序贯疗法治疗幽门螺杆菌根除失败患者的疗效

Efficacy of sequential therapy in patients who failed Helicobacter pylori eradication treatment

目的:探讨序贯疗法作为幽门螺杆菌(Helicobacter pylori,H.pylori)补救治疗方案是否有更高的H.pylori根除率.方法:经胃镜检查确诊为H.pylori阳性的慢性胃炎和消化性溃疡患者,用标准一线治疗方案进行H.pylori根除治疗,停药4wk后14C尿素呼气试验仍为阳性或复查胃镜组织学检查H.pylori为阳性的患者判定为根除失败.对于初次根除失败患者随机分为两组:治疗组(30例)方案为前5d给予奥美拉唑+阿莫西林,后5d给予奥美拉唑+替硝唑+克拉霉素;对照组(32例)给予奥美拉唑+枸橼酸铋钾+阿莫西林+左氧氟沙星,连续7d,比较治疗后两组患者的H.pylori根除率.结果:治疗组和对照组H.pylori PP根除率分别为82.14%和80.00%,ITT根除率分别为76.67%和75.00%,不具有统计学意义.结论:序贯疗法可作为H.pylori一线治疗根除失败患者的安全、有效的补救治疗方案.

AIM：To investigate the efficacy of sequential therapy in patients who failed first-line Helicobacter pylori（H.pylori） eradication therapy.METHODS：Patients who were diagnosed with H.pylori infection by rapid urease test and pathological examination and failed first-line eradication therapy were enrolled.Failure of the initial treatment is defined if the patient is positive for the 14C-urea breath test within 4 wk after the treatment.These patients were randomly divided into two groups：trial group（n = 30） and control group（n = 32）.The trial group received sequential regimen,omeprazole 20 mg plus amoxicillin 1 g,twice daily for the first 5 d,followed by omeprazole 20 mg,clarithromycin 500 mg and tinidazole 500 mg,twice daily for the last 5 d;while the control group（n = 32） received quadruple regimen,omeprazole 20 mg plus bismuth citrate 220 mg and amoxicillin 1 g,twice daily,and levofloxacin 0.4 g once daily,for 7 d.Within 4 wk after the therapy,the 14Curea breath test was performed to detect H.pylori infection status.RESULTS：The eradication rates achieved in the trial group and control group were 82.14% versus 80.00% in the per-protocol analysis,and 76.67% versus 75.00% in the intent-to-treat analysis,respectively,with significant differences between the two groups（both P 0.05）.CONCLUSION：Sequential therapy is an effective rescue regimen in patients who failed firstline H.pylori eradication treatment.