四联疗法及嗜酸乳杆菌在幽门螺杆菌根除治疗中的疗效评估

Efficacy of quadruple therapy and Lactobacillus acidophilus for Helicobacter pylori eradication

目的评估四联疗法及嗜酸乳杆菌在幽门螺杆菌(H.pylori)根除治疗中的疗效。方法 120例消化性溃疡或慢性胃炎H.pylori感染患者,随机分为4组:三联组(兰索拉唑30 mg,2次/d+克拉霉素缓释片0.5 g,2次/d+阿莫西林1.0 g,2次/d)、三联组+嗜酸乳杆菌(三联组+复方嗜酸乳杆菌片1.0 g,3次/d)、四联组(兰索拉唑30 mg,2次/d+克拉霉素缓释片0.5 g,2次/d+阿莫西林1.0 g,2次/d+枸橼酸铋钾胶囊220 mg,2次/d)、四联组+嗜酸乳杆菌(四联组+复方嗜酸乳杆菌片1.0 g,3次/d)。PPI及铋剂为早晚餐前半小时服用,抗生素为早晚餐后即服,嗜酸乳杆菌服用时间需与抗生素间隔2 h以上,3次/d,疗程均为10 d。治疗结束4周后行14C-尿素呼气试验,阴性者判断为H.pylori根除。随诊并记录患者药物不良反应,了解患者依从性和耐受性,并同步对其成本及效果进行分析。结果 4组患者的根除率分别为63.3%、88.9%、90.3%、90.6%。与三联组相比,其他3组根除率显著升高,差异有统计学意义(P<0.05)。与不含嗜酸乳杆菌组相比,含嗜酸乳杆菌组不良反应发生率明显减少(P<0.05)。4组方案中以四联组成本-效果比最低(5.88),三联组最高(8.04)。结论含铋剂四联方案H.pylori根除率显著高于标准三联方案成本效果比最低;嗜酸乳杆菌能显著降低抗生素相关副作用的发生率。

Objective To evaluate the efficacy of quadruple therapy and Lactobacillus acidophilus supplementation in the eradication treatment of Helicobaeter pylori （H. pylori）. Methods 120 patients with H. pylori related peptic ul- cer or chronic gastritis were randomized into 4 group ： Triple therapy （lansoprazole 30 mg bid, clarithromycin 0.5 g bid and amoxicillin 1.0 g bid） , Triple therapy plus Lactobacillus aeidophilus （Triple therapy plus Compound Eosinophil- Lactobacillus Tablets 1.0 gtid） , Quadruple therapy （lansoprazole 30 mg bid, clarithromycin 0.5 g bid, amoxicillin 1.0 g bid and bismuth potassium citrate 220 mg bid） , Quadruple therapy plus Lactobacillus acidophilus （Quadruple therapy plus Compound Eosinophil-Lactobacillus Tablets 1.0 g tid）. The course of treatment was 10 days. Outcome of eradication therapy was assessed by 14C-urea breath test performed at least 4 weeks after the end of treatment, IaC-UBT showed negative means H. pylori was eradicated, otherwise, means failed. Adverse reactions, compliance and tolerance were followed up. And their costs and effects were analyzed. Results The four groups eradication rates were 63.3% , 88.9% , 90.3% , 90.6% , compared with the triple therapy group, eradication rate was significantly higher in the other three groups. Compared with the groups without Lactobacillus acidophilus, the incidence of adverse reactions was signifi- cantly reduced in the groups containing Lactobacillus acidophilus （P 〈 0.05）. In four groups, the cost-effective ration of quadruple therapy was the lowest （5.88）, while the triple therapy was the highest （8.04）. Conclusion The H. py- lori eradication rate of quadruple therapy regimen was significantly higher than the triple therapy regimen. Lactobaeillus acidophilus could significantly reduce the incidence of antibiotic-associated side effects; the quadruple therapy regimen had higher eradication rate and lower cost-effective rations.