胶体次枸橼酸秘、呋喃唑酮、克拉霉素一周三联疗法对幽门螺杆菌感染的高根除率

High Cure Rate of H. pylori Infection by One-week Triple Therapy of Colloidal Bismuth Subcitrate, Furazolidone and Clarithromycin

背景：甲硝唑用于以铋剂或质子泵抑制剂为基础的三联疗法，通常可获得幽门螺杆菌（Ｈｐ）的高根除率，然而 对甲硝唑耐药的Ｈｐ菌株已成为Ｈｐ根除率下降的一个主要原因。目的：评估以铋剂为基础、不含甲硝唑的三联疗法 根治Ｈｐ感染的疗效。方法：将１８０例Ｈｐ阳性、内镜确诊为消化性溃疡或功能性消化不良的患者随机分为３个治疗 组，均给予为期１周的胶体次枸橼酸铋（ＣＢＳ）２４０ｍｇ ｂｉｄ加上两种抗生素三联治疗：Ａ组为呋喃唑酮１００ｍｇ ｂｉｄ加克拉 霉素２５０ｍｇ ｂｉｄ；Ｂ组为克拉霉素２５０ｍｇ ｂｉｄ加阿莫西林１０００ｍｇ ｂｉｄ；Ｃ组为呋喃唑酮１００ｍｇ ｂｉｄ加交沙霉素１０００ｍｇ ｂｉｄ。治疗前３天内和治疗后至少４周，分别经内镜在胃窦和胃体取活检标本，采用快速尿素酶试验、细菌培养及组织 学检查方法检测Ｈｐ感染状况。结果：１３例患者失访（Ａ组３例，Ｂ组５例，Ｃ组５例）。根据意图治疗分析（ＩＴＴ），Ａ组Ｈｐ根 除率为８８％（５３／６０），Ｂ组为５８％（３５／６０）， Ｃ组为７７％（４６／６０），Ａ组与Ｂ组之间的根除率有非常显著差异（Ｐ＜ ０．００１）， Ｂ组与Ｃ组之间也有显著差异（Ｐ＜０．０５）。Ａ组７例（１２％）、Ｂ组３例（５％）和?

Background/Aims: When metronidazole is used in bismuth-based or proton pump inhibitor-based triple therapy, the cure rate of H. pylori is usually high, however, metronidazole-resistant H. pylori strains, which are increasing in frequency, are the main cause of failure of H. pylori eradication. The aim of this study was to evaluate the efficacy of non-metronidazole containing bismuth-based triple therapy for H. pylon infection. Methods: One hundred and eighty H. pylon positive patients with endoscopically documented peptic ulcer disease or functional dyspepsia were randomly assigned to one of the three one-week regimens containing colloidal bismuth subcitrate 240mg bid and two antibiotics: furazolidone 100mg bid and clarithromycin 250mg bid (Group A); clarithromycin 250mg bid and amoxycillin 1000mg bid (Group B); furazolidone 100mg bid and josamycin 1000mg bid (Group C). H. pylori status was assessed by rapid urease test, histology and culture of gastric biopsy specimens taken from both the antrum and corpus 3 days before therapy and at least 4 weeks after completion of treatment. Results: Thirteen patients dropped out (3 in group A, 5 in group B and 5 in group C). Based on intention-to-treat analysis, the eradication rates achieved in group A, B and C were 88.3% (53/60), 58.3% (35/60) and 76.7% (46/60), respectively. These differences were significant between group A and B (P< 0.001), as well as between group B and C (P< 0.05). Side effects, occurred in 7 (11.7%) patients in group A, 3 (5.0%) in group B and 8 (13.3%) in group C, they were mild with the exception of vomiting in one patient (group C) resulted in withdrawal from the study. Conclusions: One-week triple therapy consisting of colloidal bismuth subcitrate, low dose furazolidone and low dose clarithromycin achieves a high cure rate of H. pylori.