联合用药对小儿消化性溃疡及幽门螺杆菌根除率的影响

Effects of drug combination on treatment of peptic ulcer in children and Helicobacter pylori eradication rate

目的探讨奥美拉唑、阿莫西林、克拉霉素联合枸橼酸铋钾胶在小儿消化性溃疡患者中的临床效果及对幽门螺杆菌(Hp)根除率的影响。方法选取2014年1月至2016年12月湖州市中医院收治的小儿消化性溃疡患者70例,按随机数字法分为对照组(n=35)和观察组(n=35)。对照组采用奥美拉唑、阿莫西林及克拉霉素进行治疗,观察组在对照组基础上联合枸橼酸铋钾胶颗粒进行治疗。采用胶乳增强免疫投射比浊法测定两组血清胃蛋白酶原(PG)水平,采用酶联免疫吸附法测定两组抗Hp IgG抗体水平,同时比较两组临床疗效及对Hp根除率、抗体水平的影响。结果观察组治疗后14天症状缓解、溃疡消失及幽门螺杆菌转阴时间均短于对照组(t值分别为19.284、20.441、17.471,均P<0.05);观察组及对照组治疗后14天的PGⅠ、PGⅡ及PGⅠ/PGⅡ比值(PGR)水平均低于治疗前(t值分别为12.194、14.092、15.771、16.893、11.215、14.092、均P<0.05);观察组治疗后14天的PGⅠ、PGⅡ及PGR水平均低于对照组(t值分别为14.395、13.209、11.291,均P<0.05);观察组治疗后5、10及14天Hp根除率均高于对照组(χ2值分别为5.935、4.717、6.338,均P<0.05);观察组治疗后14天药物不良反应发生率为14.29%,与对照组的11.43%比较差异无统计学意义(χ2=1.826,P>0.05)。结论小儿消化性溃疡患者采用奥美拉唑、阿莫西林、克拉霉素联合枸橼酸铋钾胶治疗效果理想,有助于提高临床Hp根除率,改善抗体水平,缩短症状改善时间,值得临床推广应用。

Objective To investigate the clinical effects of omeprazole,amoxicillin,clarithromycin combined with bismuth potassium citrate on children with peptic ulcer and their effect on Helicobacter pylori（Hp）eradication rate.Methods Seventy cases of pediatric peptic ulcer admitted in Huzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2016 were selected and divided into control group（n=35）and observation group（n=35）according to random number method.Patients in the control group were treated with omeprazole,amoxicillin and clarithromycin and those in the observation group were treated with combination of bismuth potassium citrate gel particles on basis of treatment for the control group.Serum pepsinogen（PG）level in two groups was determined by latex-enhanced immuno-turbidimetry and anti-Hp IgG antibody level was determined by enzymelinked immunosorbent assay.Clinical efficacy and,influences on Hp eradication rate and antibody level were compared between two groups.Results Symptom relief time,ulcer disappearance time and Hp negative conversion time after 14 days of treatment in the observation group were shorter than those in the control group（t value was 19.284,20.441 and 17.471,respectively,all P〈0.05）.PGI,PGII and PGI/PGII at 14 days after treatment in both groups were lower than those before treatment（t value was12.194,14.092,15.771,16.893,11.215 and 14.092,respectively,all P〈0.05）.Levels of PGI,PGII and PGR 14 days after treatment in the observation group were lower than those in the control group（t value was 14.395,13.209 and 11.291,respectively,all P〈0.05）.Hp eradication rates at 5,10,and 14 days after treatment in the observation group were higher than those in the control group（χ^2 value was 5.935,4.717 and 6.338 respectively,all P〈0.05）.Incidence of adverse drug reactions at14 days after treatment in the observation group was 14.29%,which was not statistically different from that of 11.43% in the control group（χ^2=1.826,P〉0.05）.Conclusion Use of omeprazole,amoxicillin,clarithromycin combined with bismuth potassium citrate in treatment of children with peptic ulcer has good effect,which helps to increase the eradication rate of Hp,improve antibody levels,and shorten time for symptom improvement.So it is worthy of clinical promotion and application.