枯草杆菌二联活菌联合四联疗法根除幽门螺杆菌临床疗效观察

Effects of probiotics combined with quadruple therapy in treatment of Helicobacter pylori infection

[目的]观察枯草杆菌二联活菌联合四联疗法对幽门螺杆菌(Hp)的根治效果。[方法]105例诊断为慢性糜烂性胃炎伴有Hp感染的患者随机分为A组(35例)、B组(36例)、C组(34例)。A组用三联疗法(泮托拉唑40mg,bid+阿莫西林1 000mg,bid+克拉霉素500mg,bid),B组用四联疗法(果胶铋+三联疗法),C组用枯草杆菌二联活菌0.5,tid+四联疗法,各组疗程均为14d。疗程结束后至少间隔4周行13 C尿素呼气实验评估治疗结果。记录治疗期间和治疗后不良反应发生情况。[结果]A组、B组、C组患者Hp根除率按意图治疗(ITT)分析分别为62.9%、86.1%、91.2%,按方案(PP)分析分别为68.8%、88.6%和93.9%。B组、C组的疗效明显优于A组(P<0.05);A组、B组、C组的不良反应发生率分别为18.7%、20.0%、3.0%。C组的不良反应发生率明显低于A组、B组(P<0.05)。[结论]四联疗法对Hp根除率高于三联疗法;四联疗法加枯草杆菌二联活菌尽管不能显著提升Hp根除率,但能有效的减少治疗过程中的不良反应发生率。

[Objective]To observe the efficacy of probiotics combined with quadruple therapy in treatment of Helicobacter pylori（Hp）. [Methods]One hundred and five patients with chronic erosive gastritis and Hp infection were include and randomly assigned into three groups. Thirty-five patients were adminis- tered with triple therapy including pantoprazole 40 mg bid, amoxicillin 1.0 g bid and clarithromyein 500 mg bid. Thirty-six patients received quadruple therapy including pantoprazole 40 mg bid, bismuth pectin 150 mg bid,amoxicillin 1.0 g bid and clarithromyein 500 mg bid and thirty-four patients received the same quadruple therapy combined with probiotics. All the treatment duration was two weeks. The eradication rate was evaluated by13 C-urea breath test at least 4 weeks after the completion of treatment. Adverse reac tions were recorded during and after the treatment course. [Results] One hundred patients completed the study. The Hp eradication rates by intention-to-treat（ITT）analysis in triple therapy group, quadruple ther apy groups and combination group were 62.9% ,86.1% and 91.2% ,respectively;by per protocol（PP）anal- ysis were 68.8% ,88.6% and 93.9% ,respectively. The eradication rate in triple therapy group was significantly lower than the other groups（P〈0.05）. The adverse reaction rate in the three groups were 18.7%, 20.0% and 3.0%. The adverse reaction rate in combination therapy group was significantly lower than the other groups（P〈0.05）. [Conclusion] Quadruple treatments provided higher eradication rates than tripletherapy. Although probiotics can not improve theHperadication rate,it can decreased the adverse reaction rate during the treatment.