药物三联疗法联合双歧杆菌乳杆菌三联活菌治疗船员幽门螺杆菌的临床观察

Clinical observation on the effects of drug triple therapy combined with bifidobacterium and lactobacillus triple live bacteria on the radical treatment of Helicobacter pylori among the seafarers

目的探讨药物三联疗法联合双歧杆菌乳杆菌三联活菌对船员幽门螺杆菌（helicobacter pylori，Hp）根除治疗中的疗效。方法根据患者意愿，将126例Hp感染且患有消化性溃疡的船员分为2组，对照组用兰索拉唑＋克拉霉素＋阿莫西林治疗；治疗组用兰索拉唑＋克拉霉素＋阿莫西林＋双歧杆菌乳杆菌三联活菌治疗，疗程均为2周。停药4周后复查”C尿素呼气试验及胃镜，观察2组幽门螺旋杆菌根除率、溃疡愈合率及不良反应发生情况。结果胃肠道不良反应中，恶心、腹胀、腹泻及味觉异常的发生率，治疗组分别为41．7％、46．7％、25．0％、30．0％，对照组分别为73．6％、66．0％、52．8％、56．6％，2组比较差异有统计学意义（P〈0．05或P〈0．01）；治疗4周后，对照组与治疗组溃疡愈合率分别为90．57％、95．00％，差异无统计学意义（P〉0．05）；对照组根除率按意愿（intention—to—treat，iTr）分析和按方案（per—protocol，PP）分析分别为71．4％、84．1％，治疗组分别为84．9％、88．3％，2组比较差异均无统计学意义（P〉0．05）。结论药物三联疗法联合双歧杆菌乳杆菌三联活菌不能提高Hp根除率及溃疡愈合率，但能够显著降低药物三联疗法的胃肠道不良反应，提高患者依从性。

Objective To investigate the effects of drug triple therapy combined with bifidobacterium and laetobacillus triple live bacteria on the radical treatment of Helicobacter pylori （Hp） among the seafarers. Methods In accordance with the wishes of the patients, 126 Hp-infected eases with peptic ulcer were divided into 2 groups. The control group was treated with lansoprazole, clarithromycin and amoxieillin for a succession of 2 weeks. The therapeutic group received lansoprazole, clarithromycin and amoxicillin combined with bifidobaeterium and lactobacillus triple live bacteria, also for a succession of 2 weeks. All the patients in both groups were detected with 13 C-urea breath test and gastroscopy, 4 weeks after withdrawal of the drug, and observations were made on Hp eradication rate, peptic ulcer heal rate and rate of adverse reactions in the patients of both groups. Results For adverse reactions in the gastrointestinal system of the therapeutic group, incidence of nausea, abdominal distention, diarrhea and parageusia accounted for 41.7%, 46.7%, 25.0% and 30.0% respectively, while the data for the control group were 73.6% , 66.0% , 52.8% and 56.6% respectively. Statistical significance could be noted, when comparisons were made between the 2 groups （P 〈 0.05 or P 〈0.01 ）. Following 4 weeks of treatment, peptic ulcer heal rates of both groups were 90.57% and 95.00% respectively, without statistical significance（ P 〉 0.05 ）. In accordance with intention-to-treat （ITF） and per-protocol （PP） analyses, eradication rates for the control and therapeutic groups were 71.4% and 84.1% , 84.9% and 88.3% respectively, without any statistical significance （ P 〉 0.05 ）. Conclusions Drug triple therapy combined with bifidobacterium and lactobacillus triple live bacteria failed to increase the healing rate of ulcer and eradication rate of Hp in seafarers. However, it could obviously decrease adversereactions in the gastrointestinal system induced by drug triple therapy and helped to increase the compliance of patients.