儿童幽门螺杆菌相关性胃十二指肠疾病的三联治疗临床研究

Triple combination regimen of Helicobacter pylori associated gastroduodenal disorders in children

目的分别用以雷尼替丁和胶体枸橼酸铋为主,另外加两种抗生素的2组低剂量短疗程三联疗法治疗儿童幽门螺杆菌(HP)相关性胃炎,评价不同治疗方案的疗效并探讨根除HP感染与胃炎好转的关系。方法HP相关性胃十二指肠疾病患儿55例,随机分为A、B2组,接受三联治疗。A组用胶体枸橼酸铋6～8mg/(kg·d),每日2次;阿莫西林30mg/(kg·d),每日3次;克拉霉素10～15mg/(kg·d),每日2次。B组用雷尼替丁3～5mg/(kg·d),每日睡前服1次;阿莫西林30mg/(kg·d),每日3次;克拉霉素10～15mg/(kg·d),每日2次。2组均治疗2周停药,停药满4周以上行13C尿素呼气试验及血清抗HPIgG抗体检测。结果治疗后HP根除率A组为63.3%,B组为88%(χ2=4.373,P<0.05)。两组患儿腹痛症状缓解时间A组为(5.1±3.0)d,B组为(4.3±3.5)d(P>0.05)。两组副反应均较轻,如腹泻、腹胀、恶心、纳差等胃肠症状,个别患者出现皮疹,均无肝肾、造血系统副作用,且于停药后均很快缓解,未影响治疗。2组血清抗HPIgG抗体阴转情况:A组1个月为56.7%,3个月73.3%,6个月90.0%,12个月96.7%;B组1个月为88%,3个月96.0%,6个月100.0%。结论儿童HP相关性胃炎经根除HP的治疗,可使胃炎好转。以雷尼替丁为主的联合克拉霉素和阿莫西林组成的三联疗法治疗儿童HP相关性胃十二指肠疾病具有疗程短、疗效高、副反应小和HP根除率高等优点。血清抗HPIgG抗体检测可以作为监测HP根除效果的观测指标。

Objective To evaluate the efficacy of ranitidinc or colloidal bismuth citrate plus two antibiotics （lower done and short course triple combination therapy ） for treatment of helicobacter pylofi-associatcd gastritis in children arid the relation between HP eradication and improvement of gastritis. Methods 55 children with HP-assoelated gastroduodenal were randomly divided into group A and group B to receive triple combination therapy. Components in group A included colloidal bismuth citrate （ Denol,6-8mg/kg/d, bid ） ; amoxiciUin （ 30 mg/kg/d, tid） ; and clarithromycin （ 10-15 mg/kg/d, bid ）. Components in group B included ranitidinc （ 3-Smg/kg/d, once before bedtime） ; amoxicillin （ 30mg/kg/d, tid ） and clarithromycin （ 10-15mg/kg/d, bid ）. The duration of therapy was 2 weeks in both groups. Four weeks after withdrawal, ^13 C-urea breath test and serum anti-HP-IgG antibody were performed in all children. Results （ 1 ） HP eradication rate after therapy was 63.3% in group A and 88% in group B （χ^2 =4.373,P 〈0.05）. （2） Time to relieve pain was （5.1±3.0） days in group A and （4.3±3.5） days in group B （P 〉 0.05 ）. The adverse effect was mild in both groups, including diarrhea ,flatulence, nausea, and poor appetite. Skin rash was reported in some individuals but relieved quickly after： withdrawal of medicine. No side effect was found in liver, kidney, or hematology. （ 3 ） In group A, Serum anti-HP-IgG antibody turned negative in 56.7% of children by 1 month,73.3% by 3 months,90.0% by 6 months, and 96.7% by 12 months. In group B ,anti-HP-IgG antibody turned negative in 88% of children by 1 month,96.0% by 3 months,and 100.0% by 6 months. Conclusion HP-associated gastritis in children can be improved by HP eradication therapy. Ranitidine-based triple combination therapy （plus clarithromycin and amoxicillin ） is useful for treating HP-associated gstroduodenal disorders in children,with short-term course,higher therapeutic effect and less side effect. HP-IgG antibody detection can be used to monitor the effect of HP eradication.