序贯治疗与标准治疗根除幽门螺杆菌的随机对照研究

The randomized controlled trial of sequential therapy and standard therapy for eradicating the helicobacter pylori

目的探讨幽门螺杆菌(Hp)相关胃炎的治疗对策。方法将胃镜及病理诊断为慢性萎缩性胃炎的103例患者和非慢性萎缩性胃炎120例患者分为3组并按不同方案给药。其中7d标准治疗组(80例)口服质子泵抑制剂(PPI)40mg,每日1次;阿莫西林1.0g,每12小时1次;克拉霉素0.5g,每12小时1次;连续服用7d停药。10d序贯治疗组(73例)口服质子泵抑制剂40mg,每日1次;阿莫西林1.0g,每12小时1次和克拉霉素0.5g,每12小时1次;服用7d后替换为左氧氟沙星0.2g,每8小时1次,呋喃唑酮30mg,每8小时1次;连续服用3d停药。12d序贯治疗组(70例)在10d的基础上将左氧氟沙星、呋喃唑酮延长2d结束疗程。结果 3组患者治疗后的内镜下表现和病理结果比较,差异无统计学意义(P>0.05)。7d标准治疗组Hp根除率为76.6%(59/77);10d序贯治疗组根除率为88.4%(61/69);12d序贯治疗组根除率为97.0%(64/66)。7d标准治疗组与12d序贯治疗组疗效比较,差异有统计学意义(P<0.05)。结论序贯治疗根除Hp明显优于标准治疗。

Objective To explore the treatment countermeasures for the helicobacter pylori （Hp） related gastritis .Methods 103 cases atrophic gastritis and 120 cases of non atrophic gastritis were diagnosed by gastroscope and pathology ,and were randomly di-vided into three groups according to different treatment programs ,respectively .The 7 days standard treatment group（n=80） was taken orally proton pump inhibitors （nexium） 40 mg ,once everyday ,amoxicillin 1 .0 g ,once each 12 hours ,clarithromycin 0 .5 g , once each 12 hours（7 days）;10 days sequential treatment group（n=73）was taken orally nexium 40 mg ,once ,amoxicillin 1 .0 g , once each 12 hours ,clarithromycin 0 .5 g ,once each 12 hours（7 days） ,then replaced with levofloxacin 0 .2 ,once each 8 hours ,fura-zolidone 30 mg ,once each 8 hours（3 days）;12 days sequential treatment group（n=70） was taken orally nexium 40 mg ,once every-day ,amoxicillin 1 .0 g ,once each 12 hours ,clarithromycin 0 .5 g ,once each 12 hours（7 days） ,then replaced with levofloxacin 0 .2 g , once each 8 hours ,furazolidone 30 mg ,once each 8 hours（5 days） .Results After treatment ,the performance under endoscopy and pathology of three groups had no significant differences（P＆gt;0 .05） .The eradication rate of standard treatment group was 76 .6%（59/77） ,10 days sequential treatment group was 88 .4% （61/69）;12 days sequential treatment group was 97 .0% （64/66） .The cur-ative effect had statistically significant between 7 days standard treatment group and 12 days sequential treatment group（P＆lt;0 .05） . Conclusion Sequential treatment was obviously superior to the standard treatment for eradicating Hp .