出血性十二指肠球部溃疡的三联与四联疗法对根治幽门螺杆菌的疗效比较

Anti Helicobacter pylori treatment in bleeding ulcer:Acontrolled trial comparing omeprazole and clar ithromycin quadrupletherapy versusbismuth tripletherapy

目的 旨在探讨铋剂，克拉霉素，甲硝唑和奥美拉唑的７ 天四联疗法对出血性十二指肠球部溃疡的愈合率和幽门螺杆菌（Ｈｐ）的根除率。方法 经紧急胃镜确诊的Ｈｐ 阳性的十二指肠球部溃疡并出血的住院患者止血后，改用铋剂１２０ｍｇ，克拉霉素２５０ｍｇ，甲硝唑２００ｍｇ，每日４ 次和奥美拉唑２０ｍｇ，每日２ 次的四联疗法，疗程为７ 天，治疗结束４ 周后复查胃镜，观察十二指肠球部溃疡愈合率和Ｈｐ 根除率，并以同期进行的低剂量三联疗法（铋剂１２０ｍｇ，阿莫西林２５０ｍｇ，甲硝唑２００ｍｇ，每日１ 次作为对照，疗程为２ 周。结果 四联疗法的Ｈｐ 根除率为９３ ．０ ％ ，高于三联疗法对照组的８０ ．０％ （ 二者差异无显著性，可能与病例较少有关） ；二者的溃疡愈合率分别为９３ ％ 和９２ ％（ Ｐ＞０ ．０５）；两组副反应发生率为２／２８ 例（７．１５％ ）和９／２５ 例（３６ ％） ，二者比较差异有显著性（Ｐ＜０ ．０５） ，而且四联疗法均在住院期间完成，故依从性较好。结论 奥美拉唑合用铋剂，克拉霉素，甲硝唑治疗７ 天的Ｈｐ 根除率＞ ９０ ％ ，且副反应少，依从性较好，为较为理想的Ｈｐ 根除方案。

Objective To evaluatethe efficacy,side effectand compliance of1 wk quadrupletherapy in eradicating Helicobacter pylori (Hp) and curing bleeding duodenal ulcer.Methods Patients with non ac tively bleeding duodenalulcerand Hpinfection wererandomizedtoreceivether1 wk quadrupletherapy (col loidal bismuth subcitrate120mg qid,clarithromycin 250mg qid,metronidazole200 mg qid,omeprazole20mg bid) or2 wk tripletherapy (colloidalbisnuth subcitrate 120mg qid,amoxycillian 250mg qid, mctronidazole 200mg qid).Theanti Hp therapy wascompleted during hospitalization.Endoscopy was repeated 5 wk after randomization toassessed ulcer healingand Hperadication.Results Quadrupletherapy achieved 93.0% (26/ 28)of Hp eradicationrateand93.0 %(26/28) ofulcerhealingrate,slghtly higherthanthoseintripletherapy (80 .0 % ,92.0 % ,respectively) ,which was notstatisticallysignificant(P> 0.05).There wassignificantdif ferenceintheincidenceofsideeffectin quadruplegroup(7.15% )andthatintriplegroup (36 %) , P<0 .05 , and quadrupletherapy was completed during hospitalization ,hence having good compliance.Conclusion De spitesimilar efficacyin ulcer healing,thequadrupletherapy is saferand more effectivethan triple therapyin healing Hpinfection.