质子系抑制剂维持治疗对十二指肠球部溃疡一年复发率的影响

Proton Pump Inhibitor Maintenance Therapy in the Prevention of Recurrent Duodenal Ulcer

目的：探讨低剂量兰索拉唑长期抑酸维持治疗预防十二指肠球部溃疡复发的有效性。方法：将经４周兰索拉 唑３０ｍｇｑｄ治疗进入瘢痕期的６７例十二指肠球部溃疡患者随机分入两个治疗组：组Ⅰ：兰索拉唑１５ｍｇｑｄ，维持 ３个月；组Ⅱ：兰索拉唑１５ ｍｇ ｑｄ，维持６个月。在维持治疗开始后第３、６、９、１２个月末和出现溃疡复发症状时复查胃 镜，并在维持治疗结束后胃镜检查时取胃液及胃粘膜测定胃液ｐＨ、总酸度、胃蛋白酶及胃粘膜氨基己糖含量。结 果：经１年追踪随访，组 Ⅰ和组Ⅱ患者的溃疡一年累积复发率分别为２０．６％（７／３４）和２１．２％（７／３３），两组间差异无 显著性。溃疡复发患者的胃液总酸度和胃蛋白酶含量高于未复发者，ｐＨ值和胃粘膜氨基己糖含量低于未复发者， 差异均有显著性。红色瘢痕期（Ｓ１期）溃疡患者的复发率高于白色瘢痕期（Ｓ２期）患者，吸烟者的复发率高于不吸烟者。 ４例幽门螺杆菌阴性溃疡患者无１例复发。结论：３个月或６个月低剂量兰索拉唑维持治疗可有效预防十二指肠球 部溃疡复发，其作用是通过抑制胃酸实现的。

Background/Aims: To study the efficacy of long-term maintenance therapy with low-dose lansoprazole in preventing the recurrence of duodenal ulcer (DU). Methods: 67 patients with DU in scar (S) stage treated with 30 mg lansoprazole per day for 4 weeks were divided into two groups: group Ⅰ, the patients were maintained by 15 mg of lansoprazole per day for 3 months; group Ⅱ, the patients were maintained by 15 mg of lansoprazole per day for 6 months. Gastroscopy was performed at 3, 6, 9, and 12 months after the start of maintenance therapy, or whenever the symptoms suggested recurrence of DU. The pH value, total acidity and pepsin activity in gastric juice, and the gastric mucosal hexosamine level were assayed at the 3rd and 6th month in group Ⅰ and group Ⅱ, respectively. Results: The annual cumulative recurrence rates of DU were 20.6% (7/34) and 21.2% (7/33) in group Ⅰ and group Ⅱ, respectively. There was no significant difference between the two groups. The total acidity and pepsin activity in gastric juice were higher in the relapsed group than those in the non-relapsed group. Gastric juice PH and gastric mucosal hexosamine level were lower in group Ⅰ than in group Ⅱ. The recurrence rate was much higher in the DU in S1 stage and smokers than those in S2 stage and non-smokers. No recurrence was found in 4 patients without Helicobacter pylon infection. Conclusions: The prevention of recurrence of DU is effective when treated by maintenance therapy using lowdose lansoprazole for 3 or 6 months. The effectiveness is due to suppression of gastric acid secretion.