序贯疗法治疗幽门螺杆菌阳性消化性溃疡的疗效分析

Sequential Treatment for Helicobacter Pylori Eradication in Peptic Ulcer Patients

目的:比较10d序贯疗法与7d及14d三联疗法根治幽门螺杆菌(Hp)的疗效与安全性。方法:选取113例胃镜证实为消化性溃疡行14C尿素呼气试验Hp阳性患者,随机分为3组:A组(序贯疗法组)前5d给予泮妥拉唑和阿莫西林,后5d给予泮妥拉唑、替硝唑、克拉霉素治疗;B组(7d疗法)给予泮妥拉唑、阿莫西林、克拉霉素治疗,病理为7d;C组(14d疗法)方案同7d疗法,疗程为14d。疗程结束1个月后行14C尿素呼气试验。结果:A组根除率为87.18%(34/39),C组根除率为91.43%(34/37),均高于B组根除率81.08%(30/37)(P<0.05),A组与C组根除率比较无显著差别(P>0.05)。3组不良反应发生率分别为:15.38%、13.51%和18.91%,相互比较均无显著差异,A组费用效益比好于B组和C组。结论:10d序贯疗法疗效与14d三联疗法的疗效均好,序贯疗法费用效益比最低。10d序贯疗法安全、有效、经济。

Objective：To assess the efficacy and safety of a 10-day sequential regimen compared with conventional 7-day and 14-day triple therapies.Methods： Overall,113 Helicobacter pylori（H.pylori） infected patients with peptic ulcer were enrolled.All patients were randomized either to receive 10-day sequential therapy Group A,pantoprazole plus amoxicillin for the first 5 days,followed by pantoprazole,clarithromycin and tinidazole twice daily for the remaining 5 days or to standard 7-day therapy Group B,pantoprazole,clarithromycin and amoxicillin twice daily,or standard 14-day therapy Group C.Four weeks after therapy.H.pylori eradication was assessed by 14C-urea breath test.Results：H.pylori eradication was achieved in 34（87.18%） of 39 individuals in Group A,34（91.89%） of 37 in Group C and 30（81.08%） of 39 in Group B Sequential regimen and the 10-day showed a significant gain in the eradication rate as compared to the 7-day（P〈0.05） while there was no significant difference between Group A and Group C（P〈0.05）.Adverse drug events were similar in these three groups.Conclusions： The sequential regimen and standard 14-day therapy achieved higher cure rate than standard 7-day therapy.The sequential regimen had the lowest cost-effective ratio.The 10-day sequential regimen is significantly more effective,economic and safe than both triple regimens.