首次根除幽门螺杆菌失败后二线药物治疗临床研究

Clinical study on second-line treatment for helicobacter pylori positive patients after failure of first eradication therapy

目的研究首次根除幽门螺杆菌(Hp)失败后二线药物的疗效,提高Hp最终根除率。方法选择我院消化科门诊经胃镜确诊慢性胃炎、消化性溃疡、胃癌等常见上消化道疾病Hp阳性患者,经首次根除Hp失败后病例750例作为研究对象,并随机分为A、B、C三组各250例。A组250例,首先以PPI标准剂量+果胶铋300mg+左氧氟沙星200mg+四环素500mg,bid,治疗7d;之后再以PPI标准剂量+果胶铋300mg+阿奇霉素250mg+呋喃唑酮100mg,bid,治疗7d。B组250例,PPI标准剂量+果胶铋300mg+阿奇霉素250mg+呋喃唑酮100mg,bid,疗程14d。C组250例,PPI标准剂量+果胶铋300mg+左氧氟沙星200mg+四环素500mg,bid,疗程14d。结果 A、B、C三组Hp根除率分别为99.0%、86.0%、94.0%。A组大于B组和C组。结论对于首次根除Hp失败患者,采取PPI+果胶铋+左氧氟沙星(或阿奇霉素)+四环素(或呋喃唑酮)四联14d疗法有较高的根除率,尤其是A组14d序贯疗法根除Hp疗效更佳,三组均有用药简单,价格低廉,副作用少,患者依从性好,易于接受等特点。

Objective To explore the efficacy of second-line treatment for Helicobacter Pylori（HP） positive patients after failure of first eradication therapy.Methods 750 participates were diagnosed with common upper gastrointestinal diseases,such as chronic gastritis,peptic ulcer and gastric cancer by gastroscopy,with positive HP after failure of first eradication therapy.The patients were randomly divided into group A,B and C （all n =250）.Group A were administrated with PPI standard dose ＋ Bismuth Pectin 300 mg ＋ Levofloxacin 200 mg ＋ Tetracycline 500 mg,bid,for 7 days;and then with PPI standard dose ＋ Bismuth Pectin 300 mg ＋ Azithromycin 250 mg ＋ Furazolidone 100 mg,bid,for 7 days.Group B were taken with PPI standard dose ＋ Bismuth Pectin 300 mg ＋Azithromycin 250 mg＋ Furazolidone 100 mg,bid,for 14 days.Group C were oralled with PPI standard dose ＋ Bismuth Pectin 300 mg ＋ Levofloxacin 200 mg ＋ Tetracycline 500 mg,bid,for 14 days.Results The eradication rate of HP of Group A was 99.0％,Group B was 86.0％,Group C was 94.0％.Conclusions The quadruple therapy with PPI ＋Bismuth Pectin ＋ Levofloxacin （or Azithromycin） ＋ Tetracycline（or Furazolidone）,especially for 14 days in group A,had an obvious eradication rates for HP positive patients after failure of first eradication therapy.All of the three treatments had more simple medication,lower price,less side effect and better comphance.