雷贝拉唑与奥美拉唑治疗老年反流性食管炎近期疗效对比研究

Short-term Effect Comparison of Rabeprazole and Omeprazole on Reflux Esophagitis in Elderly Patients

目的观察比较雷贝拉唑与奥美拉唑短期治疗老年人反流性食管炎的疗效。方法80例经内镜证实的反流性食管炎的老年患者,随机分为两组,分别给予口服雷贝拉唑10 mg/d与奥美拉唑20 mg/d,其中H.pylori阳性者应用质子泵抑制剂同时加用克拉霉素250 mg、阿莫西林1.0 g或甲硝唑400 mg,7 d一疗程,共治疗8个疗程。8疗程后,分别观察临床症状、不良反应,经内镜观察食管炎愈合程度,评价治疗效果。结果治疗8周后雷贝拉唑组食管炎愈合率按方案(PP)和意向治疗(ITT)分析分别为92.11%、87.50%,奥美拉唑组食管炎愈合率按PP和ITT分析分别为72.97%、67.50%,两组差异有统计学意义(P<0.05)。雷贝拉唑组烧心症状比奥美拉唑组明显改善(P<0.05)。H.Pylori阳性和阴性患者的RE愈合率比较,差异无统计学意义(P>0.05)。H.Pylori已治愈和H.Pylori仍阳性患者的RE愈合率比较,差异无统计学意义(P>0.05)。两组均无与用药相关的不良反应发生。结论雷贝拉唑和奥美拉唑相比,雷贝拉唑治疗老年人反流性食管炎愈合率高,更能有效改善症状。H.Pylori感染不影响两种质子泵抑制剂治疗反流性食管炎的愈合率。

Objective To compare the short - term efficacy of rabeprazole and omeprazole on reflux esophagitis in eld- erly patients. Methods Eighty elderly patients with endoscopically diagnosed esophagitis were randomly assigned to re- ceive rabeprazole 10 mg or omeprazole 20 mg daily for 8 weeks. Drugs were taken in the morning fasting just before break- fast. Patients with H. Pylori positive were treated with the PPI plus two antibiotics i. e., amoxicillin lg twice daily and clar- itromycin 250 mg twice daily or metronidazole 250mg four times daily for 7d. Major symptoms, compliance, and adverse events were recorded. After 8 weeks, endoscopy and clinical evaluation were repeated.. Results The healing rates of esophagitis according to per protocol （PP） and infestation to treat （ITT） in rabeprazole group were 92.11% and 87.50% respectively, and those in omeprazole group were 72.97 %, 67.50 % respectively. The healing rates were significantly different between the two groups（ P〈 0.05 ）. Rabeprazole was more effective than omeprazole in decreasing heartburn（ P〈 0.0.5）. No statistically significant difference was observed in the healing rates of esophagitis between H. -Pylori positive and H. Pylori negative patients（P〉0.05）. No significant difference was found in the healing rates of esophagitis between successfully and unsuccessfully treated H. Pylori patients（ P 〉 0.0.5）. No obrious adverse events occurred in both two groups. Conclusions In elderly patients, rabeprazole is more effective than omeprazole in healing reflux esophagitis and improving symptoms. H.Pylori infection does not influence the healing rate of esophagitis after a short - term treatment with PPI. So it is a safe and effective medicine to treat reflux esophagitis in the aged.