联合蜡样芽孢杆菌治疗方案根治幽门螺杆菌的临床疗效

Clinical efficacy of the treatment protocol combined with bacillus cereus in the radical treatment of helicobacter pylori

目的探讨联合蜡样芽孢杆菌制剂的不同根治方案对根除幽门螺杆菌(H.pylori,Hp)的临床疗效。方法将200例Hp阳性并符合根除指征患者随机分成4组,分别接受标准PPI三联方案、联合蜡样芽孢杆菌的标准PPI三联方案、铋剂经典四联方案和联合蜡样芽孢杆菌的铋剂经典四联方案治疗,疗程10 d,蜡样芽孢杆菌制剂使用14 d;治疗结束后所有方案均停用抗生素4周、PPI 3周后,行^(13)C,^(14)C尿素呼气试验(^(13)C,^(14)C-UBT)检测Hp,治疗期间随访观察患者不良反应的发生情况。结果标准PPI三联方案、联合蜡样芽孢杆菌的标准PPI三联方案、铋剂经典四联方案、联合蜡样芽孢杆菌的铋剂经典四联方案对Hp根除率分别是70.00%、74.00%、88.71%和90.00%,治疗期间不良反应的发生率分别为16.67%、4.00%、19.35%和6.00%;含铋剂的经典四联治疗方案对Hp的根除率明显高于以标准PPI三联为主的治疗方案,差异有统计学意义(P<0.05);联合蜡样芽孢杆菌的治疗方案不良反应发生率低于不含蜡样芽孢杆菌的治疗方案,差异有统计学意义(P<0.05)。结论联合蜡样芽孢杆菌制剂的治疗方案对Hp的根除率无明显提高,但可降低治疗期间不良反应的发生率,提高患者治疗的依从性。

Objective To investigate the clinical efficacy of different radical treatment protocols of combined Bacillus cereus preparation for the eradication of helicobacter pylori（Hp）. Methods 200 patients who were Hp-positive and complied with eradication indications were randomly divided into 4 groups. They were treated with the standard PPI triple therapy protocol, the standard PPI triple therapy protocol combined with Bacillus cereus, the classic bismuth quadruple therapy protocol, and the classic bismuth quadruple therapy protocol combined with Bacillus cereus. The course of treatment was 10 days, and Bacillus cereus preparation was used for 14 days; after the end of treatment, antibiotics were stopped for 4 weeks and PPI was stopped for 3 weeks in all protocols, and Hp was detected by 13C, 14C urea breath test（13C, 14C-UBT）. During the treatment, the occurrence of adverse reactions in patients were observed in follow-up visits. Results The eradication rate to Hp in the standard PPI triple therapy protocol, the standard PPI triple therapy protocol combined with Bacillus cereus, the classic bismuth quadruple therapy protocol, and the classic bismuth quadruple therapy protocol combined with Bacillus cereus were 70.00%, 74.00%, 88.71%, and 90.00% respectively. The incidence rate of adverse reactions during treatment was 16.67%, 4.00%, 19.35%, and 6.00%, respectively; the eradication rate to Hp in the classic bismuth quadruple therapy protocol was significantly higher than that in the standard PPI triple therapy protocol, and the difference was statistically significant（P〈0.05）; the incidence rate of adverse reactions in the treatment protocol combined with Bacillus cereus was lower than that in the treatment protocol not combined with Bacillus cereus, and the difference was statistically significant（P〈0.05）. Conclusion The treatment protocol combined with Bacillus cereus preparation has no significant improvement on the eradication rate to Hp, but it can reduce the incidence rate of adverse reactions during treatment and improve the treatment compliance of patients.