双歧杆菌三联活菌胶囊联合质子泵抑制药三联根除幽门螺旋杆菌的疗效观察

Efficacy of lactobacillus and enterococcus capsules combined with PPI triple therapy in eradication of Helicobacter pylori infection

目的探讨双歧杆菌三联活菌胶囊(培菲康)联合质子泵抑制药(proton pump inhibitors,PPI)三联疗法根除幽门螺旋杆菌(Helicobacter pylori,Hp)的疗效及安全性。方法选取患糜烂性胃炎或消化性溃疡并伴有Hp感染的患者150例作为研究对象,随机分为3组:标准三联组(A组,n=50),予以兰索拉唑(30 mg,2/d)+阿莫西林(1.0 g,2/d)+克拉霉素(0.5 g,2/d);四联组(B组,n=50),予以丽珠得乐(300 mg,3/d)+标准三联;培菲康组(C组,n=50),予以培菲康(630 mg,3/d)+标准三联。A、B两组疗程均为7 d,C组治疗7 d后,继续服用培菲康14 d。结果培菲康组对Hp根除率显著高于标准三联组(按PP分析91.5%vs 64.4%,按ITT分析86.0%vs 62.0%,P<0.05),与四联组比较无统计学差异(按PP分析91.5%vs85.7%,按ITT分析86.0%vs 84.0%,P>0.05);培菲康组对患者临床症状改善明显高于标准三联组(96.0%vs 74.0%,P<0.05)。而与四联组相比较则无统计学差异(96.0%vs 94.0%,P>0.05);培菲康组不良反应发生率明显低于三联组(4.0%vs16.0%,P<0.05)和四联组(4.0%vs 22.0%,P<0.05)。结论双歧杆菌三联活菌胶囊联合标准三联疗法能明显提高Hp根除率,且能显著改善临床症状,不良反应更少。

Objective To study the effect and safety of lactobacillus and enterococcus capsules in combination with PPI triple therapy on the cure rate of Helicobacter pylori （Hp）. Methods 150 patients who were diagnosed as having erosive gastritis or peptic ulcer with H. pylori infection at this hospital were randomly divided into three groups： triple therapy group （group A,n = 50, treated with lansoprazole 30 mg bid ＋ amoxicilfin 1.0 g bid ＋ levofloxacin 0.5 g q. d）, quadruple therapy group （group B,n =50, treated with bismuth potassium citrate 300 mg tid triple therapy）, and combination treatment group （group C, n = 50 ）, treated with lactobdcillus and enterocoaus capsules 630 mg tid ＋ triple therapy. The triple therapy and quadruple therapy groups were treated for 7 d, and the treatment group continued taking Bacillus licheniformis capsules for an additional 14 d. Results Hp eradication rate was significantly higher in group C than in group C by both ITr analysis （ 86.0% vs 62.0% ） and PP analysis （91.5 % vs 64.4%, P 〈 0.05 ） ; but showed no significant difference between the group C and group B both in ITT analysis （86.0% vs 84.0% ） and PP analysis （91.5% vs 85.7%, P 〉 0.05 ）. The clinical symptoms were improved more significantly in the group C than in group A （96.0% vs 74.0% ,P 〈 0.05 ） ; however, there was no significant difference in the percentage of patients showing symptom improvement between the group C and group B （96.0% vs 92.0% ,P 〉 0.05 ）. The incidence of adverse reactions was significantly lower in the group C than in the group A （4.0% vs 16.0% , P 〈 0.05 ） and group B （4.0% vs 22.0%, P 〈 0.05 ）. Conclusions Lactobacillns and enterococeus capsules improve the eradication rate of Hp, alleviate clinical symptoms and reduce the incidence of adverse reactions in patients undergoing triple therapy.