序贯疗法补救根除幽门螺杆菌感染的疗效观察

Observation of the sequential rescue therapy regimen on eradicating Helicobacter pylori

目的比较序贯疗法与传统四联疗法对幽门螺杆菌(H.pylori)根除失败后补救治疗的临床疗效。方法选取胃镜下H.pylori快速尿素酶试验或14C尿素呼气试验阳性的患者,经我国标准H.pylori一线三联根除方案治疗7天,停药4周后检测H.pylori,结果仍为阳性者判定为H.pylori根治失败,即进行H.pylori的补救根除治疗,共68例患者入选。随机分为两组:治疗组予以序贯疗法:前5天口服埃索美拉唑20mg和阿莫西林1000mg,2次/d,后5天口服埃索美拉唑20mg、克拉霉素500mg和甲硝唑400mg,2次/d;对照组予以传统四联疗法:口服埃索美拉唑20mg、阿莫西林1000mg、呋喃唑酮100mg和胶体果胶铋100mg,2次/d,疗程7天。疗程结束后4周行14C尿素呼气试验检测H.pylori。结果疗程结束后4周,治疗组H.pylori根除率为93.9%,对照组H.pylori根除率为73.3%,两组H.pylori根除率比较有显著性差异(P<0.05)。结论序贯疗法对H.pylori的根除率高于传统四联疗法,可作为有效的H.pylori补救根除治疗方案。

Objective To compare the efficacy of sequential therapy and traditional quadruple therapy on eradicating Helicobacter pylori（H.pylori）infection after first line triple therapy failure.Methods Sixty-eight patients with H.pylori infection who failed first line triple therapy were randomly divided into two groups.Patients in therapeutic group received sequential therapy：esomeprazole（20 mg）and amoxicillin（1 000 mg）twice daily for the first 5 days,followed by esomeprazole（20 mg）,clarithromycin（500 mg）and metronidazole（400 mg）twice daily for the next 5 days.Patients in control group received quadruple therapy：esomeprazole（20 mg）,amoxicillin（1 000 mg）,furazolidone（100 mg）and colloidal bismuth pectin（100 mg）twice daily for 7 days.H.pylori was detected by 14C-urea breath test at 4 weeks after treatment.Results The eradication rate of H.pylori in the sequential therapy group was 93.9%,and the eradication rate of H.pylori in the traditional quadruple therapy group was 73.3%.There was a significant difference between two groups（P0.05）.Conclusion Sequential therapy has a higher eradication rate of H.pylori compared with the traditional quadruple therapy.It is an effective eradication therapy for people failed in previous H.pylori eradication management.