幽门螺杆菌感染患儿克拉霉素三联疗法的远期疗效及治疗失败病例再治疗的探讨

Long-term therapeutic effect of triple therapy consisted of omeperazole, clarithromycin and amoxycillin in children with Helicobacter pylori infection and approach to retreatment after failure of the treatment

目的 研究奥美拉唑、克拉霉素、羟氨苄青霉素三联短程疗法对幽门螺杆菌 (Hp)感染的根除率及远期疗效 ,探讨初治失败后治疗方案的选择。方法 经胃镜检查、组织活检等确诊为Hp感染的门诊患儿 192例 ,男 118例 ,女 74例。将本组患儿分成 2组 :克拉霉素组 15 7例 ,采用奥美拉唑、克拉霉素、羟氨苄青霉素三联 1周疗法 ;灭滴灵组 35例 ,采用奥美拉唑、灭滴灵、羟氨苄青霉素三联 2周疗法。疗程结束后 4周 ,分别于 1～ 36个月内进行复查随访 ,检测Hp根除率 ,其中对克拉霉素组中 2 2例Hp根除患儿进行 3年跟踪随访。对 2组Hp未根除 (初治失败 )者进行复治 ,灭滴灵组失败的复治方案 :克拉霉素三联 1周疗法 ;克拉霉素组失败的复治方案 :增加其中克拉霉素剂量和延长奥美拉唑疗程 ;复治再失败的方案 :奥美拉唑、铋剂、呋喃唑酮、羟氨苄青霉素四联疗法。结果 克拉霉素组Hp根除率 (90 4 % ,14 2 / 15 7)较灭滴灵组 (77 1% ,2 7/ 35 )高 ,差异有显著性 (χ2 =4 6 9,P <0 0 5 )。克拉霉素组 2 2例Hp根除患儿 ,3年内随访复发率 4 5 % (1/ 2 2 )。本组共 2 9例次根除失败 ,采用 3种复治方案后 ,根除率分别为 75 % (6 / 8)、77% (11/ 15 )、10 0 % (6 / 6 )。结论 奥美拉唑、克拉霉素、羟氨苄青霉素三联 1周疗法是根?

Objective Helicobacter pylori (Hp) infection presents high prevalence in the world, but there are few pediatric assays evaluating antimicrobial treatment using a short regimen of triple therapy. To evaluate the eradication rate and long term theraputic effect of a triple therapy consisted of omeperazole, clarithromycin (CLA) and amoxycillin (AMO) on Hp infection, the authors explored the alternative theraputic programs and their effects after first therapeutic failure. Methods A total of 192 children with Hp infection were divided into two groups: 157 children were given the triple therapy for one week (CLA group); 35 children were given another triple therapy composed of omeperazole, metronidazole (MET) and AMO for two weeks (MET group). All of the children were followed up for 1 36 months after the therapies ended. Twenty two children in whom Hp was eradicated with CLA triple therapy were followed up for 3 years. The children of the two groups who had therapeutic failure were given re treatment as follows. CLA triple therapy was given for one week to the children who had failure after MET triple therapy; increased doses of CLA with longer treatment course was given to the children who had failure after CLA triple therapy. A tetra therapy consisted of omeperazole, colloidal bismuth subcitrate (CBS), furazolidone (FUR) and AMO was given to the children in whom the re treatment failed. Results The Hp eradication and ulcer recovery rate of CLA group was 90 4% (142/157) and 96 9% (32/33), respectively; the Hp eradication rate of MET group was 77% (27/35). There was significant difference between eradication rates of the two groups (χ 2=4 69, P <0 05). The recurrence rate of 22 Hp eradicated children treated with CLA triple therapy was 4 5% (1/22) during the 3 year follow up. The eradication rate of the three re treatment programs for 29 children was 75% (6/8), 77% (11/15) and 100% (6/6), respectively. Conclusion (1) Omeperazole, CLA and AMO triple therapy for one week was the best to eradicate Hp infection with high eradication rate, few side effects, short period of treatment, good compliance and low recurrence rate. (2) Proper increase of CLA dose and longer therapeutic course may increase the eradication rate. Omeperazole, CBA, FUR and AMO tetra therapeutic program may be used as an alternative treatment in patients who develop resistance to CLA triple tharapy.