十二指肠溃疡患夜间酸突破现象初探

Nocturnal gastric acid breakthrough in patients with duodenal ulcerSha WH.

目的探讨十二指肠溃疡患者的夜间酸突破现象及其与Hp感染之间的关系。方法十二指肠溃疡患者随机分为三组,每组8例,分别接受①每12h一次静注奥美拉唑40mg(静注1组);②每24h一次静注奥美拉唑40mg(静注2组);③每日二次口服奥美拉唑20mg(口服组)。均用药5日并于第5天早上7.30时起连续24小时监测其胃内pH值。结果三组的平均胃内pH、平均中位pH、夜间平均胃内pH、和夜间平均中位pH均升高,以静注1组显著高于其它二组:静注2组的夜间pH<4.0的时间占夜间监测时间的百分比(35.7％±40.3％)显著长于口服组(1.5％±1.9％)和静注2组(1.2±2.3)(p<0.05);静注2组和口服组分别有4例(50.0％)和1例(12.5％)发生NAB,而静注1组无酸突破发生;合计9例Hp阴性中4例(44.4％)发生NAB,15例Hp阳性中只有1例(6.7％)出现NAB(p<0.05)。结论十二指肠溃疡患者中,中国人的NAB发生率低,可能与国人对奥美拉唑高敏感,且Hp感染率高有关。

Aims: To assess the incidence of nocturnal acid breakthough (NAB)and it's the relationship with H. pylori infection in patients with duodenal ulcer. Methods: Twenty-four duodenal ulcer patients were randomly enrolled into three groups. Patients were treated by intravenous injection of omeprazole 40mg twice daily(first group), once daily(second group) or oral omeprazole 20mg twice daily(third group) for 5 days, respectively. Intragastric pH over 24 hours was recorded in the fifth day for each patient. Results: The mean intragastric pH,median intragastric pH, nocturnal mean pH and nocturnal median pH in the first group was significantly higher than later two group. High intragastric pH can be produced in all three groups. The fraction time pH below 4.0 in the first(3.1%)and third group(4.5%)wcre significantly lower than that of second group(27.8%).NAB occurred in 4 patients of second group and in 1 of third group.NAB in H.pylori negative patients(44.4%) was significantly higher than that in H.pylori positive (6.7%). Conclusions:Chinese patients with duodenal ulcer were more sensitive to omeprazol and feweroccurred with NAB. The high rate Hp infection appeared to be closely related to thelower incidence of NAB.