不同方案根除幽门螺旋杆菌效果对比分析

Comparison of efficacy of different treatment regimens on H. Pylori Eradication

目的观察以质子泵抑制剂（PPI）为基础的不同方案根除幽门螺旋杆菌（Hp）的效果。方法选择经内镜下活检病理及快速尿素酶试验确诊的1203例Hp感染患者，根除Hp疗程结束4周以上复查13C-尿素呼气试验，回顾性分析不同根除Hp方案疗效。所有患者均采用PPI为基础（埃索美拉唑、雷贝拉唑、兰索美拉唑、泮托拉唑、奥美拉唑，常规量每日2次）＋不同抗菌药物的三联或四联方案，用药疗程分为7、10、14d。A组421例：阿莫西林1．0g，2次／d，克拉霉素0．5g，2次／d；B组49例：阿莫西林1．0g，2次／d，左氧氟沙星0．2g，2次／d；C组69例：阿莫西林1．0g，2次／d，甲硝唑0．4g，2次／d；D组559例：克拉霉素0．5g，2次／d，左氧氟沙星0．2g，2次／d；E组105例：克拉霉素0．5g，2次／d，甲硝唑0．4g，2次／d。铋剂均为胶体果胶铋200mg，20：／a。结果含阿莫西林组Hp根除率为84．04％（453／539），不含阿莫西林组为69．12％（459／664），前者明显优于后者（X。=36．104，P=0．000），Hp的根除率可提高14．92％。四联疗法根除率76．85％（767／998），三联疗法根除率70．73％（145／205），但两组之间疗效比较差异无统计学意义（x。=3．476，P=0．062）。7、10、14d疗程根除率分别为71．07％（199／280）、75．79％（579／764）、84．28％（134／159），3个疗程疗效差异有统计学意义（X2=9．644，P：0．008），14d疗程Hp根除率明显优于7、10d疗程，差异均有统计学意义X2值分别为11．719，5．399，P值分别为0．001，0．020），7、10d两组间根除率差异无统计学意义（X2=2．398，P=0．121）。A组Hp根除率84．80％（357／421）、B组81．63％（40／49）、C组81．16％（56／69），优于D组69．95％（391／559）、E组64．76％（68／105），不同抗菌药联合根除Hp疗效对比差异有统计学意义（X2=37．999，P=0．000）。结论根除Hp治疗中应以PPI为基础，首选阿莫西林与克拉霉素联合用药的三联或四联14d疗程治疗方案，其临床疗效值得推广。

Objective To compare the efficacy in radical cure of H. Pylori （Hp） by different proton pump inhibitor （PPI）-based treatment regimens. Methods One thousand two hundred and three H. Pylori- infected patients diagnosed by both endoscopic pathology and a rapid urease test were enrolled in this study. Reviewed is C- urea breath test at the end of Hp eradication treatment for more than 4 weeks, and retrospective analyzed the different effect of Hp eradication regimens. All patients were given treatment regimens, which including PPI （ esomeprazole azole, bella, esomeprazole, pantoprazole omeprazole, 2 times/d ） plus antimicrobial for 7,10,14 d. According to antimicrobial, patients were divided into A, B, C, D, E group. Patientss in group A （421 cases） were given amoxicillin 1.0 g, 2 times/d, clarithromycin O. 5 g,2 times/d ; In group B （49 cases） were given amoxicillin 1.0 g,2 times/d,levofloxacin O. 2 g,2 times/d;In group C（69 cases） were given amoxicillin 1.0 g,2 times/d,metronidazole 0. 4 g,2 times/d;In group D（559 cases） were given clarithromycin O. 5 g/d,2 times/d, levofloxacin O. 2 g,2 times/d and in group E （105 cases） were clarithromycin O. 5 g, 2 times/d, metronidazole 0. 4 g, 2 times/d. Bismuth were colloidal bismuth pectin 200 mg, 2 times/d. Results The radical cure rate of Hp was 84. 04% （453/539） in the group treated by regimens with Amoxicillin, and significant higher than that of without Amoxicillin （ 69. 12% （ 459/664 ）, X2 = 36. 104, P = 0. 000 ）, and the radical cure rate of Hp was 14. 92%. The Hp radical cure rate of quadruple therapy was 76. 85% （767/998）, while triple therapy was 70. 73% （145/205）. However, no significant difference between these two regimens was found（ X2 = 3. 476,P = 0. 062）. The Hp radical cure rates of 14-, 10- and 7-day course therapies were 84. 28%（ 134/159）, 75. 79% （ 579/764 ）, 71.07 % （199/280） respectively, and there was significant different among the three groups （X2 = 9. 644, P = 0. 008 ）. There was significant increases trend in the 14-day therapy group comparing to 10- and 7-day regimen groups （ X2 = 5. 399,11. 719, P = 0. 020,0. 001 respectively ）, while no significant difference was shown between the 10- and 7-day therapy groups（ X2 = 2. 398 ,P = 0. 121 ）. The radical cure rates were 84. 80% （357/421）, 81.63% （40/49）, 81.16% （56/69）, 69. 95% （391/559）, 64. 76% （68/105） respectively in A, B, C, D and E groups, and there was significant difference among the groups （X2 = 37. 999 ,P = 0. 000 ）. Conclusion Radical cure therapy of Hp should be PPI-based. A 14-day triple or quadruple treatment regimen with combination of Amoxicillin and clarithromycin is suggested as a first-line therapy. It is worth to clinically popularize such regimens in the light of the superior efficacy.