小儿幽门螺杆菌阳性伴十二指肠溃疡的药物治疗研究

Study on the treatment of helicobacter pylori-associated duodenal ulcer in children

目的评价不同药物治疗方案的疗效，观察幽门螺杆菌（H．pylori）根除与渍疡愈合、胃炎好转的关系，进一步探讨H．pylori与十二指肠溃疡的关系。方法将90例H．pylori阳性的十二指肠溃疡患儿随机分为3组：1组（30例）：雷尼替丁3mg·kg^-1·d^-1×8周＋羟氨苄青霉素50mg·kg^-1·d^-1×8周；2组（30例）：雷尼替丁3mg·kg^-1·d^-1×8周＋羟氨苄青霉素50mg·kg^-1·d^-1×8周＋次枸橼酸铋钾（CBS）6mg·kg^-1·d^-1×8周；3组（30例）：奥美拉唑10mg×2周＋羟氨苄青霉素50mg·kg^-1·d^-1×8周。停药4周后复查。结果3组溃疡愈合率分别为16．7％、46．7％、93．3％；H．pylori转阴率分别为40．0％、66．7％、100％；胃炎好转率分别为26．7％、36．7％、86．7％。H．pylori转阴者溃疡愈合率67．7％，H．pylori未转阴者28例溃疡愈合5例，差异有显著性（P〈0．05）。以铋剂治疗者血铋浓度9．04～18．12μg/L.结论H．pylori的存在影响溃疡的愈合。奥美拉唑＋羟氨苄青霉素“二联”疗法治疗H．pylori阳性十二指肠溃疡在溃疡愈合、H．pyl砌根除、胃炎好转方面均有较好疗效，疗程短、副作用小、顺应性好。

Objective To evaluate the efficacy of different drug in the treatment of duodenal ulcer （DU） and to observe the relationship between eradication of Helicobacter pylori （H, pylori） and ulcer heating, and improvement of gastritis. Methods 80 children with H. pylori-associated duodenal ulcer were treated respectively： （1） Ranitidine 3 mg·kg^-1·d^-1×8 for 8 weeks and amoxillin 50 mg·kg^-1·d^-1×8 for 4 weeks; （2） Ranitidine 3 mg·kg^-1·d^-1×8 for 8 weeks and amoxillin 50 mg·kg^-1·d^-1×8 for 4 weeks and bismuth subcitrate （CBS） 6 mg＇kg-1 ＂d-~ for 6 weeks; （3） Omepragole 10 mg·kg^-1·d^-1×8 for 2 weeks and amoxillin 50 mg·kg^-1·d^-1×8 for 4 weeks.The patients were followed up with endoscopic biopsies 4 weeks after each treatment course. Results The; recovery rates of 3 groups were 16.67 % ,46. 67% and 93.3% respectively,H, pylori eradication rates were 40.0%, 66.6% and 100.0% and the gastritis improvement rates were 26.67 %, 36.6 % and 86.6% respectively. In the H. pylori eradicated patients, the ulcer healing rate was 67.74%, while in those with H. pylori persistent infection 8/18 （ P 〈 0.05）. In 30 patients treated with CBS,serum dismuth concentration ranged from 9.04 μg/L to 18.12 μg/L. Conclusions The H. pylori eradication is associated with DU recovery and gastritis improvement. H. pylori persistence may play an important role in the recurrence of DU. Both the CBS-triple therapy and the omeparagole double therapy are effective and safe.