慢性乙型肝炎伴萎缩性胃炎患者幽门螺旋杆菌感染序贯根除的疗效

Clincal effects of H. pylori eradication with 10-day sequential therapy in patients with chronic atr phic gastritis and chronic hepatitis B

目的探讨慢性乙型肝炎伴萎缩性胃炎患者幽门螺旋杆菌的感染率及序贯根除的临床效果。方法300例慢性乙型肝炎患者通过胃镜进行组织活检,病理证实为慢性萎缩性胃炎,均通过组织WS染色及14C-尿素呼气试验(UBT)检测幽门螺旋杆菌,其中195例阳性者随机分为治疗组105例和对照组90例,治疗组先给予雷贝拉唑+阿莫西林5 d,随后给予雷贝拉唑+克拉霉素+甲硝唑5 d,进行10 d序贯治疗,对照组给予传统三联既雷贝拉唑+克拉霉素+阿莫西林7 d疗法,治疗结束4周后予14C-UBT复查。结果慢性乙型肝炎患者伴萎缩性胃炎幽门螺旋杆菌的感染率为65.0%,传统方法幽门螺旋杆菌的根除率约为70.0%,治疗组幽门螺旋杆菌的根除率达92.3%,两者比较,10 d序贯疗法明显优于7 d疗法(P<0.05),两组副作用发生率无明显差异。结论慢性乙型肝炎伴萎缩性胃炎患者幽门螺旋杆菌的感染率较高,序贯治疗有较好的根除效果。

Objective To study the effects of H. pylori eradication with 10-day sequential therapy and the infectious rates of H. pylori in gatiqnts with chronic atrophic gastritis and chronic hepatitis B. Methods ：Gastrtl mucosa was observed by electric gastroscope in 300 cases of patients with chronic hepatitis B, the pathology of gastru mucosa were studied by biopsy and atrophic gastritis confirmed were. 195 patients with atrophic gastritis H. pylofi mtection was proved by W-S tissue stainning andl4C-urea breath test （14C-UBT） The patients were randomly divided into two groups 105 patients were administered with 10-day sequential therapy and 90 patients received 7-day standard triple therapy. 14C-UBT were reexamined 4 weeks after a course of treatment to evaluate the eradication of H. pylori. Results In 300 cases , H. pylori were positive in 195 cases and the total positive rateswere 65%. The H. pylori eradication rates in 10-day sequential therapy group were significantly higher than those in 7-day standard triple therapy group （92. 3% vs70% ,p 〈 0. 05 ）. The incidence of adverse reactions in 10-day sequential therapy group and 7-day triple therapy group were no significantly difference. Conclusion The positive rat of H. pylori was higher in patients with chronic atrphic gastritis and chronic hepatitis B, 10-day sequential therapy has high eradication rate.