不同时期抗幽门螺杆菌对溃疡愈合质量及与复发的研究

Effect of anti-helicobacter pylori on quality of ulcer healing and recurrence in different stages of treatment for DU

为探讨在十二指肠溃疡（ ＤＵ） 治疗的不同时期抗幽门螺杆菌（ ＨＰ） 对溃疡愈合质量（ ＱＯＵＨ） 及其与复发的关系，以及对治疗后准确评估ＨＰ 根除的时间，将２５３ 例胃镜确诊的ＨＰ 阳性活动期ＤＵ 患者随机分为三组。Ａ 组先抗ＨＰ 治疗；Ｂ 组抗ＨＰ 与奥美拉唑（Ｏｍ ｅ） 同时应用；Ｃ 组先用Ｏｍ ｅ 。结果三组溃疡愈合率１００ ％ 。１ 年溃疡复发率Ａ 组显著低于Ｂ和Ｃ 组（ Ｐ ＜ ０ ．０５） 。Ｓａ 期溃疡瘢痕较Ｓｂ 和Ｓｃ 期更易复发（ Ｐ ＜ ０ ．０５） ，Ｓｃ 期无一例复发。Ａ 组进入Ｓｃ 期者显著高于Ｂ组和Ｃ 组（ Ｐ ＜ ０ ．０５） 。三组ＨＰ 根除率差异无显著性（ Ｐ ＞ ０ ．０５） ，停用Ｏｍ ｅ１ 个月后ＨＰ 检出率Ａ 组显著低于Ｂ 和Ｃ组（ Ｐ ＜ ０ ．０５） 。提示：在应用Ｏｍ ｅ 之前先抗ＨＰ 可改善ＱＯＵＨ 减少复发，可能与防止ＨＰ 球变有关；停用Ｏｍ ｅ １ 个月后ＨＰ 检出率较根除率更有临床价值。

This study assessed the efficacy of anti-helicobacter pylori (HP) on quality of ulcer healing (QOUH) and recurrences in different treatment stages and the eradication time of HP. 252 patients with dynamic ulcer proven by gastric endoscopy were divided randomizedly into groupsA, B, and C. GroupA was treated with anti-HP firstly. GroupB was treated with anti-HP and omeprazole (OME) at the same time. Group C was given OME firstly. Results showed that all patients in three groups were healed. The rate of recurrence in one year in groupA is lower than those in groupB and C (P<0.05). Healing ulcer in Sa stage recurred more easily than in Sb and Sc stage (P<0.05). No patients in Sc stage recurred. More patients in groupA developed into Sc stage than in groupB and C, (P<0.05). There was no significant difference in eradication rate in three groups, (P>0.05). The detectable rate of HP in groupA was obviously lower than in groupB and C after Ome was stopped giving, (P<0.05). It could be concluded that the treatment with anti-HP prior to OME was helpful for QOUH and could reduce the recurrence of ulcer. It might prevent coccoid HP. The detectable rate had more clinical value than the eradication rate one month after stopping giving OME.