摘要
目的 探讨以泮托拉唑为基础的四联疗法加用胃黏膜保护剂对幽门螺杆菌（Hp）阳性的十二指肠球部溃疡者肠道微生物菌群的影响.方法 选择我院2015年9月至2016年9月收治的120例Hp阳性的十二指肠球部溃疡者,经随机数字表法将患者分成三联组、四联组、四联＋保护剂组,三联组患者给予泮托拉唑40 mg,2次/d,口服＋阿莫西林1 000mg,2次/d,口服＋克拉霉素500 mg,2次/d,口服;疗程14 d;四联组：三联方案＋枸橼酸铋钾220 mg,2次/d,口服,疗程14 d;四联＋保护剂组：四联方案＋瑞巴派特200 mg,3次/d,口服.比较治疗结束后Hp根除疗效及肠道微生物菌群分布情况.结果 三联组Hp根除率为65.00％ （26/40）,四联组为82.50％（33/40）,四联＋保护剂组为87.50％（35/40）,四联＋保护剂组Hp根除率高于三联组和四联组（P＜0.05）;四联＋保护剂组总体症状改善率（95.00％）优于四联组（80.00％）及三联组（75.00％）,差异有统计学意义（P＜0.05）;根除后,胃窦乳酸杆菌属数量高于胃体[（1.742±0.162）、（1.680±0.223） lg cfu/mg],差异有统计学意义（t=4.023,P＜0.05）;胃窦乳酸杆菌属、柔嫩梭菌属、肠杆菌科的数量高于根除前[（分别为（1.742±0.162） lg cfu/mg与（1.505±0.250）lgcfu/mg,（2.106±0.083）lg cfu/mg与（2.010±0.131） lg cfu/mg,（2.030±0.119） lg cfu/mg与（1.609±0.399） lg cfu/mg,t值分别为3.225、3.174、3.571,P均＜0.05],拟球梭菌属数量低于根除前[（1.654±0.177）lg cfu/mg与（1.808±0.300） lg cfu/mg,t=2.896,P＜0.05];胃体乳酸杆菌属数量高于根除前[（1.680±0.223） lg cfu/mg与（1.524±0.294） lg cfu/mg,t=2.974,P＜0.05];拟球梭菌属数量低于根除前[（1.694±0.216） lg cfu/mg与（1.852±0.119） lg cfu/mg,t=1.332,P＜0.05];粪便乳酸杆菌属数量高于治疗前[（40.406±3.242）、（38.203±3.036） lg cfu/mg,t=3.115,P＜0.05].结论 泮托拉唑为基础的四联疗法加用胃黏膜保护剂可提高Hp阳性的十二指肠球部溃疡者Hp的根除率,改善患者的总体症状;而Hp根除后更加有利于肠道微生物菌群的平衡.
Objective To investigate the use of protective agent of gastric mucosa of helicobacter pylori quadraple therapy with pantoprazole based plus （Hp） positive duodenal ulcer intestinal microflora influence.Methods One hundred and twenty cases patients with Hp positive duodenal ulcer who were treated in Fuzhou University Hospital from September 2015 to September 2016 were selected and randomly divided into triplet group,quadruplet group,quadruplet ＋ protective agent group.Triplet group were treated with pantoprazole 40 mg,oral amoxicillin 1 000 mg and oral clarithromycin 500 mg,2 times one day,for 14 d treatment.Quadruplet group were given triple group therapy plus bismuth potassium citrate 220 mg,2 times one day,oral treatment,for 14 d treatment.Quadruplet＋protective agent group was given quadruple group therapy plus oral rebamipide 200 mg,3 times one day.The effect of Hp eradication and the distribution of intestinal microflora after treatment were compared.Results The eradication rate of Hp in triple group was 65.00%（26/40）,in quadruplet was 82.50%（33/40）,in quadruplet＋protective agent group was 87.50% （35/40）,Hp eradication rate in quadruplet ＋protective agent group was higher than the triple group and quadruplet group （P 〈 0.05）.Overall symptom improvement rate in quadruplet ＋ protective agent group（95.00%） was better than quadruple group（80.00%）and triplet Group （75.00%）,the difference was significant （P〈 0.05）.After the eradication of gastric antrum,gastric body was higher than the number of Lactobacillus（（1.7424±0.162） vs.（1.6796±0.223）,t=4.023,P〈0.05）.Ggastric acid bacillus,clostridium,and number of enterobacteriaceae were higher than the before eradication（（1.742±0.162） lg cfu/mg vs.（1.505±0.250） lg cfu/mg,（2.106±0.083） lg cfu/mg vs.（2.010± ±0.131） lg cfu/mg,（2.030±0.119）lg cfu/mg vs.（1.609±0.399） lg cfu/mg）,the differences were significant （t =3.225,3.174,3.571,P 〈 0.05）.The number of clostridium quasiballs lower than before eradication（（1.654± 0.177） lg cfu/mg vs.（1.808 ± 0.300） lg cfu/mg）,the difference was significant （t=2.896,P〈0.05）.The body of the stomach Lactobacillus number was higher than before eradication（（1.680± ±0.223） lg cfu/mg vs.（1.524±0.294） lg cfu/mg）,the difference was significant（t =2.974,P 〈0.05）.Clostridium quasiballs quantity was lower than before eradication （（1.694±0.216） lg cfu/mg vs,（1.8526± ±0.1193） lg cfu/mg）,the difference was significant（t =1.332,P〈0.05）.The number of fecal lactobacillus was higher than that before treatment （（40.406 ± 3.242） lg cfu/mg vs.（38.2034 ＋ 3.036） lg cfu/mg）,the difference was significant （t =3.115,P 〈 0.05）.Conclusion Pantoprazole based quadruple therapy plus the eradication rate of gastric mucosal protective agent can improve the use of Hp positive duodenal ulcer Hp,improve the overall symptoms,and it is more conducive to the balance of intestinal micro flora after Hp eradication.
出处
《中国综合临床》
2017年第6期515-519,共5页
Clinical Medicine of China
