兰索拉唑治疗胃食管反流病的临床研究

The clinical study of lansoprazole in the treatment of GERD.

目的：探讨兰索拉唑治疗胃食管反流病（ＧＥＲＤ）的效果及维持用药的方法。方法：７０例ＧＥＲＤ随机分为两组，兰索拉唑（Ｌ）组４０例，第１至４周口服兰索拉唑３０ｍｇ每日１次，第５至１２周改为隔日１次，雷尼替丁（Ｒ）组３０例，治疗用雷尼替丁１５０ｍｇ每日２次加西沙必利５ｍｇ每日３次口服，维持用药则单用雷尼替丁。观察两组治疗前后症状评分及食管２４小时ｐＨ监测结果。结果：Ｌ组治疗阶段各周末症状评分依次下降（Ｐ＜０．０５），且分别低于Ｒ组（Ｐ＜０．０５），Ｒ组用药后第２、第３及第４周末之间的症状评分差异不大（Ｐ＞０．０５）。而第４周末和第５周末症状评分差异有显著意义（Ｐ＜０．０５）。Ｌ组第４、第８和第１２周末症状完全缓解率分别为９５％、９３％和９０％，分别高于Ｒ组的８３％、５０％和３７％。第１２周末食管２４小时ｐＨ监测复查结果显示：治后两组食管酸暴露各项指标均有改善，Ｌ组的改善比Ｒ组更为明显，Ｌ组的酸反流总计分９５％（３８／４０）恢复正常（少于１４分），高于Ｒ组的４０％（１２／３０）（Ｐ＜０．０５）。Ｌ组食管炎１１例于第１２周末均痊愈，而Ｒ组１０例只痊愈５例。结论：与雷尼替丁加西沙必利疗法比较，兰索拉唑治疗ＧＥＲＤ具有症?

bjective: To study the effect of lansoprazole on gastroesophageal reflux disease (GERD) and the dose for maintenance treatment. Methods: 70 patients with GERD were randomly divided into two groups. In lansoprazole (L) group, 40 patients were treated with lansoprazole 30 mg daily for 4 weeks, followed by 8 weeks maintenance therapy with lansoprazole 30 mg once every other daily. In ranitidine (R) group, 30 cases received ranitidine 150 mg twice a day and cisapride 5 mg three times a day followed by maintenance treatment with ranitidine 150 mg twice a day alone. The efficacy was evaluated by symptom composite score system and esophageal 24h pH monitoring. Results: During 4 weeks treatment, the symptom composite score decreased progressively every week in L group (P<005), lower than that in R group (P<005). Symptom relief of L group in the 4th week, 8th week and 12th week were 95%, 93%, 90% respectively and higher than those were 83%, 50% and 31% in R group (P<005). Esophageal 24h pH monitoring showed less esophageal acid exposure by the end of 12th week than that before treatment in both group (P<005), and the composite score of esophageal acid reflux returned to normal (<14) in 38 of 40 L group patients and 12 of 30 R group (P<005). All 11 cases with esophagitis in L group healed and only 5 of 10 cases in R group did. Conclusion: Lansoprazole induces more rapid symptom relief and higher relief rate than ranitidine combining with cisapride. The effect of lansoprazole 30 mg once every other day is superior to that of ranitidine of standard dose in maintenance therapy of GERD.