益生菌联合改良序贯疗法治疗初治失败幽门螺杆菌感染的疗效研究

Radical curative efficacy of probiotics combined improved sequential therapy on Helicobacter pylori infection after initial treatment failure

目的探讨益生菌联合改良序贯疗法治疗初治失败幽门螺杆菌（Hp）感染的疗效。方法将96例经标准三联疗法初治失败的Hp感染患者，随机分为研究组（48例）及对照组（48例），研究组给予益生菌联合改良序贯疗法，方案为前5天为雷贝拉唑＋阿莫西林克拉维酸钾＋双歧杆菌乳杆菌三联活菌片（金双歧），后5天改为雷贝拉唑＋左氧氟沙星＋克拉霉素＋金双歧。对照组给予四联疗法，方案为雷贝拉唑钠＋阿莫西林克拉维酸钾＋克拉霉素＋枸橼酸铋钾，2组疗程均为10天，治疗结束4周后复查13C呼气试验，观察并比较两组Hp根除率、不良反应发生情况及患者对药物的耐受程度。结果研究组和对照组Hp根除率按意向性（Ir丌）分析分别为87．50％和79．17％，按方案（PP）分析分别为89．36％和84．44％，差异无统计学意义（P〉0．05）。研究组不良发生率明显低于对照组（12．8％比31．1％），差异有统计学意义（P〈0．05）；研究组对药物的耐受程度明显高于对照组，差异有统计学意义（P〈0．05）。结论益生菌联合改良序贯疗法根除初治失败的Hp感染的疗效与四联疗法疗效相当，均有明显的临床效果，前者不良反应发生率更低，药物耐受程度更好。

Objective To investigate radical curative efficacy of probiotics combined improved sequential therapy on Helicobacter pylori infection, after initial treatment failure. Methods 96 patients with Helicohacter pylori infection after failure of triple therapy were randomly divided into two groups, stu- ty group（48 cases） and control group （48 cases）. The patients in stuty group was given probiotics com- bined improved sequential therapy（ Rabeprazole ＋ Amoxicillin and Clavulanate Potassium ＋ Live Combined Bifidobacterium and Lactobacillus Tablets for the first 5 days, Rabeprazole ＋ Clarithromycin ＋ Levofloxacin ＋ Live Combined Bifidobacterium and Lactobacillus Tablets for the next 5 days ）. The patients in control group was given quadruple chemotherapy （ Rabeprazole ＋ Amoxicillin and Clavulanate Potassium ＋ Clarithromycin ＋ Colloidal Bismuth Subcitrate ）. The course of treatment was 10 days. 13 carbon-Urea Breath Test（13C-UBT） was rechecked 4 weeks after treatment. Comparison was performed on eradication rates, as well as adverse drug reactions between two group. Results The Helicobacter pylori eradication rates by intention-to-treat （ITF） analysis in stuty group and control group were 87.50% and 79.17% ,respectively, by per-protocol （PP） analysis, they were 89.36% and 84.44% respectively, there was no significant difference betweet these two therapies by ITr and PP analysis （ P 〉 0.05 ）. The incidence of adverse reactions was significantly lower in study group than that in control group（ 12.8% vs 31.1% , P 〈 0.05 ）. The drug tolerability in stuty group was significantly higher than that in control group （P 〈 0. 05 ）. Conclusion Probiotics combined improved sequential therapy is as effective as the quadruple therapy in the eradication of Helicobacter pylori infection after initial treatment failure,, with both having the significant effects. The former has lower rate of the gastrointestinal adverse reaction and higher level of drug tolerability than the latter.