含铋剂四联疗法作为幽门螺杆菌根除失败后补救治疗方案的疗效

Outcomes of bismuth-containing quadruple rescue regimen in treating helicobacter pylori-positive patients failed to the first-line eradication regimen

目的评估含铋剂四联疗法作为幽门螺杆菌(Hp)根除失败后补救治疗方案的疗效及安全性。方法选择经过一线或二线Hp根除治疗失败的90例患者,随机均分为A、B、C三组。A组给予雷贝拉唑20mg+枸橼酸铋钾胶囊220mg+阿莫西林1.0g+呋喃唑酮0.1g;B组给予雷贝拉唑+铋剂+阿莫西林+多西环素0.1g;C组给予雷贝拉唑+铋剂+多西环素+呋喃唑酮。均每日2次,疗程10d。随访6周。治疗结束至少4周后通过13 C-尿素呼气试验确定Hp根除率。结果总Hp根除率为76.7%[按意愿治疗分析(ITT)]和81.2%[按方案分析(PP)]。完成治疗A组28例,B组29例,C组28例,Hp根除率分别为:ITT 73.3%、PP 81.5%;ITT 80%、PP 82.8%;ITT76.7%、PP 82.1%。组间比较(P>0.05)。不良反应的发生率为7.8%,均在治疗1周内消失。结论雷贝拉唑、铋剂联合两种抗生素的四联疗法用于Hp根除失败后的补救治疗安全、有效。

Objective To study the effectiveness and safety of rescue treatment using bismuthcontaining quadruple regimen in treating helicobacter pylori（Hp）-positive patients failed to the firstline eradication regimen. Methods Ninty Hp-positive patients failed to the flrst-line eradication regimen were equally randomized into three groups. Group A was treated by ray Bella 20 mg＋bismuth 220 mg＋ amoxicillin 1.0 g-＋furazolidone 0. 1 g. Group B was treated by ray Bella＋bismuth ＋ amoxicillin＋doxycycline 0. 1 g. Group C was treated by ray Bella ＋bismuth＋furazolidone 0. 1 g＋ doxycycline 0. 1 g. The drugs were given twice a day for 10 days. Hp status was rechecked by 13C-urea breath test 4 weeks at the end of therapy. Results The eradication rates in intention to treat（ITT） and per protocol（PP） analyses were 73. 3% and 81.5% for group A（28 cases） ,80. 0% and 82.8% for group B（29 cases）, and 76. 7% and 82. 1% for group C（28 cases）. The differences among three groups were not significant（P〈0. 05）. The incidence rate of side effects was 7.8 %, which disappeared within one week. Conclusion Bismuth-containing quadruple regimen for Hp-positive patients after failure of first-line eradication regimen is effective and safe.