10d含呋喃唑酮三联、四联疗法补救治疗幽门螺杆菌感染的比较研究

背景:近年随着抗菌药物的耐药率逐渐上升,标准三联疗法对幽门螺杆菌(Hp)的根除率不断下降。目的:比较含呋喃唑酮的三联、四联疗法补救治疗Hp阳性慢性胃炎患者的疗效和安全性。方法:选取标准三联疗法(质子泵抑制剂+阿莫西林+克拉霉素或甲硝唑)根除失败的Hp阳性病例80例,将患者随机分为对照组和治疗组。对照组患者给予埃索美拉唑20 mg bid+阿莫西林1 g bid+呋喃唑酮0.1 g bid,疗程10 d;治疗组给予埃索美拉唑20 mg bid+阿莫西林1 g bid+呋喃唑酮0.1 g bid+枸橼酸铋钾220 mg bid,疗程10 d。治疗结束至少4周后行14C-尿素呼气试验,评估Hp根除率、症状缓解情况和不良反应。结果:与对照组相比,治疗组PP分析和ITT分析Hp根除率均显著升高(PP:94.7%对73.7%,P=0.012;ITT:90.0%对70.0%,P=0.025),症状缓解率显著升高(92.1%对65.8%,P0.05),而不良反应发生率无明显差异(12.5%对10.0%,P0.05)。结论:含呋喃唑酮的四联疗法对Hp根除失败者的疗效明显高于三联疗法,且不良反应无明显增加,可作为一线方案用于临床根除Hp。

A Comparative Study of 10-day Furazolidone-containing Triple and Quadruple Therapy as Rescue Therapy for Helicobacter pylori Infection

With the increase of incidence of antibiotic resistance, Helicobacter pylori （Hp） eradication rate of standard triple therapy has gradually decreased in recent years. Aims ： To compare the efficacy and safety of furazolidone- containing triple and quadruple therapy as rescue therapy for Hp-positive chronic gastritis patients. Methods： Eighty Hp- positive patients in whom standard triple therapy （ proton pump inhibitor ＋ amoxicillin ＋ clarithromycin or metronidazole ） failed were enrolled, and were randomly divided into two groups. Patients in the control group received esomeprazole 20 mg bid ＋ amoxieillin 1 g bid ＋ furazolidone 0.1 g bid for 10 days, while patients in the treatment group received esomeprazole 20 mg bid ＋ amoxicillin 1 g bid ＋ furazolidone 0.1 g bid ＋ colloidal bismuth subcitrate 220 mg bid for 10 days. ~4C-urea breath test was conducted at least 4 weeks after completion of the treatment course, Hp eradication rate, symptom relief and side-effects were evaluated. Results： Compared with the control group, PP and ITr analysis of Hp eradication rates were significantly increased in the treatment group （PP： 94.7% vs. 73.7% , P =0. 012; ITY： 90.0% vs 70.0% , P = 0.025）, symptom relief rate was significantly increased （92. 1% vs. 65.8%, P 〈 0.05）, however, no significant difference in incidence of side-effects was found between the two groups （12.5% vs. 10.0% , P 〉 0.05 ）. Conclusions： Furazolidone-eontaining quadruple therapy is more efficient for paitents with failed Hp eradication than triple therapy, and side-effects is not significantly increased, which can be used as a first-line treatment for Hp eradication.