含奥美拉唑二联及三联疗法对幽门螺杆菌阳性十二指肠溃疡的疗效及随访研究

Follow upstudy of dualandtripletherapies of omeprazolecombination for thetreatmentof duodenal ulcer with H. pyloriinfection

目的 探讨含奥美拉唑的二联及三联疗法对Ｈｐ 阳性十二指肠溃疡的疗效，并随访观察我国Ｈｐ 根除后复发和再感染的发生率以及对十二指肠溃疡复发的影响。方法 １７７ 例Ｈｐ 阳性的十二指肠溃疡病人随机分成两组，Ａ组口服奥美拉唑（洛赛克）２０ｍｇ 每日２ 次，羟氨苄青霉素１０００ｍｇ 每日２次；Ｂ组口服奥美拉唑２０ｍｇ 每日２ 次，羟氨苄青霉素１０００ｍｇ 每日２ 次，甲硝唑４００ｍｇ 每日２ 次，疗程均为２ 周，于停药后１ 个月、１２ 个月复查胃镜。对Ｈｐ 根除后再现的病人，比较治疗前后菌株的基因型，鉴别复发和再感染。结果 奥美拉唑三联疗法Ｈｐ 根除率及溃疡愈合率分别为９２．１１ ％ 和９７．３７％ ，略高于二联疗法的８２．０５％ 和９４ ．８７ ％ ，但差异无显著性（ Ｐ＞ ０．０５） ，两组病人均未发现严重副反应。在完成随访的３８ 例Ｈｐ 根除的病人中，４ 例感染复发，１ 例Ｈｐ 再感染，复发和再感染率分别为１０ ．５３％ 和２．６３％ 。Ｈｐ 根除组十二指肠溃疡复发率为６．０６％ ，明显低于Ｈｐ 未根除或Ｈｐ 感染再现组的６４．２９ ％（ Ｐ＜０ ．００５）。结论 含奥美拉唑的二联及三联疗法均可达到较满意的Ｈｐ 根除率及溃疡愈合率，我国Ｈｐ根除后年再感?

Objective Toinvestigatetheefficacyofdualandtripletherapiesofomeprazolecombination forthetreatmentof duodenal ulcer with H. pyloriinfection. Rates of recrudescence and reinfection of H. pyloriaftereradication were also determined byfollow up study.Methods Seventy seven patients with H. pyloripositive duodenal ulcer were randomised into two groups. Group Areceived omeprazol 20mg bid, amoxicillin 1000mg bid,and group Bomeprazol20mg bidcombined with amoxicillin 1000mg bid and metron idazole 400mg bid.Both therapies wereadministered fortwo weeks.Endoscopicexamination wascarried be foretreatmentand one month,twelve monthsaftercessation ofthetreatment.Recrudescenceandreinfection were determined by comparing genotype of strains before and after treatment.Results Eradication rates of H.pylori were 82 .05 % and 92.11% in group Aand group B,respectively (P> 0.05) .Ulcerhealingrates were 94.87% and 97.37% in group Aand group B,respectively ( P> 0.05). No seriousside effects were foundin both groups.Amongthethirty eight patientsthat H. pylori were successfully eradicated,four pa tients wererecrudescentand onereinfected.Ratesofrecrudescenceandreinfection were10 .53 % and2 .63 % , respectively.Relapse rate of duodenalulcerin patients with H.pylori eradication was 6 .06 % , which was muchlowerthan thatin patients with H. pyloriinfection ( P<0 .005).Conclusions Dualandtriplethera pies ofomeprazolecombination were both highlyeffectiveinthetreatmentofduodenalulcer with H.pyloriin fection.Rate ofreinfection of H. pyloriaftereradication was2 .63 % peryearin ourcountry.Duodenalulcer would relapseif H.pyloriinfection continued orrecurred.