幽门螺杆菌根除失败后的进一步治疗——克拉霉素四联与四环素四联疗效比较

FURTHER TREATMENT OF H·PYLORI AFTER FAILURE IN ITS ERADICATION

目的：应用克拉霉素（Ｃｌａｒ）四联法提高抗幽门螺杆菌（Ｈｐ）治疗失败后进一步治疗的Ｈｐ根除效果。方法：将抗Ｈｐ治疗失败的病例随机分为二组。Ａ组予臭美拉唑（Ｏｍｅ）２０ｍｇ，秘剂（ＤｅＮｏｌ）１０８ｍｇ，羟氨苄青霉素（Ａｍｏ）５００ｍｇ，盐酸四环素２５０ｍｇ，每日５次，连服１２ｄ；Ｂ组予Ｏｍｅ２５０ｍｇ，秘剂（ＤｅＮｏｌ）１０８ｍｇ，Ａｍｏ５００ｍｇ，每日５次，Ｃｌａｒ２５０ｍｇ，每日３次，连服１２ｄ。Ｂ组中有３例因Ａｍｏ过敏反应改用四环素。Ｈｐ感染诊断采用内镜、尿素酶快速试验，组织学及培养。应用Ｅ－检验确定耐甲硝基菌株。结果：Ａ组２３例（５１％）根除，Ｂ组为３９例（８５％），两组差异有显著性（Ｐ＜０．０５）。Ａ组９例对甲硝唑耐药（４１％），Ｂ组为２４例（６３％）。Ａ、Ｂ两组的副作用平均分数分别为２６．８％及２７．７％。此外，Ａ组中有４例出现血性腹泻，肠镜诊为伪膜性肠炎，１例培养Ｃｌ·ｄｉｆｉｃｉｌｅ阳性。结论：①新的含Ｃｌａｒ四联法治疗Ｈｐ根除失败效果良好，但其安全性仍有问题；②与含传统三联的四联法不同，Ｃｌａｒ四联法有伪膜性肠炎发生；③仍有少数病例Ｈｐ根除再次失败。

This investigation was to observe the effect of clarithromycinincluded quadrigroup therapy in the treatment of Hpylori after failure in its eradicationPatients with eradication failure were randomly divded into A group and B groupA group:①quadringroup drugs consisted of omeprazole 20 mg,bismuth subcitrate 108 mg,amoxycillin 500 mg,and tetracycline HCL 250 mg;②administration:5 times daily,for 12 daysB group:①quadrigroup drugs consisted of omeprazole 20 mg,bismuth subcitrate 108 mg,amoxycillin 500 mg,and clarithromycin 250 mg;②administration:clarithromycin 3 times daily,for 12 days,and the other drugs 5 times daily,for 12 daysIn group B,there were 3 patients who were allergic to amoxycillin,and tetracycline HCL was used insteadDiagnosis of Hpylori was assessed by endoscope,urease test,histological examination and cultureMetronidazole resistance was assessed by EbestResults:In A group Hpylori was eradicated in 23 cases(51%),while in B group Hpylori was eradicated in 39 cases(85%).The difference between the two groups was significant(P<005)In A group,metronidazole resistance was found in 9 cases(41%),while in B group such resistance was found in 24 cases (63%)The average side effects scores were 268% and 277% in A group and B group respectivelyFurthermore,in the clarithromycin included B group four patients developed bloody diarrhea,which was colonoscopically diagnosed as pseudomembranous colitisIn one patent Cldifficile culture was positiveOur results indicate that:①This new clarithromycincontaining quadrigroup therapy is effective in treating patients who have experienced Hpylori eradication failureHowever,the safety of this threapy is still questionable;②Unlike classical triple group therapy,pseudomembranous colitis occurs in clarithromycinincluded quadrigroup therapy;③There is a small number of patients whose Hpylori eradication is still not complete