洛赛克、克拉霉素合并呋喃唑酮或甲硝唑短程三联疗法根除幽门螺杆菌的研究

Short-Term Triple Therapies with Losec, Clarithromycin plus Furazolidone or Metronidazole for Eradication of Helicobacter pylori Infection

70例幽门螺杆菌(Hp)感染的消化性溃疡或功能性消化不良患者随机分成A、B两组,接受7天抗Hp三联治疗。A组的治疗方案为:洛赛克20mg、克拉霉素250mg和呋喃唑酮100mg,一日二次:B组的方案为:洛赛克20mg、克拉霉素250mg和甲硝唑400mg,一日二次:A、B组中分别有1例和2例失访。结果显示,A、B组的Hp根除率分别为88.2％(30/34)和78.8％(26/33)(P=0.297):治疗前Hp菌株对克拉霉素和甲硝唑的耐药率分别为5.9％(4/67)和37.7％(25/67):克拉霉素耐药4例的Hp均未得到根除:B组中对甲硝唑耐药者的Hp根除率为66.6％(8/12),而敏感者的根除率为85.7％(18/21)(P=0.198);A、B组中消化性溃疡的愈合率分别为93.3％(14/15)和85.7％(12/14)(P=0.501);两组中各2例有轻度的副反应。Hp菌株对克拉霉素、甲硝唑耐约是影响上述低剂量、短疗程方案疗效的重要因素。A组三联疗法的Hp根除率高于B组,可作为第一或第二线方案应用。

Aims: To evaluate the effects of short-term low-dose triple therapies with Losec, clarithromycin (CLA) plus furazolidone (FUR) or metronidazole (MET) on eradicating Helicobacter pylori (Hp). and to determine the influence of primary resistance to CLA and MET on the efficacy of the therapies. Methods: Seventy patients with peptic ulcer or functional dyspepsia associated with Helicobacter pylori (Hp) infection received one week triple therapy with Losec 20mg bid. CLA 250mg bid. plus FUR 100mg bid (Group A) or MET 400mg bid (Group B). Endoscopy and biopsy were performed before and 4 weeks after cessation of treatment. Hp was detected by the urease test, culture and histology, and the sensitivity test of Hp to CLA and MET was carried out by disc diffusion. Results: Three patients (1 in group A. 2 in group B) were dropped out. The eradication rates of Hp in group A and Group B were 88.2%(30. 34) and 78.8%(26/33)<P = 0.297), and the primary resistance rates of Hp isolates to CLA and MET were 5.9%(4 67) and 37.3%(25 67) respectively. The patients infected with CLA-resistant isolates all failed to be cured. The eradication rate was 85.7%(18/21) in patients with MET-sensitive isolates while the rate was 66.6%(8 12) in those with MET-resistant isolates (P = 0.198). Side effects were mild and few in both groups. Conclusions: Primary CLA- and MET-resistance is the major factor in influencing the efficacy of the low-dose triple therapy. The short-term low-dose triple therapy with FUR as the alternative to MET may get better results.