三联疗法结合服药后体位改变根除残胃幽门螺杆菌的疗效研究

背景:常规幽门螺杆菌(Hp)根除方案对残胃Hp的根除疗效存在争议。目的:评价三联疗法结合服药后体位改变根除残胃Hp的有效性和安全性。方法:纳入残胃Hp感染患者54例、非残胃Hp感染患者30例。残胃患者随机分为残胃A组和B组,非残胃患者作为对照组。残胃A组给予埃索美拉唑20 mg bid+阿莫西林1.0 g bid+呋喃唑酮100 mg bid(EAF方案),疗程10 d;残胃B组给予EAF方案结合服药后保持水平左侧卧位30 min,疗程10 d;对照组给予EAF方案,疗程10 d。治疗结束后3个月行快速尿素酶试验和胃黏膜组织切片染色镜检评估Hp根除疗效。治疗前和治疗结束后3个月行胃镜检查,采用新悉尼系统直观模拟评分法行组织病理学分级。结果:残胃A组按意向治疗(ITT)分析和按方案(PP)分析的Hp根除率显著低于对照组(P<0.05);残胃B组ITT和PP根除率较残胃A组有所升高,但差异无统计学意义(P>0.05);残胃B组ITT和PP根除率与对照组相比差异无统计学意义(P>0.05)。手术术式(BillrothⅠ或BillrothⅡ)对Hp根除率无明显影响(P>0.05)。治疗后三组患者炎症、活动性评分显著下降(P<0.01),萎缩、肠化生评分无明显变化(P>0.05)。三组患者治疗期间不良反应发生率差异无统计学意义(P>0.05),未见严重不良反应发生。结论:EAF方案三联疗法结合服药后体位改变(保持水平左侧卧位30 min)是根除残胃Hp有效、安全的治疗方案。

Therapeutic Effect of Triple Therapy Combined with Posture Change after Taking Medicine for Helicobacter pylori Eradication in Remnant Stomach

The effect of conventional therapy for Helicobacter pylori （Hp） eradication in remnant stomach is controversial. Aims： To evaluate the efficacy and safety of triple therapy combined with posture change after taking medicine for Hp eradication in remnant stomach. Methods： A total of 54 Hp infected patients with remnant stomach and 30 Hp infected patients with intact stomach were enrolled. Patients with remnant stomach were randomly assigned into remnant stomach A and B groups, and patients with intact stomach were served as control group. Patients in remnant stomach A group were given esomeprazole 20 mg bid ＋ amoxicillin 1000 mg bid ＋ furazolidone 100 mg bid （ EAF regimen） for 10 days. Patients in remnant stomach B group were given the EAF regimen for 10 days and kept at lying on the left side for 30 min after taking the drugs. Patients in control group were given the EAF regimen for 10 days. Three months after treatment, rapid urease test and microscopic examination of stained gastric mucosal tissue section were performed to assess Hp eradication. Gastroscopy was applied before and 3 months after treatment, the updated Sydney System visual analogue scales were used for grading the histopathologic features. Results： Hp eradication rate in remnant stomach A group was significantly lower than that in control group by intention-to-treat （ITT） and per protocol （PP） analysis （ P 〈 0.05 ）. Eradication rate in remnant stomach B group was higher than that in remnant stomach A group by ITF and PP analysis but not reaching statistical significance （P 〉 0.05）. Eradication rate between remnant stomach B group and control group wasnot significantly different by ITT and PIP analysis （ P 〉 0.05 ）. There was no correlation between Hp eradication rate and method of reconstruction （ Billroth I or Billroth lI ） （P 〉 0.05）. After treatment, inflammation and activity scores were significantly decreased in the three groups （P 〈 0.01 ）, but no significant differences were found in glandular atrophy and intestinal metaplasia scores （ P 〉 0.05 ）. Incidence of adverse effects was not significantly different between the three groups （P 〉 0.05 ）, and no serious adverse effects were seen. Conclusions： Triple therapy （EAF regimen） combined with posture change （keeping at lying on the left side for 30 min） after taking medicine is a safe and effective measure for eradication of Hp in remnant stomach.