四联疗法与序贯疗法根除幽门螺杆菌疗效观察

Comparative Study on Quadruple and Sequential Therapies for H.pylori Eradication

目的:探讨四联疗法和序贯疗法根除幽门螺杆菌的疗效和安全性。方法:将150例14C尿素呼气试验阳性的慢性胃炎患者随机分为A、B、C 3组各50例。A组(四联疗法)给予雷贝拉唑、枸橼酸铋钾、克拉霉素、阿莫西林治疗7 d;B组(序贯疗法)前5d给予雷贝拉唑、阿莫西林,后5d给予雷贝拉唑、克拉霉素、甲硝唑治疗;C组(标准三联疗法)给予雷贝拉唑、克拉霉素、阿莫西林治疗治疗7 d。疗程结束4周后行14C尿素呼气试验检测。结果:A组根除率为94%,B组根除率为90%,C组根除率68%。A组和B组优于C组(P<0.01);A组、B组无显著差异性(P>0.05)。三组均无严重不良反应。结论:四联疗法与序贯疗法H.pylori根除率优于标准三联疗法,四联疗法和序贯疗法疗效无明显差异性。

Objective： To evaluate the curative effect and safety of quadruple and sequential therapies for H.pylori eradication. Methods： A total of 150 H.pylori-positive patients were enrolled in the study and randomly allocated into the following three groups： group A were treated with 10 mg rabeprazole bid, 220 mg bismuth pectin bid,500 mg clarithromycin bid, 1000 mg amoxicillin bid for 7 days; group B were treated with 10 mg rabeprazole bid, 1000 mg amoxicillin bid, for the first 5 days; followed by 10 mg rabeprazole bid, 500 mg clarithromycin bid, 400 mg metronidazole bid,for the remaining 5 days; group C were treated with 10 mg rabeprazole bid, 500 mg clarithromycin bid, 1000 mg amoxicillin bid for 7 days. Helicobacter pylori status was assessed by 14C-urea breath test at baseline at 4 weeks after completion of treatment. Results： The eradication rate was 94 % in group A, 90 % in group B, and 68 % in group C. The eradication rate of either group A or B was statistically higher than that of group C （P 〈0.01）, and there is no statistical difference between the eradication rate of group A and B （P 〉0.05）.The three treatment protocols were generally well tolerated. Conclusion： Quadruple and sequential therapies have achieved significantly higher eradication rates in comparison with standard triple therapies, but there is no significant difference between quadruple and sequential therapies.