根除幽门螺杆菌对出血性十二指肠溃疡自然病程影响的3年随访研究

目的：探讨根除幽门螺杆菌（Ｈｐ）对出血性十二指肠溃疡自然病程的影响。方法：选择胃镜证实的出血性十二指肠溃疡病人１３６例，均有Ｈｐ感染（胃粘膜Ｇｉｅｍｓａ染色和１４Ｃ尿素呼吸试验二项均阳性）。予奥米拉唑２０ｍｇ，每日２次；羟氨苄青霉素７５０ｍｇ，每日２次；甲硝唑４００ｍｇ，每日３次，疗程２周。疗程结束后４周复查胃镜和Ｈｐ，溃疡愈合者分Ａ组（Ｈｐ根除）和Ｂ组（Ｈｐ未根除）进入随访阶段，随访观察３年。结果：溃疡愈合１２４例（９１２％），Ｈｐ根除１１１例（８１６％）；Ｈｐ根除的溃疡愈合率为９９１％（１１０／１１１），显著高于Ｈｐ未根除的５６％（１４／２５，Ｐ＜０００５）；Ｂ组１年内溃疡复发率达１００％，显著高于Ａ组８３％（Ｐ＜００５）；Ｂ组３年累积再出血率１００％，显著高于同期Ａ组的９０％（Ｐ＜００５）。结论：根除Ｈｐ可提高十二指肠溃疡愈合率和减少溃疡复发率，尤可显著减少溃疡再出血率，提示根除Ｈｐ很可能改变出血性十二指肠溃疡的自然病程。

Effect of eradication of Helicobacter pylori on the natural history of bleeding duodenal ulcer over a 3 year follow up period

Aims To investigate whether the eradication of Helicobacter pylori has any impact on the history of bleeding duodenal ulcer.Methods:One hundred and thirty six patients,with endoscopically proven bleeding duodenal ulcer,with a positive 14 C-urea breath test and confirmed presence of Helicobacter pylori by Giemsa staining in gastric biopsy specimens,were enrolled into the study.Anti-H.pylori therapy was administered with omeprazole 20mg b.i.d.plus amoxycillin 750mg b.i.d.plus metronidazole 400mg b.i.d.for 2 weeks.Endoscopy was porformed 4 weeks after antimicrobial therapy ended,and the presence or absence of H.pylori was determined with the tests initially used.Then,all patients with healed ulcers divided into group A(H.pylori eradicated) and group B (H.pylori not eradicated) were followed for 3 years.Results:Of 136 patients,ulcer was healed in 124 (91.2%) and H.pylori eradicated in 111( 81.6 %).Ulcer healing rates were significantly higher in group A(99.1%) than in group B(56%,P< 0.005 ).The ulcer recurrence rates during 1 year follow up were significantly higher in group B(100%) than in group A(8.3%,P<0.05).The three year cumulated ulcer rebleeding rates were 100% in group B,as compared with 9 0% in group A(P<0.05).Conclusion:Eradication of H.pylori can increase the healing rate and reduce the recurrence rate of DU,and reduce significantly the ulcer rebleeding rate especially.Our findings suggests that eradication of H.pylori could change the history of bleeding duodenal ulcer.