改良序贯疗法与不同四联疗法根除幽门螺杆菌的疗效分析

Efficacy analysis of modified sequential therapy versus different quadruple therapy for eradicating the helicobacter pylori

目的评价含呋喃唑酮的改良序贯疗法根除幽门螺杆菌（H.pylori）的疗效和安全性。方法收集H.pylori阳性的非萎缩性胃炎伴糜烂和消化性溃疡患者240例,均分为序贯疗法组（A组）、伴同疗法组（B组）、铋剂四联7d组（C组）、铋剂四联10d组（D组）。A组：先予雷贝拉唑10mg＋阿莫西林1 000mg,每天2次,5d,再予雷贝拉唑10mg＋克拉霉素500mg＋呋喃唑酮100mg,每天2次,5d;B组：雷贝拉唑10mg＋阿莫西林1 000mg＋克拉霉素500mg＋呋喃唑酮100mg,每天2次,7d;C组：雷贝拉唑10mg＋枸椽酸铋钾220mg＋阿莫西林1 000mg＋克拉霉素5 00mg,每天2次,7d;D组：方案同C组,疗程10d。治疗结束停药至少4周后空腹行14C-尿素呼气试验,结果阴性者判为H.pylori根除成功。结果 224例患者完成治疗,A、B、C、D组H.pylori根除率按意向性（ITT）分析分别为88.33%、83.33%、73.33%、81.67%,按方案（PP）分析分别为92.98%、90.90%、78.57%、87.50%。A组与C组ITT和PP分析比较差异均有统计学意义（χ^2=4.36、4.83,P=0.037、0.028）。结论含呋喃唑酮的改良序贯疗法对H.pylori根除率较高,是一种可供选择的一线治疗方案。

Objective To evaluate the efficacy and safety of modified sequential therapy versus different quadruple therapy for the helicobacter pylori （H .pylori） eradication .Methods A total of 240 H .pylori infected patients with non atrophic gastritis accompanies erosion and peptic ulcer diagnosed by gastroscopy ,were evenly divided into sequential therapy group （A group） ,con-comitant therapy group（B group） ,7 days bismuth-containing quadruple therapy group（C group） and 10 days bismuth-containing quadruple therapy group（D group） .A group ：rabeprazole 10 mg ,amoxicillin 1 000 mg were taken twice daily for 5 days firstly ,then rabeprazole 10 mg ,clarithromycin 500 mg ,furazolidone 100 mg were taken twice daily for 5 days .B group ：rabeprazole 10 mg , amoxicillin 1 000 mg ,clarithromycin 500 mg ,furazolidone 100 mg were taken twice daily for 7 days .C group and D group ：rabe-prazole 10 mg ,bismuth 220 mg ,amoxicillin 1 000 mg ,clarithromycin 500mg were taken twice daily for 7 and 10 days respectively . H .pylori status was re-assessed with 14C-urea breath test after 4-weeks therapy .Results Among them ,224 cases completed the study .According to the analysis of intention-to-treat （ITT ） ,the H .pylori eradication rates of A ,B ,C ,D group were 88 .33% , 83 .33% ,73 .33% ,81 .67% respectively ,and according to per-protocol （PP ）analysis which were 92 .98% ,90 .90% ,78 .57% , 87 .50% .The difference between A and C group was statistically significant （χ2 = 4 .36 ,4 .83 ,P= 0 .037 ,0 .028） .Conclusion Fura-zolidone-containing sequential therapy provide provide high H .pylori eradication rates ,which could be the first-line treatment option .