三联、四联疗法及Boulardii酵母菌在幽门螺杆菌根除治疗中的疗效评估

Effectiveness of Saccharomyces boulardii with Triple Therapy or Quadruple Therapy in Helicobacter Pylori Eradication

目的评估潘托拉唑三联疗法与枸橼酸铋钾(CBS)四联疗法复合Boulardii酵母菌对根除幽门螺杆菌(helicobacter pylori,H.pylori)疗效的影响.方法 H.pylori阳性的慢性胃炎、消化性溃疡患者280例,随机分为4组:三联组(克拉霉素+阿莫西林+潘托拉唑)、三联组+Boulardii酵母菌组(三联组+Boulardii酵母菌粉剂,三联联合组)、四联组(克拉霉素+阿莫西林+潘托拉唑+CBS胶囊)、四联组+Boulardii酵母菌组(四联组+Boulardii酵母菌粉剂,四联联合组),连续治疗14 d,治疗后第5周复查14C-UBT,比较各组H.pylori根除率、药物不良反应发生率,复查阴性患者在治疗结束后第3、6、9、12月复查14C-尿素呼气试验检测复发率.结果258例患者按试验设计完成治疗,241例患者按试验设计完成随访;三联联合组与四联联合组根除率(91.2%、94.0%)显著高于三联组与四联组(77.8%、81.7%),P<0.05;三联联合组与四联联合组不良反应发生率(32.2%、30.1%)显著低于三联组与四联组(79.6%、65.3%)(P<0.05);三联联合组与四联联合组累积复发率(2.5±2.2)%、(2.4±1.0)%较三联组与四联组(10.6±6.0)%、(9.8±7.1)%显著降低(P<0.05).结论三联疗法和四联疗法联用Boulardii酵母菌均能显著提高H.pylori根除率,降低其不良反应,减少复发风险,临床实践可依据实际情况选择治疗方案.

Objective To observe the different clinical efficacy of Triple therapy or Quadruple therapy with saccharomyces boulardii in Helicobacter pylori（H. pylori） eradication. Methods 280 H. pylori-positive patients with chronic gastritis or peptic ulcer were randomly divided into four groups： Triple therapy group, Triple therapy plus Saccharomyces boulardii group,Quadruple therapy group,Quadruple therapy plus Saccharomyces boulardii group. The course of treatment lasted 14 days. The outcome of eradication therapy was assessed by 14C-urea breath test performed at 5th week after the end of treatment,14C-UBT showed negative meant H.pylori was eradicated,otherwise,meant treatment failure.The adverse reactions, compliance and tolerance were compared among four groups.The outcome of 14C-UBT was collected on month 3,6,9,12 and analyzed for the recurrent rates.Results In total, 258 patients completed the treatment and 241 patients were followed up according to theexperimental design and completed the recurrent test. The H.pylori eradication rates of Triple therapy group and Quadruple therapy group were significantly lower than that of Triple therapy plus Saccharomyces boulardii group and Quadruple therapy plus Saccharomyces boulardii group（77.8%,81.7% vs 91.2%,94.0%,P〈0.05）. The incidence of adverse reactions was significantly higher in Triple therapy group and Quadruple therapy group than Triple therapy plus Saccharomyces boulardii group and Quadruple therapy plus Saccharomyces boulardii group（79.6%,65.3% vs 32.2%,30.1%, P〈 0.05）. And the accumulative recurrent rate in Triple therapy group and Quadruple therapy group（10.6%±6.0%,9.8%±7.1%） were significantly lower than that in Triple therapy plus Saccharomyces boulardii group and Quadruple therapy plus Saccharomyces boulardii group（2.5%±2.2%,2.4%±1.0%）, P〈0.05.Conclusion Triple therapy plus Saccharomyces boulardii group and Quadruple therapy plus Saccharomyces boulardii group could improve the H.pylori eradication rate and decrease the recurrent rate, reduce the incidence of antibiotic-associated side effects, so the suitable treatment protocol should be chosen in clinical practice.