十天序贯疗法根除幽门螺杆菌临床疗效分析

Clinical Curative Effect Of 10-day Sequential Therapy in Eradicating Helicobacter Pylori

【目的】观察10d序贯疗法根除消化性溃疡幽门螺杆菌（Hp）感染的疗效，并与标准三联疗法作比较。【方法】将本院200例确诊为消化性溃疡幽门螺杆菌感染的患者随机分成四组，每组50例。A组：疗程10d，前5d埃索美拉唑（20mg，每天2次）＋阿莫西林（1000mg，每天2次），后5d埃索美拉唑（20mg，每天2次）＋克拉霉素（500mg，每天2次）＋替硝唑（500mg，每天2次）；B组：埃索关拉唑（20mg，每天2次）＋阿莫西林（1000mg，每天2次）＋克拉霉素（500mg，每天2次），疗程7d；C组：治疗方案与B组相同，疗程10d；D组：治疗方案与B组相同，疗程14d。所有患者治疗结束4周后进行胃镜和Hp复查，并评估患者对各种治疗方案的依从性和安全性。【结果】A、B、C、D四组Hp根除率按意向治疗分析（ITT-）分别为92．0％、72．0％、76．0％、88．0％，按完成治疗分析（PP）分别为95．8％、73．7％、79．2％、95．2％，四组药物不良反应总发生率分别为20．8％、16．3％、16．7％、19．6％。【结论】10d序贯疗法根除幽门螺杆菌感染疗效明显优于7d及10d标准三联疗法，在费用一效益分析及病人依从性方面明显优于14d标准三联疗法，而副作用无明显增加。

[Objective] To observe the curative effect of 10-day sequential therapy in eradicating helicobacter pylori infection of peptic ulcer as compared with standard triple therapy. [Methods]A total of 200 patients with helicobacter pylori infection of peptic ulcer were randomly divided into four groups with 50 for each. Group A received D1-D5 Esomeprazole（20mg, bid. ） ＋ amoxicillin（1000mg, bid. ）, D6-D10 Esome- prazole（20mg, bid. ） ＋ Clarithromycin（500mg, bid. ） ＋ Tinidazole（500mg, bid）. Group B received Esomeprazole（20mg, bid. ） ＋ amoxicillin （1000rag, bid. ） ＋ Clarithromycin（500mg, bid. ）, and 7 days was the course of treatment. Group C received the same therapeutic schemes as Group B and 10 days was the course of treatment. Group D received the same therapeutic schemes as Group B, and 14 days was the course of treatment. All patients reexamined gastroscope and H. pylori in four weeks later after the end of treatment. The compliance and safety of each group were evaluated. [Results] According to inclination treatment test（ITT） analysis, the Hp eradication rate of four groups（A,B,C,D） was 92.0%, 72.0%, 76.0% and 88.0%, respectively. According to PP analysism, the Hp eradication rate of four groups was 95.8%, 73.7%, 79.2% and 95.2%, respectively, and the adverse reaction rate of four groups was 20.8%, 16.3%, 16.7% and 19.6%, respectively. [Conclusion] The curative effect of 10-day sequential therapy in eradicating helicobacter pylori infection of peptic ulcer is obviously better than that of the 7-day and 10-day standard triple therapy, and better than that of 14-day standard triple therapy in cost-benefit analysis and compliance, and the side effects are not significantly increased.