铋剂四联疗法根除幽门螺杆菌疗效研究

Effect of bismuth-based quadruple therapy on Helicobacter pylori eradication

目的比较不同疗程铋剂四联疗法与经典三联疗法根除幽门螺杆菌(Hp)的疗效。方法选择403例符合条件的Hp阳性的消化性溃疡或慢性胃炎患者。随机分为三组,其中A组138例、B组142例、C组123例。A组采用果胶铋200 mg+雷贝拉唑10 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,2次/天,共10 d;B组采用果胶铋200 mg+雷贝拉唑10 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,2次/天,共14 d;C组采用雷贝拉唑10 mg+阿莫西林1 000 mg+呋喃唑酮100 mg,2次/天,共14 d。观察三组患者Hp根除率、不良反应发生率及其成本-效果比。结果 A、B、C三组患者Hp根除率分别为83.33%、83.80%、71.54%,A组与B组Hp根除率比较差异无统计学意义(P>0.05),A组与C组、B组与C组Hp根除率比较均差异有统计学意义(P<0.05)。A、B、C三组患者的不良反应发生率分别为1.45%、2.11%、0.81%,均差异无统计学意义(P>0.05)。A、B、C三组成本-效果比分别为1.50、2.09、2.04。结论三种治疗方案均未达到Hp根除率>90%的理想方案。但三种方案的比较中含铋剂10 d与14 d四联疗法Hp根除率较高,接近理想方案。含铋剂10 d四联疗法成本-效果比最好,建议临床使用。14 d三联疗法Hp根除率仅达71.54%,远低于理想标准,不建议临床使用。

Objective To compare the efficacy of bismuth-based quadruple therapy for different courses and classic triple therapy in the eradication of Helicobacter pylori( Hp). Methods Four hundred and three patients with Hp-positive peptic ulcer or chronic gastritis were randomly assigned into group A( n = 138),group B( n = 142) and group C( n = 123). Patients in group A were treated with colloidal bismuth pectin 200 mg + rabeprazole 10 mg + amoxicillin 1 000 mg + furazolidone 100 mg twice daily for 10 days. Patients in group B were treated with colloidal bismuth pectin 200 mg + rabeprazole 10 mg + amoxicillin 1 000 mg + furazolidone 100 mg twice daily for 14 days. Patients in group C were treated with rabeprazole 10 mg + amoxicillin 1 000 mg + furazolidone 100 mg twice daily for 14 days. Hp eradication rate,incidence of adverse events and cost-effectiveness ratio were analyzed among the three groups. Results The Hp eradication rates of group A,B and C were 83. 33%,83. 80%,and 71. 54%,respectively. There was no significant difference in the Hp eradication rate between group A and B( P > 0. 05). The Hp eradication rate of group A and group B was higher than group C( P <0. 05). The incidences of adverse events of group A,B and C were 1. 45%,2. 11%,and 0. 81%,respectively. No significant difference was observed among the three groups( P > 0. 05). Cost-effectiveness ratio( C/E) of group A,B and C were 1. 50,2. 09,and 2. 04,respectively. Conclusions Although the Hp eradication rates of the three treatment regimens are lower than 90%,they are relatively higher in patients treated with bismuth-based quadruple therapy for 10 days and 14 days compared with patients treated with classic triple therapy. Bismuth-based quadruple therapy for 10 days is recommended because of its highest cost-effectiveness ratio. With the lowest Hp eradication rate among these three groups,classic triple therapy for 14 days is not recommended.