1515例幽门螺杆菌根除治疗分析

Eradication of Helicobacter pylori infection in 1515 cases

目的对临床常用的幽门螺旋杆菌(HP)根治方案的疗效进行比较,探讨影响HP治疗的可能因素,为选择更为有效的HP根治方案提供依据。方法收集2000年11月-2008年6月浙江中医药大学附属第二医院消化科的HP根治资料,按照不同年龄、性别、治疗方案及疗程分别统计,并对各组数据进行分析,计算不同因素对HP根除率的影响。结果资料完整者共1515例,HP总体根除率73.5%。其中男性根除率74.4%(572/769),女性根除率72.7%(542/746),两者之间无明显差异(P>0.05)。以≤25岁,≥66岁及中间每10岁为一年龄段将患者分为6个年龄段,其中≤35岁患者的HP根除率均大于80%,显著高于>35岁的患者(P=0.001)。本组共有13种不同治疗方案,各方案之间HP根除率存在显著差异(P=0.000)。其中奥美拉唑+阿莫西林+呋喃唑酮、雷尼替丁枸橼酸铋+阿莫西林+呋喃唑酮、铋剂+阿莫西林+呋喃唑酮、铋剂+阿莫西林+甲硝唑方案的HP根除率大于80%;质子泵抑制剂(PPIs)/铋剂+3种抗生素的HP根除率达96.7%。以PPIs+2种抗生素的三联治疗方案与以铋剂为基础+2种抗生素的三联治疗方案相比,其HP根除率相当(P=0.832)。14d疗程HP根除率明显优于7d疗程(P=0.001)。结论年龄、疗程及治疗方案与HP根除率有关;3种抗生素联合抑酸剂对提高HP根除率更为有效。

Objective To compare the curative effect of different treatments to eradicate Helicoacter pylori commonly used in clinic, and explore the potential impact factors affecting the treatment result. Methods All the information of H. pylori eradication treatments from Nov. 2000 to Jun. 2008 was collected and analyzed statistically according to patients＇ age, gender, treatment regime and duration Eradication rates of H. pylori infection were also calculated and analyzed. Results 1515 cases with H. pylori infection were involved in the present study. The total eradication rate was 73. 5%. The eradication rate was 74.4% （572/769） in males and 72. 7% （542/ 746） in females, no significant difference existed between the both sexes （P〉0. 05）. Based on the age, patients studied were also stratified into 6 age groups （≤25, 26--35, 36 45, 46--55, 56--65, ≥66）. The eradication rates in patients of 425 and 26-35 age groups were higher than 80%, much higher than that in the patients of the other 4 age groups （ P=0. 001）. Among the 13 therapeutic regimens for H. pylori eradication, significant differences were found in the eradication rates （ P= 0. 000）. The therapeutic regimens with eradication rate over 80% were Orneprarole ＋ Amoxicilin ＋Furazolidone, Ranitidine bismuth citrate ＋ Amoxicilin ＋ Furazolidone, Bismuth ＋Amoxicilin ＋ Furazolidone and Bismuth ＋ Amoxicilin ＋ Metrozole. The eradication rate of proton pump inhibitors （PPIs）/bismuth plus 3 kinds of antibiotics reached 96. 7 %. There was no significant difference on the eradication rates between PPls-based and bismuth-based quadruple therapy （ P=0. 832）. The eradication rate of 14 day treatment was higher than that of 7-day-treatment （ P=0. 001）. Conclusions Age, treatment duration （7d or 14d） and therapeutic regimen are the factors that affect the eradication rate of It. pylori infection. PPIs-or bismuth-based quadruple therapy may give more satisfactory results in the eradication of II. pylori infection.