多西环素、左氧氟沙星、枸橼酸铋钾联合奥美拉唑根除幽门螺杆菌效果观察

The effect of helicobacter pylori eradication by doxycycline,levofloxacin,bismuth potassium citrate combined ;with omeprazole

目的：观察多西环素、左氧氟沙星、枸橼酸铋钾联合奥美拉唑根除幽门螺杆菌的效果及安全性。方法选择幽门螺杆菌阳性患者240例，按照数字表法随机分为治疗组（多西环素＋左氧氟沙星＋枸橼酸铋钾＋奥美拉唑）60例、对照组 A（多西环素＋左氧氟沙星＋奥美拉唑）60例、对照组 B（阿莫西林＋克拉霉素＋枸橼酸铋钾＋奥美拉唑）60例、对照组 C（阿莫西林＋克拉霉素＋奥美拉唑）60例。根除幽门螺杆菌治疗疗程为7 d。胃炎患者疗程结束后停药，消化性溃疡患者7 d 后再服奥美拉唑5周后停药，停药2周后复查14 C 呼气试验，观察临床效果及不良反应。结果治疗组、对照组 A、对照组 B、对照组 C 幽门螺杆菌根除率分别为93．3％、80．0％、91．7％、75．0％，治疗组与对照组 A 比较根除率明显升高（χ2＝4．61，P ＜0．05），治疗组与对照组 C 比较根除率明显升高（χ2＝7．57，P ＜0．05），治疗组与对照组 B 比较根除率差异无统计学意义（χ2＝0．12，P ＞0．05）。对照组 B 口腔异味发生率较治疗组高（χ2＝6．56，P ＜0．05）。对照组 C 口腔异味发生率较治疗组高（χ2＝5．46，P ＜0．05）。结论多西环素、左氧氟沙星、枸橼酸铋钾联合奥美拉唑可显著提高幽门螺杆菌根除率，且价格低廉，副作用少，无需青霉素皮试，对经济困难或青霉素过敏患者可选择使用。

Objective To observe the effect and safety of helicobacter pylori eradication by doxycycline, levofloxacin,bismuth potassium citrate combined with omeprazole.Methods 240 patients who infected helicobacter pylori were selected,and were randomly divided into four groups：treatment group（doxycycline,levofloxacin,bismuth potassium citrate,omeprazole）,control group A（doxycycline,levofloxacin,omeprazole）,control group B（amoxicillin, clarithromycin,bismuth potassium citrate,omeprazole）,control group C （amoxicillin,clarithromycin,omeprazole）, 60 patients in each group.Helicobacter pylori eradication treatment for 7 days,patients with gastritis stop after the course of the treatment,peptic ulcer patients continue taking omeprazole 5 weeks after 7 days treatment.All patients stopped medicine 2 weeks accepted 14 carbon breath test.And adverse events were investigated.Results In the treatment group and the control group A,B,C,the helicobacter pylori eradication rates were 93.3%,80.0%,91.7%, 75.0%.Compared with group A,the treatment group helicobacter pylori eradication rate increased significantly（χ2 =4.61,P 〈0.05 ）.Compared with group C,the treatment group helicobacter pylori eradication rate increased significantly（χ2 =7.57,P 〈0.05）.But compared with group B,the treatment group helicobacter pylori eradication rate had no significant difference（χ2 =0.12,P 〉0.05）.Compared with the treatment group,group B had high inci-dence of oral odor（χ2 =6.56,P 〈0.05）.Compared with the treatment group,group C had high incidence of oral odor （χ2 =5.46,P 〈0.05）.Conclusion Doxycycline,levofloxacin,bismuth potassium citrate combined with omeprazole can improve the helicobacter pylori eradication rate significantly,and with low price,has little side effect,no need of penicillin skin test,can used for the patients poverty or allergic to penicillin.