例（12.8%）,7 d三联组发生6例（13.0%）,14 d三联组发生9例（20.5%）,三组差异无统计学意义（P〈0.05）。结论 10 d序贯疗法治疗治疗幽门螺杆菌性消化性溃疡具有安全、经济、高效、患者依从性好的优点,有利于广泛应用于基层医院。

Cfinical efficacy of sequential therapy and triple therapy in the treatment of Helicobacter pylori peptic ulcer.

Objective To investigate the clinical efficacy and safety of sequential therapy （composed of pan- toprazole, amoxicillin, clarithromycin, tinidazole） and 7 d, 14 d triple therapy in the treatment of Helicobacter pylori （Hp） peptic ulcer. Methods One hundred and forty-four patients confirmed as Helicobacter Fylori peptic ulcer by gas-troscopy and 14C urea breath test were randomly divided into the sequential therapy group （n--48）, 7 d triple therapy group （n=47）, 14 d triple therapy group （n=49）. Patients in the sequential therapy group received pantoprazole＋amoxi- cillin for 1-5 d, oral pantoprazole＋tinidazole＋clarithromycin therapy for 6--10 d. Patients in 7 d triple therapy group received pantoprazole＋amoxicillin＋clarithromycin for 7 d, while those in 14 d triple therapy group were treated by pantoprazole＋amoxicillin＋clarithromycin for 14 d. The Hp eradication and adverse reactions one month after treat- ment were compared between the three groups. Results After 1 month of treatment, the Hp eradication rates of the sequential therapy group （93.6%） and 14 d triple therapy group （90.9%） were significantly higher than that in the 7 d triple therapy group （73.9%）, P〈O.05, There was no significant difference in the Hp eradication rate between the se- quential therapy group and the 14 d triple therapy group （P〉0.05）. Adverse reactions were found in 6 patients （12.7%） in the sequential therapy group after treatment, 6 patients （13%） in the 7 d triple therapy group, and 9 patients （20.4%） in the 14 d triple therapy group. The incidence of adverse reactions was significantly higher in the 14 d triple therapy group than the other two groups （P〈0.05）. Condusion In the treatment ofHelicobacter pylori peptic ulcer, 10 d se- quential therapy is safe, economical, high efficient, with good patient compliance, which is worthy of wide application in basic hospitals.