含莫西沙星三联疗法对幽门螺杆菌根除失败的补救治疗

Efficacy of second-line treatment based on moxifloxacin triple therapy for Helicobacter pylori infection

目的评价含莫西沙星的三联疗法补救治疗幽门螺杆菌（Hp）的有效性和安全性。方法将Hp感染经常规三联疗法治疗失败的109例患者按随机数字表分为A组（53例）和B组（56例）。A组患者给予以奠西沙星为主的三联疗法（莫西沙星＋雷贝拉唑钠肠溶片＋阿莫西林），B组患者使用常规四联补救疗法（雷贝拉唑钠肠溶片＋胶体果胶铋＋克拉霉素＋甲硝唑），均治疗7d，结束后4周做”C尿素酶呼气试验比较根除Hp情况。结果A组48例完成治疗及随访，其中40例补救治疗成功；B组49例完成治疗及随访，35例根除治疗成功，A、B两组的按意向治疗（ITT）Hp根除率分别为75．5％（40／53）和62．5％（35／56），其按符合方案（PP）Hp根除率分别为83．3％（40／48）和71．4％（35／49），差异均无统计学意义（均P〉0．05）。结论对既往标准三联疗法治疗失败的患者，莫西沙星＋阿莫西林＋雷贝拉唑1周疗法PP分析Hp根除率〉80％，是可供选择的根除Hp的补救治疗方案。

Objective To evaluate the efficacy and tolerability of moxifloxacin-based triple therapy as an alternative second-line treatment for Helicobacter pylori （ H. pylori） infection. Methods A total of 109 patients, in whom the initial standard PPI triple therapy had failed to eradicate Hpinfection, were included. Patients were randomized to one of the following 7-day treatment regimens ： （ 1 ） rabeprazole 10 mg twice a day, moxifloxacin 400 mg/day and amoxieillin 1000 mg twice a day; and （2） rabeprazole 10 mg twice a day, bismuth salts 150 mg three times a day; clarithromycin 500 mg twice a day, metronidazole 400 mg twice a day. The eradication rates and side-effect rates of these two regimens were compared. Results The eradication rates were 75.5% （40/53） and 83.3% （40/48） with moxifloxacin-based triple therapy, and 62. 5% （35/56） and 71.4% （35/49） with bismuth-based quadruple therapy by intention-to-treat and per-protocol analyses （ both P 〉 0. 05 ） respectively. Conclusions The 7-day moxifloxacin-based triple therapy has a high eradication rate with fewer slde-effects. This regimen can be a safe and effective option as secondline treatment for H. pylori iufection.