门诊幽门螺杆菌感染者治疗分析

Analysis of Treatment of Outpatients with Helicobacter pylori Infection

背景：在幽门螺杆菌（Hp）感染的根除治疗中，患者的执行是治疗链的最终端和关键环节，但在临床实践中常常被忽视。目的：从门诊患者角度了解Hp感染根除治疗中存在的问题，以促进治疗的进一步规范化。方法：对2012年12月1日～2013年4月1日在新疆医科大学第一附属医院消化科门诊就诊的Hp感染者进行调查，调查内容包括治疗原因、根除治疗药物、疗程、复查时间和复查结果。结果：共139例次门诊Hp感染者纳入研究，治疗原因主要是慢性胃炎，占61．9％。根除治疗方案主要采用第三次全国共识推荐的PPI＋两种抗菌药物三联疗法，以PPI＋阿莫西林＋克拉霉素标准三联疗法为主，占46．8％；采用第四次全国共识推荐的铋剂＋PPI＋两种抗菌药物四联疗法者仅占18．7％；采用不规范方案者占9．4％。43．2％的患者疗程为第四次全国共识规定的10～14d，69．1％的患者于停药≥4周后复查。结论：在执行Hp感染的根除治疗时，临床医师应及时进行知识更新，掌握最新共识推荐的根除治疗方案，并注意对患者进行治疗方案的解释和交待。

Background： Execution in patients, the last and crucial step of Helicobacter pylori （Hp） eradication, is usually ignored in clinical practice. Aims： To investigate the problems existing in Hp eradication from the perspective of outpatients for further standardization of treatment process. Methods： A survey was conducted in patients recruited from outpatient clinic of Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University from 1 st Dec. 2012 to 1 st Apr. 2013. All patients enrolled were positive for Hp infection. Cause for eradication, treatment regimen and treatment course, time of re-examination and treatment outcome were inquired. Results： A total of 139 cases of outpatients with Hp infection were investigated. Chronic gastritis was the main cause for Hp eradication （61.9%）. Triple therapy containing PPI and two antibiotics recommended by the 3rd Chinese consensus was the commonly used eradication regimen, among which, the standard triple regimen, PPI plus amoxicillin and clarithromycin was the most frequently used one （46.8%）. Bismuth containing quadruple therapy （bismuth ＋ PPI ＋ two antibiotics） recommended by the 4th Chinese consensus was only adopted by lg. 7% of the cases. Non-regnlar regimens were used in a small portion of the cases （9.4%）. In 43.2% of the cases, the treatment course was 10-14 days as defined by the 4th Chinese consensus; re-examination was carried out four weeks after eradication therapy in 69.1% of the cases. Conclusions： For transacting the Hp eradication therapy, clinicians must update their knowledge promptly, grasping the treatment regimens recommended by the new consensus, and explaining the regimen in more detail to the patients.