两种方案治疗十二指肠溃疡幽门螺杆菌感染的临床分析

目的分析小剂量奥关拉唑、左氧氟沙星及呋喃唑酮新三联与小剂量奥关拉唑、阿莫西林及甲硝唑标准三联疗法治疗十二指肠溃疡幽门螺杆菌(Helicobacter pylori，Hp)感染的临床疗效对比。方法98例符合条件的患者随机分成两组，其中47例为新三联疗法，即口服小剂量奥美拉唑20mg，1次／d，连服6周，左氧氟沙星200mg及呋喃唑酮200mg，均为2次／d，连服2周。另一组51例为标准三联疗法，即口服小剂量奥关拉唑20mg，1次／d，连服6周，阿莫西林1000mg及甲硝唑400mg，均为2次／d，连服2周，疗程结束后1个月复查胃镜。结果96例患者完成治疗及随访，小剂量奥美拉唑新三联组与小剂量奥关拉唑标准三联组疗法Hp根除率分别为84．8％、82．0％，差异无统计学意义(P=0．715)；溃疡愈合率分别为95．7％、92．0％，差异无统计学意义(P=0．752)。两组患者不良反应发生率分别为12．8％、15．7％，差异无统计学意义(P=0．680)。HP根除组溃疡愈合率(100．0％)明显高于HP未根除组(62．5％)，差异有统计学意义(P=0．001)。结论小剂量奥关拉唑新三联组与标准三联组疗法均有较理想的Hp根除率及溃疡愈合率，新三联组疗法不良反应发生率与标准三联组疗法相当；同时发现Hp根除有利于溃疡愈合。因此，在当今面临Hp对常规抗生素耐药率上升的情况下，推荐新三联疗法在阿莫西林及甲硝唑耐药地区可作为根除十二指肠溃疡HP感染的一线治疗或失败后的补救治疗方案。

Clinical analysis on two therapies eradicating Helicobacter pylori infection in patients with duodenal ulcer

Objective To investigate the effects of the two met hods to treat Helicobacter pylori(Hp)infection in patients with duodenal ulcer(DU):a new triple therapy with 6-week low-dose omeprazole(Ome) and 2-week of levofloxacin plus furazolidone (OVF)compared with a standard triple therapy with 6-week low-dose Ome and 2-week of amoxicillin plus metronidazole(OAM) for ulcer healing , Hp eradication in DU and side effects of drugs. Methods Ninety-eight DU patients,confirmed by endoscopy with Hp infection(confirmed by 14C-UBT and pathology),were divided randomly into two groups,OVF group and OAM (triple therapy )group. Results Ninety-six patients received one of the therapies and were followed up. The ulcer healing rates were 95.7% and 92.0% respectively in OV and OAM groups(P= 0.752).The eradication rates of Hp were 84.8% and 82.0%(P= 0.715) respectively. There were no difference in the side effects of OV group( 12.8%) and OAM group( 15.7%)(P= 0.680). The ulcer healing rates were 100.0% and 62.5% respectively for Hp eradication and failure of Hp eradication group (P= 0.001). Conclusion Considering the effectiveness, the OVF therapy has efficacy as the OAM therapy, especially the rates of ulcer healing are higher in patients with Hp infection eradication. Nowadays the rate of routine antibiotics (metronidazole and amoxicillin) resistance is rising, the new triple therapy will be the first treatment selected for Hp-infected patients after failure of standard triple therapies.