艾普拉唑十天标准四联和序贯方案治疗幽门螺杆菌感染慢性胃炎200例的疗效观察

Clinical observation on ilaprazole containing ten-day standard quadruple therapy and sequential therapy in the treatment of two hundred cases of chronic gastritis with Helicobacter pylori infection

目的：观察艾普拉唑联合铋剂10 d 标准四联方案及序贯方案治疗H ．pylori 感染慢性胃炎患者的临床疗效。方法经胃镜、快速尿素酶试验确诊的H ．pylori 阳性慢性胃炎初治患者200例，按区组随机化分组法分为标准四联方案组和序贯疗法方案组，每组100例，分别接受艾普拉唑＋枸橼酸铋钾＋阿莫西林克拉维酸钾＋左氧氟沙星的10 d 标准四联方案或艾普拉唑＋阿莫西林克拉维酸钾＋左氧氟沙星＋呋喃唑酮的10 d 序贯疗法方案。疗程结束后4～6周内行14 C尿素呼气试验检测H ．pylori根除情况，并观察临床症状改善及不良反应发生情况。符合正态分布、方差齐性的计量资料比较采用t 检验，无序分类资料比较用卡方检验或 Fisher 确切概率法，有序分类资料比较采用两独立样本比较的秩和检验。结果标准四联方案组和序贯疗法方案组H ．pylori 根除率符合方案数据分析分别为88．54％（85/96）和87．23％（82/94）；意向性分析分别为85．00％（85/100）和82．00％（82/100）。标准四联方案组和序贯疗法方案组对上腹痛、反酸、烧心等临床症状缓解有效率分别达95．83％（92/96）和95．74％（90/94），不良反应发生率分别为6．25％（6/96）和7．44％（7/94），且轻微。两组患者在上述3个方面差异均无统计学意义（P 均＞0．05）。结论艾普拉唑联合铋剂10 d 标准四联方案或10 d 序贯疗法方案治疗H ．pylori阳性慢性胃炎患者均可取得临床症状改善率高、不良反应轻、H ．pylori根除率高的疗效。

Objective To investigate the clinical efficacy of ilaprazole and bismuth combined ten-day standard quadruple therapy and sequential therapy in the treatment of patients with Helicobacter pylori （H .pylori）infected chronic gastritis.Methods A total of 200 patients with H .pylori-positive chronic gastritis diagnosed by gastroendoscopy examination and rapid urease test （RUT）were randomly divided into standard quadruple therapy group and sequential therapy group,100 cases in each group.One group received ilaprazole,bismuth,amoxicillin-clavulanatepotassium and ofloxacin 10-day standard quadruple therapy, and the other group received ilaprazole, amoxicillin-clavulanatepotassium, ofloxacin and furazolidone 10-day sequential therapy.In four to six weeks after the therapy,the condition of H .pylori eradication was detected by a 14 C-urea breath test.The improvement of clinical symptoms and adverse effects were also observed. Normal distributed and variance homogenized measurement data were compared by t test,while unordered categorical data were analyzed by chi-square test and the exact probability method,and categorical data were compared by two independent sample rank sum test.Results The per-protocol analysis values of H .pylori eradication rates of the standard quadruple therapy group and the sequential therapy group were 88.54%（85/96）and 87.23%（82/94）,respectively,while the intention-to-treat analysis values were 85 .00%（85/100）and 82.00%（82/100 ）,respectively.The effective rates of symptomatic relief of upper abdominal pain,acid regurgitation,heart burning in the standard quadruple therapy group and the sequential therapy group were 95 .83%（92/96）and 95 .74%（90/94）,respectively. The incidence of adverse effects which weve very mild was 6.25 % （6/96 ） and 7.44% （7/94 ）, respectively.There was no statistically significant difference in the above three factors between the two groups （all P 〉0.05）.Conclusions Ilaprazole and bismuth combined 10-day standard quadruple therapy and sequential therapy in the treatment of patients with H .pylori positive chronic gastritis both achieves high rates of H .pylori eradication and symptom relief with mild adverse effects.