两种二线补救方案治疗幽门螺杆菌三联疗法初次根除失败的临床比较研究

目的评价含铋剂的两种补救方案治疗消化性溃疡患者HP初次根除失败的有效性和安全性。方法将一线治疗失败后的170例HP阳性消化性溃疡患者分成A组和B组,每组各85例。A组接受（质子泵抑制剂＋铋剂＋阿莫西林＋甲硝唑）治疗,7天1个疗程,B组接受（枸橼酸雷尼替丁＋利福喷汀＋甲硝唑）治疗,7天1个疗程；观察两组治疗期间不良反应发生情况。治疗结束4周后患者接受胃镜检查,检验HP根除情况。结果 A组中有54例患者根除,根除率为65.06%,B组中有76例患者根除,根除率为91.57%。枸橼酸雷尼替丁＋利福喷汀＋甲硝唑补救治疗的根除率显著高于质子泵抑制剂＋铋剂＋阿莫西林＋甲硝唑补救治疗方案,两组疗效比较有统计学意义（P〈0.05）。结论两种含铋剂的二线治疗均有效,含利福喷汀的补救方案疗效更佳。

Comparative Study on Two Rescue Regimens for Patients Failed in Initial Eradication of Helicobacter Pylori by a First-line Regimen

OBJECTIVE To evaluate the clinical efficacy and safety of bismuth-based regimen as rescue therapies for patients of peptic ulcer who failed by initial eradication therapy of Helicobacter Pylori（HP）. METHODS A total of 170 patients who failed in initial eradication therapy of Helicobacter pylori were divided into two groups（A and B）, and 85 for each group. The patients in group A received proton pump inhibitors ＋bismuth agent, amoxicillin and metronidszole as rescue therapy for 7 days, and the patients in group B received ranitidinebismuthcitrate, rifapentin and metronidazole as rescue therapy for seven days. The status of HP was assessed by gastroscope 4 weeks after therapy. RESULTS 54 cases in group A were eradicated, eradicate rate was 65.06%, 76 cases in group B were eradiated, eradicate rate was 91.57%. CONCLUSION The two rescue regimens containing bismuth agent were effective rescue therapy after a failed initial eradication therapy, but the regimens containing Rifapentin was much better than the quadruple one.