序贯疗法与四联疗法在2型糖尿病患者中根除幽门螺杆菌的疗效观察

Effects of sequential therapy and quadruple therapy on the eradication of Helicobacter pylori in type 2 diabetes mellitus patients

目的：探讨2型糖尿病患者采用序贯疗法与四联疗法根除幽门螺杆菌（Hp）的疗效。方法以拟长期服用阿司匹林的2型糖尿病患者为研究对象，将确诊为 Hp 感染的216例2型糖尿病患者随机分为序贯疗法组和四联疗法组。序贯疗法组前5 d 给予埃索美拉唑＋阿莫西林，后5 d 给予埃索美拉唑＋克拉霉素＋甲硝唑治疗。四联疗法组给予埃索美拉唑＋枸橼酸铋钾胶囊＋克拉霉素＋阿莫西林治疗10 d；治疗结束至少停药4周后复查14 C尿素呼气试验，阴性表示根除成功。同时评估疗效和安全性，并进行成本-效果分析。对 Hp 根除率进行意向性分析和符合方案分析比较。结果意向性分析显示序贯疗法组及四联疗法组的 Hp 根除率分别是81.5%（88/108）及84.3%（91/108），符合方案分析显示序贯疗法组及四联疗法组的 Hp 根除率分别是85.4%（88/103）及90.1%（91/101），意向性分析及符合方案分析均表明序贯疗法组 Hp 根除率低于四联疗法组，但两组比较差异无统计学意义（P 〉0.05）。结论序贯疗法及四联疗法可我的天做为2型糖尿病患者临床根治 Hp 的一线治疗方案。

Objective To investigate the efficacy of sequential therapy and quadruple therapy on Helicobacter py-lori（Hp）eradication in type 2 diabetes mellitus patients. Methods A total of 216 type 2 diabetes mellitus patients with positive Hp infection and planning to take long-term aspirin treatment were enrolled in this study. They were randomly di-vided into sequential therapy group and quadruple therapy group. The patients in sequential therapy group received esome-prazole and amoxicillin for 5 days,and then esomeprazole,clarithromycin and metronidazole for another five days. The pa-tients in quadruple therapy group received esomeprazole,colloidal bismuth subcitrate,amoxicillin and clarithromycin for 10 days. The 14 C-urea breathe test was re-examined at least 4 weeks after the completion of medication,and the negative re-sults indicating the success of Hp eradication. The efficacy,safety and cost-benefit analysis was also evaluated. Hp eradica-tion rates were compared by the intention-to-treat（ITT）and per protocol（PP）analysis. Results According to ITT analy-sis,the eradication rate of Hp in sequential therapy group and quadruple therapy group was 81. 5%（88 / 108）and 84. 3%（91 / 108）. According to PP analysis,the eradication rate of Hp in sequential therapy group and quadruple therapy group was 85. 4%（88 / 103）and 90. 1%（91 / 101）. Both ITT analysis and PP analysis indicated that the Hp eradication rate in sequential therapy group was lower than that in quadruple therapy group. But there was no significant difference between the two group（P 〉 0. 05）. Conclusions Sequential therapy and quadruple therapy can be considered as the first line choice in the eradication of Helicobacter pylori in type 2 diabetes mellitus patients.