多药联合治疗肝硬化合并消化性溃疡临床研究

Clinical study of triple therapy for liver cirrhosis with peptic ulcer

目的:观察普萘洛尔、双歧杆菌活菌制剂、法莫替丁三联方案与胶体次枸橼酸铋、阿莫西林、呋喃唑酮三联方案治疗幽门螺杆菌(Hp)阳性的肝硬化患者消化性溃疡(PU)2周的疗效。方法:将59例确诊为肝硬化并经胃镜证实合并直径≥3mm的活动期且经快速尿素酶试验证实Hp阳性的PU,随机将其分为甲、乙两组,甲组30例给予普萘洛尔30～120mg/d,分3次口服(以静息心率下降20%～25%为度),双歧杆菌活菌制剂100ml,法莫替丁20mg,均每日2次口服;乙组29例给予胶体次枸橼酸铋120mg,每日三餐前及睡前口服,阿莫西林0.5g、呋喃唑酮0.1g均每日三餐后及睡前服。两组疗程均为2周。结果:甲组愈合率、总有效率和Hp根除率分别为70.0%、96.7%和26.7%,乙组分别为31.0%、69.0%和82.8%,两组比较,差异均有统计学意义(P<0.05)。其中胃溃疡(GU)愈合率、总有效率和Hp根除率甲组分别为73.7%、100.0%和26.3%,乙组分别为40.0%、75.0%和80.0%;十二指肠溃疡(DU)愈合率、总有效率和Hp根除率甲组分别为63.6%、90.9%和27.2%,乙组分别为22.2%、55.6%和88.9%,GU、DU的甲、乙两组比较,差异均有统计学意义(P<0.05)。结论:降低门脉高压,对抗内毒素血症有助于肝硬化患者PU愈合;Hp感染与该类PU的形成无关,对于Hp阳性患者不需根除治疗。

Objective：To observe the efficacy and safety of triple therapy with proparnolol-bifidobacteria system of bacterial preparation-famotidine,also with amoxicillin-colloidal bismuth subcitrate-furazolidone for Helicobacter pylori（H.pylori） infection and peptic ulcer（PU） disease in patients with liver cirrhosis for two weeks.Methods：59 patients with liver cirrhosis Hp infection in active PU were attested by gastroscopy and H. pylori rapid urease test were randomly allocated to No.1 group,in which patients were given proparanolol 30-120 mg tid,bifidobacteria system of bacterial preparation 100 ml bid,famotidine 20 mg bid for two weeks;No.2 group as control,in which patients were given colloidal bismuth subcitrate 120 mg qid（fasting and bedtime） ,amoxicillin 0.5 g qid（postprandia and bedtime） ,furazolidone 0.1 g qid（postprandia and bedtime） for two weeks. Results：Ulcer cure rate,total effective rate and H. pylori eradication rate after treatment for NO.1 group were 70.0%,96.7% and 26.7% respectively,while for NO.2 group were 31.0%,69.0% and 82.8%. There were significant differences between the two groups,P0.05. The gastric uler cure rate,total effective rate and H. pylori eradication rate after treatment for NO.1 group were 73.7%,100.0% and 26.3% respectively,while for NO.2 group were 40.0%,75.0% and 80.0%;the duodenal uler for NO.1 group were 63.6%,90.9% and 27.2% respectively,while for NO.2 group were 22.2%,55.6% and 88.9% respectively. There were significant differences between the two groups,P0.05. Conclusion：To down portal hypertension and relieve the internal toxin from bacteria inside intestine seem to be beneficial for healing of the peptic ulcer in liver cirrhosis,there is no significant relationship between H.pylori infection and the occurrence of pepetic ulcer,there for routine eradication of Hp is no necessary.