含克拉霉素的短程三联疗法根除幽门螺杆菌

CLARITHROMYCINCOMBINEDSHORT┐TERMTRIPLETHERAPIESFORERADICATIONOFHELICOBACTERPYLORIINFECTION

为了探讨较为理想的根除幽门螺杆菌（Ｈｐ）的治疗方案，将８８例Ｈｐ感染的十二指肠溃疡（ＤＵ）和非溃疡性消化不良（ＮＵＤ）患者分两期，接受克拉霉素合并的三联治疗。第一期为预初研究，２８例随机分成两组接受克拉霉素５００ｍｇ、呋喃唑酮２００ｍｇ合并胶体次枸橼酸铋（ＣＢＳ）２４０ｍｇ（Ａ组）或兰索拉唑３０ｍｇ（Ｂ组）每日２次治疗。６０例进入第二期研究者亦分为Ａ和Ｂ两组，药物配合方案同第一期。但除ＣＢＳ外，其他药物剂量减半。第一、二期中分别有４例和１例因药物副反应未完成治疗，失访２例。结果显示：第一期Ａ、Ｂ组的Ｈｐ根除率分别为１００．０％（１２／１２）和９１．７％（１１／１２）；第二期Ａ、Ｂ组的Ｈｐ根除率分别为９２．６％（２５／２７）和９０．０％（２７／３０）。各组间的Ｈｐ根除率差异无显著性（Ｐ＞０．０５）。第一、二期中副反应率分别为６４．２％（１８／２８）和５．１％（３／５８）（Ｐ＜０．００１）。第二期Ａ、Ｂ两组的ＤＵ愈合率分别为９４．４％（１７／１８）和１００．０％（１８／１８）。研究表明，第二期中的２种低剂量短程三联疗法是较为理想的Ｈｐ根除方案。本研究中７．５％（４／５３）的Ｈｐ菌株对克拉霉素原发耐药，是治疗失败?

InordertoexploretheoptimalregimensfortheeradicationofHelicobacterpylori(Hp),eighty-eightpatientswithduodenalulcer(DU)ornon-ulcerdyspepsiaandHpinfection,definedbycul-tureandhistology,receivedtheone-weektripletherapywithclarithromycin(Cla),furazolidone(Fur)pluslansoprazole(Lan)orcoloidalbismuthsubcitrate(CBS).Twenty-eightpatientsenteredthephaseonepreliminarystudy,randomizedtoreceivethetreatmentofCla500mgb.i.dandFur200mgb.i.dpluseitherCBS240mgb.i.d(groupⅠA)orLan30mgb.i.d(groupⅠB).Sixtypatientsenteredthephasetwomainstudy,receivingthetreatmentofCla250mgb.i.dandFur100mgb.i.dpluseitherCBS240mgb.i.d(groupⅡA)orLan30mgq.d(groupⅡB).Fivepatients(2ingroupⅠA,2ingroupⅠB,1ingroupⅡA)werewithdrawnbecauseofthesideefectsofthetreatment,andtwo(ingroupⅡA)droppedout.TheeradicationratesofHpingroupⅠA,ⅠB,ⅡA,ⅡBwere100.0%(12/12),91.7%(11/12),92.6%(25/27)and90.0%(27/30)respectively.TherewasnosignificantdifferenceintheeradicationratesofHpbetweenthetreatmentgroups(P>0.05).TheprimaryresistantrateofHpiso-latestoClawas7.5%(4/53)andnopatientinfectedwiththestrainresistanttoClasucceededintheeradicationofHp.ThehealingratesofDUwere94.4%(17/18)ingroupⅡAand100.0%(18/18)ingroupⅡB(P>0.05).Themainsideefectswerenausea,vomitingandtastedisturbance.Eighteenofthe28(64.2%)patientsinthephaseonestudyhadsideefectswitharatesignificantlyhigherthanthatof5.1%(3/58)inthephasetwostudy(P<0.001).Conclusions:(1)Bothoftheregimensusedinthephasetwostudywithlow-dose,oneweektripletherapyarehighlyefectiveintheeradicationofHpinfectionandhealingofDU,andareweltolerated.(2)TheprimaryresistanceofHpstrainstoClaistheprincipalfactoroftreatmentfailureinthesetworegimens.