两种三联疗法治疗幽门螺杆菌相关的十二指肠溃疡

Comparison of different triple therapy for treatment of Helicobacter pylori infection associated duodenal ulcer

目的 :观察两种三联疗法治疗幽门螺杆菌 (Hp)相关的十二指肠溃疡。方法 :6 6例甲硝唑敏感的患者随机分为两组 ,铋剂组 (34例 ) :po德诺 2 40 mg bid,克拉霉素 5 0 0 m g tid,甲硝唑 40 0 g bid;奥美拉唑组 (32例 ) :po奥美拉唑 2 0 mg qd,羟氨苄青霉素 5 0 0 m g tid,甲硝唑 40 0 mg bid。疗程均为 2 wk。疗程结束 1mo后胃镜复查。 2 3例体外培养为甲硝唑耐药菌株者也分为两组服用上述药物。结果 :对甲硝唑敏感菌株 ,铋剂组的 Hp根除率和溃疡愈合率分别为 91.2 %、94.1% ,稍高于奥美拉唑组的 87.5 %、93.7% ,但无统计学差异 (P>0 .0 5 ) ;但平均不良反应积分铋剂组为 4.2 5 ,奥美拉唑组为 2 .2 6 ,两组比较有显著性差异 (P<0 .0 5 )。对甲硝唑耐药菌株 Hp的根除率在铋剂组和奥美拉唑组分别为 83.3%和 6 3.6 % (P>0 .0 5 )。结论 :两种疗法在治疗 Hp相关 (无论对甲硝唑耐药或敏感 )的十二指肠溃疡疗效相当 ,具有疗效高、不良反应发生率低。铋剂组的不良反应高于奥美拉唑组。

AIM:To compare different triple therapy for treatment of Helicobacter pylori ( Hp ) associa ted duo denal ulcer (DU). METHODS: Sixty six metronidazole sensitive patients were randomly devided into 2 groups: 34 patients (A, bismuth group) were given De Nol 240 mg, bid, clarithromycin 500 mg, tid, metronidazole 400 mg, bid; 32 patients (B, omperazole group) were given omperazole 20 mg, qd, amoxicillin 500 mg, tid, metronidazole 400 mg, bid, the course was 2 wk. Upper endoscopy was performed 1 mo after the end of the course. Twenty three metronidazole resistant patients were also treated with one of above two triple therapy. RESULTS: In patients with metronidazole sensitive strains, the eradication rates of Hp and the healing rates of DU were 91 2% and 94 1%, respectivcly in bismuth group, in omperazole group, which were 87 5% and 93 7%, resepctively, but there were no significant differences in the eradication rates of Hp and the healing rates of DU between the 2 groups ( P >0 05, P >0 05, respectively). The mean total adverse drug reaction (ADR) score was 4 25 in bismuch group, 2 26 in omperazole group, the former was higher than the latter ( P <0 05). In patients with metronidazole resistant strains, the eradication rates of Hp was 83 3% in bismuth group and 63 6% in omperazole group ( P <0 05). CONCLUSION: Both regimens are effective in treatment of Hp associated DU, the ADRs are low. In patients with metronidazole resistant strains, the efficacy in bismuth group is higher than in omperazole group, but at the same time ADRs occur more often in bismuch group.