二联方案在幽门螺杆菌根除治疗中的应用进展

Progress in application of dual therapy in the eradication of Helicobacter pylori

幽门螺杆菌(Helicobacter pylori,H.pylori)在世界范围内感染率高,随着H.pylori对常用抗生素的耐药率逐渐增加,高效的经验性治疗方案亟待探索。新近Maastricht V/Florence共识及我国第五次幽门螺杆菌感染处理共识均推荐含铋剂四联方案可作为一线治疗方案。但是,四联方案存在用药多、药物不良反应多、患者依从性差、部分老年人及肝、肾功能不全的患者无法耐受等缺点。近年来多项研究显示高剂量阿莫西林联合质子泵抑制剂(proton pump inhibitor,PPI)的二联方案与含铋剂四联方案的疗效相近,但用药少,不良反应少,患者依从性更高,有可能成为经验性的一线治疗方案,或成为一线、二线治疗失败后的补救方案。本文就二联方案在H.pylori根除治疗中的应用进展作一综述。

Helicobacter pylori(H. pylori) infection has a high incidence worldwide. However, as the resistance rates to common antibiotics have gradually increased, effective empirical treatment options need to be explored. The latest Maastricht V/Florence Consensus and the Fifth Chinese National Consensus Report on the Management of H. pylori Infection recommended that bismuth-quadruple therapy can be used as a first-line treatment. But the quadruple therapy has some disadvantages, such as use of more drugs that leads to more adverse events, low compliance of patients, and intolerance of some elderly patients and patients with liver or kidney dysfunction. Several studies have shown that the high-dose dual therapy which combines amoxicillin with proton pump inhibitor(PPI) can achieve similar eradication rate as the quadruple therapy does, while dual therapy has fewer medications, less adverse events, and higher patient compliance. It may become an empirical first-line treatment, or a rescue therapy after the failure of first-line and second-line treatments. This article discussed in detail the progress in application of dual therapies in the eradication of H. pylori infection.