摘要
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.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1996年第12期803-806,共4页
Chinese Journal of Internal Medicine