幽门螺杆菌感染对非甾体类抗炎药消化性溃疡转归的影响研究

EFFECT OF H. PYLORI INFECTION ON OUTCOME OF NON-STEROID ANTI-INFLAMMATORY DRUG IN PEPTIC ULCER

目的探讨幽门螺杆菌(H.pylori,Hp)感染对非甾体类抗炎药(non-steroidal inflammatory dugys,NSAIDs)消化性溃疡(PU)转归的影响。方法400例确诊NSAIDs消化性溃疡和感染Hp患者按配对分组法分为根除Hp感染组(根除组)200例、单纯抑酸治疗组(抑酸组)200例。患者在研究治疗期间暂停服用NSAIDs。根除组予奥美拉唑(商品名:洛赛克)20mg,2次/d,克拉霉素0.5g,2次/d,羟氨苄阿莫西林1.0g,2次/d,共1周。第二至第八周予洛赛克20mg/d。抑酸组予洛赛克20mg/d共8周。二组患者在治疗后1个月、24个月进行胃镜和Hp复查,对比其溃疡的愈合率、复发率、并发症发生率情况。结果根除组Hp的根除率为98%,二组溃疡愈合率差异无统计学意义(85.7%比88.0%,P>0.05),2年内溃疡复发率:抑酸组明显低于根除组(26.5%比12.0%,P<0.05);胃溃疡(GU)并出血发生率:抑酸组明显低于根除组(28.1%比15.5%,P<0.05);十二指肠溃疡(DU)并出血发生率:二组差异无统计学意义(10.7%比9.5%,P>0.05)。结论Hp和NSAIDs是消化性溃疡发生的二个重要独立危险因素,二者间无相加或协同作用。Hp感染并不影响NSAIDs性溃疡的愈合,并且可能降低其近期的复发率。Hp感染与NSAIDs胃溃疡引起出血呈明显反比关系,而与十二指肠出血无关。

Objective To approach the effect of H. pylori （Hp） infection on outcome of patients with peptic ulcer treated by nonsteroidal anti- inflammatory drugs （NSAIDs）. Methods 400 patients with peptic ulcer and Hp infection were divided into Hp eradication group （200 cases） and antacid group （200 eases） in easecontrol study. NSAIDs were stopped during treatment. Patients in Hp eradication group were treated with Omeprazole （Losec） 20mg Bid, Clarithromyein 0. 5 Bid, Amoxieilline 1.0 Bid for one week, then Omeprazole 20mg qid for 8 weeks. Patients in antiaeid group were treated with Omeprazole 20mg qid for 8 weeks. All patients were given endoscopies and Hp examinations in 1 month and 24 months. The cure rate, recurrent rate and complication rate were compared between the two groups. Results The eradication rate of Hp eradication group was 98%, the cure rates of the two groups had no significant difference （85.7% ,88.0~~ ,P^0.05）. The ulcer recurrent rate in 2 years in antacid group was significantly lower than that in Hp eradication group （12% ,26.5%, P〈0.05）. Incidence of bleeding gastric ulcers in antacid group was significantly lower than that in Hp eradication group （15. 5% ,28.1% ,P〈0.05）. Incidences of bleeding duodenal ulcers had no significant difference in two groups （9.5%, 10. 7% ,P〉0.05）. Conclusion Hp and NSAIDs are two independent risk factors of peptic ulcer, they wont work in cooperation. NSAIDs peptic ulcer doesn＇t affect by Hp infection, and the presence of Hp is associated with a lower risk of short - term recurrence. There is a negative interaction between Hp and NSAID used in patients with bleeding gastric ulcer, but no interaction is found between Hp and bleeding duodenal ulcer.