三种方法用于初次根除幽门螺杆菌疗效对比研究

Effective comparison among three treatment methods of first time eradication of helicobacter pylori

目的 对比3种方法用于初次根除幽门螺杆菌（Hp）的疗效.方法 将168例Hp感染患者完全随机分为3组,每组56例,均以口服埃索美拉唑＋枸橼酸铋钾为基础加用不同抗生素组合：阿莫西林＋左氧氟沙星组：阿莫西林1.0g,2次/d＋左氧氟沙星0.4g,1次/d×10 d;四环素＋呋喃唑酮组：四环素2片,3次/d＋呋喃唑酮1片,3次/d×10 d;序贯治疗组：前5d给予阿莫西林＋左氧氟沙星组合,后5d给予四环素＋呋喃唑酮组合.4周疗程结束复查胃镜及14C呼气试验评价疗效,并观察不良反应发生情况.结果 阿莫西林＋左氧氟沙星组、四环素＋呋喃唑酮组、序贯治疗组临床有效率分别为82.1％（46/56）、92.9％（52/56）、94.6％ （53/56）;其中阿莫西林＋左氧氟沙星组与序贯治疗组差异有统计学意义（P＜0.05）,二者与四环素＋呋喃唑酮组比较差异无统计学意义（P＞0.05）.胃镜检查病灶愈合率分别为85.7％（48/56）、91.1％（51/56）、92.9％（52/56）,组间比较差异均无统计学意义（均P＞0.05）.Hp根除率分别为80.4％ （45/56）,89.3％（50/56）,91.1％ （51/56）,组间比较差异均无统计学意义（均P＞0.05）.不良反应发生率3组分别为5.4％（3/56）、8.9％（5/56）、7.1％（4/56）,组间比较差异均无统计学意义（均P＞0.05）.结论 以埃索美拉唑＋铋剂为基础,选择阿莫西林、左氧氟沙星、四环素、呋喃唑酮不同组合用于Hp初治患者效果明显,具体应根据患者年龄、基础疾病、经济状况等合理选择.

Objective To compared the effects of three treatment methods of first time eradication of helicobacter pylori （Hp）.Methods Totally 168 patients with Hp infection from July 2013 to July 2014 were enrolled and randomly divided into in three groups （56 cases in each group） and all the patients were administrated with esomeprazole and bismuth as a basic treatment for 4 weeks.In amoxicillin ＋ levofloxacin group,amoxicillin （1.0 g,2 times/d） and levofloxacin （0.4 g,1 time/d） were additionally given for 10 d;in tetracycline ＋ furazolidone group,tetracycline （2 tablet,3 times/d） and furazolidone （1 tablet,3 times/d） were additionally given for 10 d;in sequential treatment group,amoxicillin and levofloxacin were additionally given for 5 d,followed by tetracycline and furazolidone for 5 d.After 4 weeks,gastroscope and 14C breath test were used to assess the effects.Results The effective rate in sequential treatment group was significantly higher than that in amoxicillin ＋ levofloxacin group [94.6% （53/56） vs 82.1% （46/56）] （P 〈 0.05）,but there were no significant differences between above groups and tetracycline ＋ furazolidone group [92.9% （52/56）] （P 〉 0.05）.The lesions healing rate shown in gastroscopy was not significantly different among amoxicillin ＋ levofloxacin group,tetracycline ＋ furazolidone group and sequential treatment group [85.7% （48/56）,91.1% （51/56）,92.9% （52/56）],so were the Hp eradication rate [80.4% （45/56）,89.3% （50/56）,91.1% （51/56）] and the incidence of adverse reactions [5.4% （3/56）,8.9% （5/56）,7.1% （4/56）] （all P〉0.05）.Conclusion Different combinations of amoxicillin,levofloxacin,tetracycline and furazolidone have significant effect on first time eradication of helicobacter pylori with esomeprazole and bismuth as a basic treatment.