克拉霉素治疗幽门螺杆菌感染患者的临床疗效研究

Clinical effect of clarithromycin on treatment of patients with Helicobacter pylori infection

目的：探讨克拉霉素的药理特性及治疗幽门螺杆菌感染的应用，指导消化性溃疡幽门螺杆菌感染的治疗。方法选取2009年4月－2013年12月收治的消化性溃疡患者106例，均为幽门螺杆菌感染所致，将其随机分为两组，各53例，治疗组采用奥美拉唑、阿莫西林联合克拉霉素三联进行治疗，对照组使用奥美拉唑联合阿莫西林进行治疗，比较两组患者的临床疗效及不良反应。结果服药两周后治疗组总有效率、不良反应发生率分别为86．79％、7．55％，对照组分别为69．81％、15．09％，两组比较差异有统计学意义（ P＜0．05）；不良反应症状主要为恶心呕吐、头晕、腹泻；治疗组服药两周后幽门螺杆菌清除率为84．91％，显著高于对照组的67．92％，两组比较差异有统计学意义（P＜0．05）。结论克拉霉素主要通过抑制转肽作用和mRNA合成细菌蛋白质发挥抗菌活性，并且在患者体内2～3h可达到血药浓度峰值，可有效治疗消化性溃疡；同时其胃肠道反应低，降低不良反应发生率，值得在临床上推广。

OBJECTIVE To investigate the pharmacological properties of clarithromycin and explore the effect on treatment of Helicobacter pylori infection so as to provide guidance for treatment of peptic ulcer patients with H . pylori infections .METHODS A total of 106 patients with peptic ulcer induced by H .pylori infections who were treated from Apr 2009 to Dec 2013 were enrolled in the study and randomly divided into two groups ,with 53 cases in each ;the treatment group was treated with omeprazole and amoxicillin combined with clarithromycin ,while the control group was given omeprazole combined with amoxicillin;the clinical effects and the adverse events were ob‐served and compared between the two groups of patients .RESULTS After the drug administration for two weeks , the total effective rate of treatment was 86 .79% in the treatment group ,69 .81% in the control group;the inci‐dence of adverse events was 7 .55% in the treatment group ,15 .09% in the control group ,there was significant difference between the two groups （P〈0 .05） .The major adverse events included the nausea vomiting ,dizziness , and diarrhea .The clearance rate of H .pylori of the treatment group was 84 .91% after the drug administration for weeks ,significantly higher than 67 .92% of the control group （P〈0 .05） .CONCLUSION Clarithromycin has the antimicrobial activity mainly through inhibiting transpeptidation and synthesis of mRNA proteins in synthetic chain of mobile and reaches the peak of plasma concentration within 2‐3 hours ,and it can effectively treat the peptic ul‐cer and is worthy to be promoted in the hospital ,owning to the low incidence of gastrointestinal reactions and the adverse events .