7日序贯疗法根除幽门螺杆菌的随机对照研究

Random and research of eradication of Helicobacter pylori with seven days sequential therapy

目的比较雷贝拉唑、阿莫西林、克拉霉素、呋喃唑酮组成的7日序贯疗法与标准三联疗法、10日序贯疗法根除幽门螺杆菌的疗效。方法将经检查确诊为慢性胃炎或消化性溃疡且Hp阳性的300例患者随机分成三组。治疗组(100例):前3d雷贝拉唑10mg,阿莫西林1000mg,克拉霉素500mg,2次/d;后4d雷贝拉唑10mg,阿莫西林1000mg,呋喃唑酮100mg;2次/d。对照组一(100例)为标准三联疗法:雷贝拉唑10mg,阿莫西林1000mg,克拉霉素500mg,2次/d,疗程7d。对照组二(100例)为10日序贯疗法:前5d雷贝拉唑10mg,阿莫西林1000mg,2次/d;后5d雷贝拉唑10mg,克拉霉素500mg,呋喃唑酮100mg;2次/d。所有患者停药4周后复查14C-呼气试验,检测Hp根除率。结果治疗组Hp根除率为88.76%,对照组一77.27%,对照组二90.11%,治疗组与对照组一比较、对照组一与对照组二比较,差异均有统计学意义(P<0.05),而治疗组与对照组二比较差异无统计学意义(P>0.05);且7日序贯疗法并未增加患者的经济负担,3种方案不良反应的发生率无明显差异(P>0.05)。结论 7日序贯疗法治疗Hp感染疗效明显优于7日标准三联疗法,与10日序贯疗法相当,是一种安全、经济、有效的方案选择。

Objective To determine whether the 7-day sequential therapy is better than the standard triple-drug therapy and the 10-day sequential therapy in treatment of Hp infection for adults with chronic gastritis or peptic ulcer.Methods 300 patients with Hp positive were randomly divided into three groups.100 patients received the 7-day sequential therapy [rabeprazole（10mg,twice daily）plus amoxicillin（1000mg,twice daily）plus clarithromycin（500mg,twice daily）for the first 3 days,followed by rabeprazole（10mg,twice daily）plus amoxicillin（1000mg,twice daily）plus furazolidone（100mg,twice daily）for the remaining 4 days].100 patients received the 7-day triple therapy [rabeprazole（10mg）,amoxicillin（1000mg）,clarithromycin（500mg）,twice daily].100 patients received the 10-day sequential therapy [rabeprazole（10mg,twice daily）plus amoxicillin（1000mg,twice daily）for the first 5 days,followed by rabeprazole（10mg,twice daily）plus clarithromycin（500mg,twice daily）plus furazolidone（100mg,twice daily）for the remaining 5days].Hp eradication was checked four weeks after treatment using 14C-urea breath test.Results The eradication rate of the 7-day sequential therapy was 88.76%,triple therapy was 77.27%,and 10-day sequential therapy was 90.11%.The difference between 7-day sequential therapy and 7-day triple therapy,7-day triple therapy and 10-day sequential therapy were all significant（P0.05）,but there was no difference between 7-day sequential therapy and 10-day sequential therapy.7-day sequential therapy did not increase the financial burde and there was no difference in incidence of side effects between the three groups（P0.05）.Conclusion The 7-day sequential therapy achieves a higher eradication rate than the standard triple therapy for the first time in adults,and the rate is no difference between 7-day sequential therapy and 10-day sequential therapy.It is an effective,safe and economical option for patients and possesses great potential.