含左氧氟沙星的三种方法根除幽门螺杆菌疗效比较

Analysis of the effect of triple, colloidal bismuth pectin quadruple and sequential therapies with levofloxacin on Helicobacter pylori infection Sill

目的比较含左氧氟沙星的三联疗法、铋剂四联疗法及序贯疗法根治幽门螺杆菌（Hp）的疗效。方法115例Hp阳性患者按时间先后顺序随机分为3组：三联组38例，给予口服兰索拉唑胶囊30mg、阿莫西林克拉维酸钾片685．5mg、左氧氟沙星胶囊200mg，2次／d，治疗7d；四联组38例，予以口服兰索拉唑胶囊30mg、阿莫西林克拉维酸钾片685．5mg、左氧氟沙星胶囊200mg、胶体果胶铋胶囊200mg，2次／d，7d；序贯组39例，前5d口服兰索拉唑胶囊30mg、阿莫西林克拉维酸钾片685．5mg，后5d口服兰索拉唑胶囊30mg、克拉霉素片500mg、左氧氟沙星胶囊200mg，均2次／d。疗程结束后4周复查”C呼气试验检查，评估治疗结果及不良反应。结果三联组完成35例，失访2例，未能按要求服药1例；铋剂四联组完成36例，失访2例；序贯组完成37例，未能按要求服药2例。三联组成功根除29例，按符合方案（PP）分析根除率为82．9％（29／35），意向性治疗（ITT）分析根除率为76．3％（29／38）；铋剂四联组成功根除32例，PP根除率为88．9％（32／36），ITT根除率为84．2％（32／38）；序贯组成功根除34例，PP根除率为91．9％（34／37），ITT根除率为87．2％（34／39）。3组间Hp根除率差异无统计学意义（P〉0．05）。结论含左氧氟沙星的铋剂四联与序贯治疗均有较高的Hp根除率，但从安全性与疗效方面考虑，含左氧氟沙星的铋剂四联疗法可作为Hp初治的首选方案。

Objective To compare the effect of triple, colloidal bismuth pectin quadruple and sequential therapies with levofloxacin on Helicobacter pylori （Hp） infection. Methods All 115 Hp positive patients were ran- domly allocated to three groups. The patients in triple therapy group received a 7-day triple therapy （ lansoprazole capsules 30 mg bid, amoxicillin and clavulanate potassium tablets 685.5 mg bid, levofloxacin capsule 200 mg bid）. Quadruple therapy group received a 7-day colloidal bismuth pectin quadruple therapy （ lansoprazole capsules 30 mg bid, colloidal bismuth pectin 200 mg bid, amoxicillin and clavulanate potassium tablets 685.5 mg bid, levofloxacin capsule 200 mg bid）. Sequential therapy group received a 10-day sequential therapy （lansoprazole capsules 30 mg bid, amoxicillin and clavulanate potassium tablets 685.5 mg bid for the first 5 days; lansoprazole capsules 30 mg bid, clarithromycin 500 mg bid and colloidal bismuth pectin 200 mg bid for the remaining 5 days）. We assessed the effect of the eradication of Hp by 14C-urea breath test after finishing of Hp therapy at least four weeks later, and ad- verse reactions were analysed. Results According to intention-to-treat（ITr）, the eradication rates in triple therapy group, quadruple group, sequential therapy group were 76.3% （29/38）, 84.2% （32/38） and 87.2% （34/39） ; according to per-protocol（ PP）, the eradication rates in triple therapy group, quadruple group, sequential therapy group were 82.9% （29/35）, 88.9% （32/36）, 91.9% （34/37）. There were no significant differences among three groups （ P 〉 0.05 ）. Conclusion Quadruple group and sequential therapy group of levofloxacin both have higher Hp eradication rates, but taking the security and the curative effect into consideration, colloidal bismuth pectin quadrup- le therapy with levofloxacin can be used as the first choice of the eradication of Hp for the first treatment.