序贯疗法与标准三联疗法治疗幽门螺杆菌阳性十二指肠溃疡疗效观察

Sequential therapy versus standard triple therapy for duodenal ulcer with Hp infection

目的评价序贯疗法与标准三联疗法对幽门螺杆菌（Hp）阳性十二指肠溃疡的Hp根除和溃疡愈合情况。方法将95例Hp阳性的十二指肠溃疡活动期患者随机分为2组。序贯治疗组（48例）给予雷贝拉唑10mg，阿莫西林1g，连续口服5d后再给予雷贝拉唑10mg，克拉霉素500mg和替硝唑400mg，均每天两次，连用10d。标准三联组（47例）给予雷贝拉唑10mg，克拉霉素500mg和替硝唑400mg，均每天两次，连用7d。所有患者在根治Hp后继续用雷贝拉唑10mg，每日1次口服，合计总疗程均为4周。停药4周后复查胃镜观察溃疡愈合情况并检测Hp。结果序贯治疗组Hp根除率89．5％（43／48），标准三联组Hp根除率70．2％（33／47），Hp根除率比较2组差异有统计学意义（P〈0．05）。序贯治疗组溃疡愈合率87．5％（42／48），标准三联组溃疡愈合率82．9％（39／47），溃疡愈合率比较2组差异无统计学意义（P〉0．05）。结论序贯治疗对Hp阳性十二指肠溃疡患者Hp根除率高于标准三联疗法，溃疡愈合率近似。

Objective To compare the efficacy of 10-day sequential therapy （including rabeprazole amoxillin clarithromycin tinidazole） and 7-day traditional trigeminy therapy （including rabeprazole amoxillin and clarithromycin） in patients with duodenobulbar ulcer and Hp infection. Methods Ninty-five patients with duodenobulbar ulcer and Hp infection were enrolled into the study and divided into two groups randomly： sequential therapy group and traditional trigeminy therapy group. Patients in the first group received 10-day sequential medications：rabeprazole 10 mg plus amoxillin 1 g for the first 5 days,followed by rabeprazole 10 mg plus clarithromycin 500 mg and tinidazole 500 mg for another 5 days;while in the second group patients received the standard 7-day traditional triple medications ： rabeprazole 10 mg plus clarithromycin 500 mg and tinidazole 400 mg. All drugs were given twice daily. All patients received rabeprazole 10 mg daily following the two types of therapys for another four weeks, kip statuses were assessed by rapid urease test and 14C urea breath test at baseline and 4 weeks after completion of the treatment. Ulcer cicatrization was assessed by gastroscope. Results The eradication rate of Hp infection was significantly higher in sequential group than triple group （ 89. 5% vs. 70. 2%, P 〈 0. 05 ）, but we found no statistically significant difference in the comparison of the ulcer cicatrization rate between sequential group and triple group （87. 5% vs. 82. 9% ,P 〉 0. 05 ）. Conclusion Sequential therapy had a better Hp eradication effect than standard triple therapy, but the eradication rate was very close between the two therapys.