奥美拉唑、克拉霉素、阿莫西林三联疗法根除幽门螺杆菌

目的　比较奥美拉唑、克拉霉素、阿莫西林与奥美拉唑、甲硝唑、阿莫西林两种“三联疗法”对幽门螺杆菌 (Hp)的根除效果。方法　 10 3例Hp阳性的消化性溃疡患者分为 2组 :A组 5 8例 ,以奥美拉唑 2 0mg、克拉霉素 5 0 0mg加阿莫西林 10 0 0mg口服 ,2次·d-1,疗程 7d ;B组 45例 ,以奥美拉唑 2 0mg、甲硝唑 40 0mg加阿莫西林 10 0 0mg口服 ,2次·d-1,疗程7d。活动期溃疡患者抗Hp治疗后继续服用奥美拉唑 2 0mg ,1次·d-1,疗程 2～ 4周。抗Hp治疗结束 2个月后复查胃镜并检测Hp。结果　A、B两组的Hp根除率分别为 89.3 %和 84.1% ,活动期溃疡愈合率分别为 96.7%和 10 0 % ,副反应发生率分别为 10 .3 %和 11.1% ,两组间Hp根除率、活动期溃疡愈合率和副反应发生率均无显著性差异 (均为P >0 .0 5 )。结论　克拉霉素或甲硝唑与奥美拉唑、阿莫西林组成的两种“三联疗法”疗效相当 ,而甲硝唑因价廉、安全在临床上更为实用。

Triple therapy with omeprazole, clarithromycin and amoxycillin for eradication of Helicobacter pylori infection

Objective To compare the efficacy of clarithromycin 500 mg and metronidazole 400 mg twice a day when they were combined with omeprazole amoxycillin for the eradication of Helicobacter pylori(Hp) .Methods 103 subjects with Hp associated peptic ulcer were divided into two groups.They accepted one week triple therapy with omeprazole 20?mg bid, amoxycillin 1?000?mg bid and either clarithromycin 500?mg bid (group A, n =58) or metronidazole 400?mg bid(group B, n =45).Patients with active peptic ulcer were treated with omeprazole 20?mg daily for 2 to 4 weeks after anti Hp therapy.Endoscopic examination with four biopsies (two specimens from the antrum and two from the gastric body) was performed.Two months after anti Hp therapy,endoscopy and gastric biopsies were reexaminated.Results The Hp eradication rates in Groups A and B were 89.3% (50/56) and 84.1% (37/44),there was no difference between them( P >0.05).The active ulcer healing rate was 96.7% (29/30) in Group A and 100% (21/21) in Group B.Six patients in group A (10.3%) and five in group B (11.1%) reported adverse events ( P >0.05).The active ulcer healing rate and adverse rate were found no differences between group A and group B( P >0.05).Conclusion One week triple therapy with omeprazole and amoxycillin in combination with either clarithromycin or metronidazole is effective for eradication of Hp .Metronidazole has the advantage of lower cost,good compliance and mild side effects,it may offer a good choice for treatment of peptic ulcer associated with Hp infection in clinical practice.