含铋剂四联一线治疗方案根除幽门螺杆菌疗效观察

Efficacy of bismuth-based quadruple therapy as first-line treatment for helicobacter pylori infection

目的:评价含铋剂四联方案(耐信+克拉霉素+阿莫西林+丽珠得乐)治疗消化性溃疡或慢性胃炎Hp感染患者的疗效,寻找高效、经济的一线Hp根除方案。方法:①136例消化性溃疡或慢性胃炎Hp感染初治患者,随机分为四联组(67例)和三联组(69例);四联组采用埃索美拉唑20 mg+克拉霉素缓释0.5 g+阿莫西林1.0 g+枸橼酸铋钾胶囊220 mg/d,三联组采用埃索美拉唑20 mg+克拉霉素缓释片0.5 g+阿莫西林1.0 g/d,7 d为1疗程。②采用14C-UBT检测Hp根除率。③按ITT和PP分析,计算成本-效果比(C/E)及增量成本-效果比(△C/△E)。结果:四联组Hp根除率为88.71%,三联组Hp根除率为73.02%,两组比较差异有统计学意义(P<0.05)。四联组和三联组成本-效果比分别为4.15和4.82,含铋剂四联相对于标准三联方案增量成本-效果比为1.02。结论:Hp根除率含铋剂四联方案较标准三联方案高,可推荐为经济、高效的一线治疗方案。

Objective:To evaluate the efficacy of bismuth-based quadruple therapy as the first-line treatment for H.pylori infection.Methods:A total of 136 patients with H.pylori related peptic ulcer or chronic gastritis were randomized into two groups:67 patients in bismuth-based quadruple group received esomeprazole 20 mg,clarithromycin 0.5 g,amoxicillin 1.0 g,and bismuth potassium citrate 220 mg for 7 d;69 patients in standard triple group received esomeprazole 20 mg,clarithromycin 0.5 g and amoxicillin 1.0 g for 7 d.Outcome of eradication therapy was assessed by 14C-UBT.On ITT and PP analysis,calculating the cost-effectiveness ratio(C/E) and the incremental cost-effectiveness ratio(△C/△E).Results:On ITT and PP analysis,the eradication rates of the quadruple therapy group were 82.09% and 88.71%,and those of the triple therapy group were 66.67% and 73.02%(P<0.05).The cost-effectiveness ratio of two groups was 4.15 and 4.82;The incremental cost-effectiveness ratio of quadruple therapy group was 1.02 as against triple therapy group.Conclusion:Compared to the standard triple therapy regimen,the bismuth-containing quadruple therapy regimen has higher eradication rate and cost-effectiveness,which can be recommended as the fist-line treatment for H.pylori infection.