提高幽门螺杆菌根除率的当代观点

Contemporary Perspectives on Elevating Eradication Rate of Helicobacter pylori

幽门螺杆菌（H．pylori）对克拉霉素和甲硝唑耐药率进行性上升降低了标准三联疗法的疗效，目前我国多数地区标准三联疗法根除率已降低到不可接受的水平[按意向治疗（ITT）分析H．pylori根除率〈80％]。本文讨论了有可能达到可接受根除率的初次治疗的当代方案，包括含铋剂四联疗法、序贯疗法、质子泵抑制剂（PPI）加3种抗生素（不含铋剂四联疗法）和高剂量PPI方案，对治疗失败后补救治疗问题也提出了讨论和建议。

The increasing resistance of clarithromycin and metronidazole undermines the effectiveness of the standard triple therapy for eradication of H. pylori, and in most regions of our country, the cure rates have declined to unacceptable level （〈80% in ITT analysis）. Current initial therapies including bismuth-containing quadruple therapy, sequential therapy, proton pump inhibitor （PPI） plus three-antibiotics therapy （non-bismuth-containing quadruple therapy） and high-dose PPI- based therapy,which have the potential of providing acceptable cure rates are discussed. The principles of rescue therapies for initial treatment failure are also discussed and summarized.