洛赛克、克拉霉素、替硝唑三联疗法治愈的十二指肠球部溃疡组织成熟度以及球部粘膜IL—10、IL—12水平的研究

目的 :探讨洛赛克、克拉霉素、替硝唑三联疗法治愈的十二指肠球部溃疡 (DU)“再生”粘膜组织成熟度和IL- 10、IL- 12的水平。方法 :将 64例幽门螺杆菌 (HP)阳性 DU患者随机分成 2组 :A组 3 6例 ,应用洛赛克 2 0 mg+克拉霉素 5 0 0 mg+替硝唑 5 0 0 mg,bid,共 1周 ;B组 2 8例 ,采取雷尼替丁 15 0 mg bid+阿莫西林 5 0 0 mg、甲硝唑 4 0 0 mg,tid,共 4周。停药 4～ 6周后复查胃镜 ,从 DU边缘或溃疡疤痕处活检粘膜组织以备组织学检查及 IL- 10、IL- 12的测定。用快速尿素酶试验和美蓝染色来检查 HP。结果 :A组溃疡愈合率 90 .91% ,显著高于 B组的 69.2 3 % (P<0 .0 5 ) ;A组 HP根除率也明显高于 B组 (93 .90 % vs69.2 3 % ,P<0 ,0 5 )。从再生粘膜组织成熟度来看 ,A组 73 .3 3 %为“良”,而 B组为“良”者仅 3 3 .3 3 % ,P<0 .0 1。A、B组治疗前球部粘膜 IL- 10水平均高于对照组 ,IL- 12水平也都高于对照组 ;治疗后 A组 IL-10的水平显著高于 B组和对照组 ,IL- 12水平恢复到正常水平 ;B组 IL- 10、IL- 12的水平基本上也恢复到正常水平。结论 :洛赛克、克拉霉素、替硝唑三联疗法治愈的组织成熟度优于含雷尼替丁方案。其可能抑制 IL- 12分泌 ,而促进 IL- 10的分泌 ,使 IL- 10在溃疡愈合后的一段时间内维持在较

Triple Therapy with Losec, Clarithromycin and Tinidazole for the Histological Maturityof

Purpose: To investigate the histological maturity of “regenerated” mucosa in duodenal ulcer(DU) and level of IL-10, IL-12 after triple therapy with losec, clarithromycin and tinidazole. Methods: 64patients with helicobacter pylori (HP)-positive DU were randomly divided into 2 groups: A group ( n = 36)with losec 200 mg bid+ clarithromycin 500 mg tid+ tinidazole 500 mg bid for one week (LCT); B group(n = 28) with ranitidine 150 mg bid + amoxicilline 500 mg tid + metronidazole 400 mg tid for 4 weeks(RAM). Endoscopy was repeated 4～6 weeks after the end of treatment, biopsy specimens were got fromthe edge of DU or in the scars of DU for observing the histological maturity and measuring the levels of IL10, IL-12. HP status was determined by rapid urease test and methyl blue stain. Results: 4～6 weeks afterthe end of treatment, healing rate of A group was much higher than that in B group(90.91% vs 69.23%,P <0.05); HP eradication rate in A group was also higher than that of B group(93.90% vs 69.23%, P<0.05). For histological maturity, 73.33% patients in A group were ”good”, but 33.33% patients in Bgroup, P < 0.01. Prior of the treatment, te levels of IL-10 in A、B group were much higher than control,so did IL-12; the levels of IL-10 in ”healed” mucosa of A group were significantly higher than B and controlgroup, the levels of IL-12 returned the normal level; the levels of IL-10、 IL-12 of B group also nearly returned the normal value. Conclusion: After triple therapy with losec, clarithromycin and tinidazole, thehistological maturity of ”regenerated” mucosa with LCT should be preferred to with RAM. LCT may decrease the secretion of IL-12 and increase IL-10, and IL-10 remained a higher level for a peroid of time tobuild the favorable environment for mucosal reconstitution.