益生菌、铋剂分别联合标准三联与标准三联疗法根除幽门螺杆菌的效果比较

Comparision of the effects of standard triple therapy and triple therapy combined with probiotic or bismuth on the Helicobacter pylori eradication

[目的]比较益生菌、铋剂分别联合标准三联疗法(埃索美拉唑片20mg克拉霉素片0.5g阿莫西林胶囊1.0g每日2次)与标准三联疗法根除幽门螺杆菌(Hp)的效果。[方法]选取186例Hp阳性的初治患者,随机分为益生菌组、铋剂组和三联组各62例,三联组:采用标准三联疗法;益生菌组:标准三联疗法基础上+嗜酸乳杆菌0.5g每日3次;铋剂组:标准三联疗法基础上+胶体果胶铋胶囊0.1g每日2次;3组疗程均为10d。疗程结束后观察3组对Hp的根除率,比较3组患者临床症状缓解情况、药物不良反应及成本疗效比。[结果]益生菌组、铋剂组、三联组对Hp根除率分别为83.87%、90.32%、72.58%,铋剂组Hp根除率高于益生菌组、三联组(P<0.05);3组患者临床症状均呈明显缓解趋势,铋剂组症状缓解显著优于益生菌组、三联组(P<0.05);益生菌组、铋剂组、三联组不良反应发生率分别为9.68%、33.87%、22.58%,益生菌组与铋剂组不良反应发生率比较差异有统计学意义(P<0.05),三联组与铋剂组、益生菌组比较差异无统计学意义(P>0.05);成本效果分析显示,铋剂组单位效果成本最低。[结论]铋剂联合标准三联疗法对Hp根除率高,单位效果成本低,可作为根治Hp的一线方案。

[Objective]Comparison of the effects of standard triple therapy of esomeprazole ,clarithromycin ,amoxicillin and the triple therapy combined with probiotic＋bismuth on the eradication of Helicobacter pyloria（Hp）. [Methods]Total 186 cases with Hp infection were randomly divided into the probiotic group ,bismuth agent group and standard triple terapy group with 62 cases in every group.In standard tri‐ple therapy group ,patients were treated with esomeprazole 20 mg bid＋ clarithromycin 0.5 g bid＋ amoxicillin 1.0 g bid.In probiotic group and bismuth group ,the patients accepted lactobacillus acidophilus 0.5 g tid or colloidal bismuth pectin capsules 0.1 g bid except the triple therapy respectively.All patients were treated for 10 days.The eradication rate ,clinical remission ,adverse reaction and cost‐effective ration among the three groups were compared after the treatment.[Results]The H p eradication rate in probiotics group , bismuth agent group ,triple therapy group were 83.87% ,90.32% and 72.58%.Bismuth agent group was the highest（P〈0.05）.The clinical symptoms in patients of three groups were relieved obviously.Patients in bismuth group ,the remission of symptoms was significantly better than the probiotic group and triple therapy group（P〈 0.05）.Adverse reactions in probiotic group ,bismuth agent group and triple therapy group was 9.68% ,33.87% and 22.58% respectively.The incidence of adverse reactions in probiotics group and bismuth agent group was significantly different （P〈0.05）.Cost effect analysis showed that the lowest cost in bismuth group.[Conclusion]Bismuth combined with standard triple therapy shows high eradication rate ,low unit cost ,which suggests that it can be used as first‐line eradication therapy of H p.