克拉霉素为基础的三联方案根除幽门螺杆菌的疗效研究

Therapeutic Effect of Clarithromycin-based Triple Therapy for Helicobacter pylori Eradication

背景:克拉霉素是根除幽门螺杆菌(H.pylori)感染的有效药物,以克拉霉素为基础的三联方案根除H.pylori在临床上广泛应用。目的:评估克拉霉素为基础的三联方案根除H.pylori的疗效。方法:133例H.pylori感染患者随机分为3组,A组:埃索美拉唑20 mg bid+克拉霉素0.5 g bid+阿莫西林1 g bid,疗程7 d;B组:埃索美拉唑20 mg bid+克拉霉素0.5 g bid+左氧氟沙星0.5 g qd,疗程7 d;C组:埃索美拉唑20 mg bid+克拉霉素0.5 g bid+呋喃唑酮0.1 g tid,疗程7 d。治疗结束后4～8周复查^(13)C-尿素呼气试验和快速尿素酶试验以评估根除疗效。结果:128例患者按方案完成治疗。A、B、C组按意向治疗(ITT)分析H.pylori根除率分别为84.4%、77.3%、75.0%,按方案(PP)分析分别为88.4%、79.1%、78.6%。A组的ITT和PP根除率高于B组和C组,但差异无统计学意义(P>0.05)。结论:克拉霉素联合质子泵抑制剂(PP1)和阿莫西林7d疗法仍为有效的H.pylori感染根除方案。

Clarithromycin is effective for eradication of Helicobacter pylori （ H. pylori） infection. Clarithromycin- based triple therapy has been widely used in clinical practice. Aims： To assess the efficacy of clarithromycin-based triple therapy for H. pylori eradication. Methods： A total of 133 11. pylori-infected patients were enrolled and randomly assigned into three groups. Patients in group A were given esomeprazole 20 mg bid ＋ elarithromyein 0.5 g bid ＋ amoxicillin 1 g bid for 7 days. Patients in group B were given esomeprazole 20 mg bid ＋ clarithromycin 0.5 g bid ＋ levofloxacin 0.5 g qd for 7 days. Patients in group C were given esomeprazole 20 mg bid ＋ clarithromycin 0.5 g bid ＋ furazolidone 0.1 g tid for 7 days. At 4-8 weeks after a course of treatment, H. pylori eradication was assessed by 13 C-urea breath test and rapid urease test. Results： A total of 128 patients completed the study. H. pylori eradication rates by intention-to-treat （ITY） analysis in group A, B and C were 84.4%, 77.3% and 75.0% , respectively; by per-protocol （PP） analysis were 88.4% , 79.1% and 78.6% , respectively. The eradication rate in group A was higher than that in group B and C by both ITF and PP analysis, but no statistically significant differences were found among the three groups （ t9 〉 0.05 ）. Conclusions ： The proton pump inhibitor （PPI）-clarithromycin-amoxicillin 7-day triple therapy is still an effective treatment for eradication of H. pylori infection.