根除幽门螺杆菌和消化性溃疡再出血的关系研究

Study of relationship between Helicobacter pylori and rebleeding in peptic ulcer diseases

目的探讨根除幽门螺杆菌（Ｈｐ）对预防消化性溃疡再出血作用。方法对消化性溃疡并出血病人行急诊胃镜检查，取胃窦组织检测Ｈｐ。随机选择Ｈｐ阳性病人分为Ａ、Ｂ两组，分别用洛赛克（２０ｍｇ／次）＋羟氨苄青霉素（７５０ｍｇ／次）和单独用洛赛克（２０ｍｇ／次）治疗，每天２次，共２周。Ｈｐ阴性组（Ｃ组）单用洛赛克（２０ｍｇ／次）治疗，每天２次，共２周。之后，三组病人再用洛赛克（２０ｍｇ／次），一日一次，治疗２周。疗程结束，复查胃镜及检测Ｈｐ，并随访１８个月。结果Ａ、Ｂ、Ｃ三组病人经治疗后，溃疡愈合率分别为１００％，９６８％和９７５％，三组之间相互比较无明显差异，（Ｐ＞００５）。Ａ、Ｂ两组Ｈｐ根除率分别为８３３％和１８７％，两者比较有显著性差异（Ｐ＜００５）。随访１８个月后，Ａ、Ｂ两组的再出血率分别为２７％和３１３％，两者比较有显著性差异（Ｐ＜００５），而Ｃ组再出血率为１２５％，分别与Ａ、Ｂ两组比较，再出血率无显著性差异（Ｐ＞００５）。结论根除Ｈｐ能降低消化性溃疡再出血，所有Ｈｐ阳性的消化性溃疡并出血病人需要进行根除Ｈｐ治疗。

AIMS The aim of the present study was to examine whether eradication of Helicobacter pylori has any impact on the rebleebing in peptic ulcer diseases.METHODS All patients had emergency endoscopy,and tests for H.pylori proved to be positive in all.After discharge,patients with positive of H.pylori were randomized to receive either combination of Losec 20mg Bid and Amoxicillin 750mg Bid (Group A n=36) or Losec 20mg Bid alone (Group B n=32)for 2 weeks.Patients with negative of Helicobacter pylori were treated with Losec 20mg Bid (Group Cn=40) for 2 weeks.After discharge,all patients were treated with Losec 20mg Qd for 2 weeks.Endoscopy was performed after treatment ended to check for eradication of H.pylori.Then,all patients were followed for 18 months.RESULTS Ulcer healing rates were 100%(Group A) and 96.8%(Group B) and 97.5%(Group C).Through the comparison of the three groups respectively,ulcer healing rates were no difference (P>0.05).Helicobacter pylori eradication rates were 83.3%(Group A) and 18.7%(Group B).H.pylori eradication rates of Group A were significantly higher than that of Group B.Followed for 18 months,rebleeding rates were significantly lower in Group A (2.7%) than in Group B(31.3%) (p<0.05).However,comparison of Group A (Group B) with Group C,rebleeding rates were no significant difference (P>0.05).CONCLUSION Eradication of H.pylori significantly reduces the rates of rebleeding in peptic ulcer disease.So,eradication should be considered in all such patients in order to reduce rebleeding.