胶体次枸橼酸铋合并交沙霉素或强力霉素两联疗法根除幽门螺杆菌研究

Dual Therapy of Colloidal Bismuth Subcitrate Combined with Josamycin or Doxycycline for Eradication of Helicobacter Pylori

180例幽门螺杆菌(Hp)感染的消化性溃疡或非溃疡性消化不良(NUD)患者分3组接受胶体次拘椽酸铋(CBS)合并的两联治疗。A组方案为CBS 240mg,交沙霉素1000mg;B组为CBS 240mg,强力霉素100mg;C组(对照组)为CBS 240mg,羟氨苄青霉索l000mg。上述剂量每日2次,疗程2周。162例完成治疗后停药4周后胃镜复查。结果显示:A、B和C组的Hp根除率分别为69.6％(39/56)、16.3％(9/55)和43.1％(22/51),各组间的Hp根除率有非常显著差别(P<0.01或P<0.001):A、B和C组的十二指肠溃疡(DU)愈合率分别为86.9％(20/23)、60.8％(14/23)和75.O％(12/16),A组的DU愈合率显著高于B组(P<O.05)。Hp菌株对羟氨苄青霉素和强力霉素很敏感,7.7％(4/52)的菌株对交沙霉素原发耐药。本研究结果提示,交沙霉素在体内有较强的抗Hp作用,与CBS合用可根除Hp,促进DU愈合。

Background/Aims: The effect of josamycin (Jos) and doxycycline (Dox) on the eradication of Helicobacter pylori (Hp) has rarely been reported. The aim of this study was to assess the eradication rate of Hp with new dual therapy consisted of colloidal bismuth subcitrate (CBS) combined with Jos or Dox. Methods: One hundred and eighty Hp positive patients with duodenal ulcer (DU) or non-ulcer dyspepsia were randomly assigned to receive two-week dual therapy with CBS 240 mg bid combined with Jos 1000mg bid (group A), or Dox 100mg bid (Group B), or amoxicillin (Amo) 1000mg bid (group C, as control). Hp infection was assessed by urease test, histology and culture before treatment and four weeks after cessation of treatment. Results: 162 patients completed the study, 12 lost follow-up, and 6 were non-compliant. The eradication rate of Hp was 69.6% (39/56) in group A, significantly higher than 16.3% (9/55) in group B (P<0.001), and 43.1% (22/51) in group C (P<0.01). The healing rates of DU in group A, B and C were 86.9% (20/23), 60.8% (14/23) and 75.0% (12/16), respectively, with significant difference between group A and group B (P<0.05). The primary resistant rate of Hp strains to Jos was 7.7% (4/52), to Dox 1.96 (1/51), and no resistant to Amo (0/51). Conclusion: Jos in dual therapy with CBS for the eradication of Hp is more effective than Amo and Dox, and the eradication of Hp promotes the healing of DU.