两种四联方案联合中药对幽门螺杆菌阳性胃癌前病变的根除及逆转疗效比较

A comparative study of curative effect of two quadruple therapies combined with TCM in the treatment of PLGC with Hp infection

[目的]比较2种四联方案联合中药对胃癌前病变患者合并幽门螺杆菌(Hp)感染的根除及逆转疗效。[方法]入选胃镜及病理检查诊断为胃癌前病变且13 C-尿素呼气试验证实Hp阳性的患者共200例,随机分为对照组(A组)和观察组(B组)。A组患者给予标准四联治疗方法,即雷贝拉唑+阿莫西林+克拉霉素+胶体果胶铋,共服用14d。B组采用雷贝拉唑+胶体果胶铋服用14d,同时阿莫西林+呋喃唑酮服用10d。根除治疗后停药4周以上再次复查13 C-尿素呼气试验。Hp治疗结束后2组患者立即行中药治疗,服用6个月后再次行胃镜及病理检查。[结果]Hp根除率:A组Hp根除率为79.0%,B组Hp根除率为93.0%,2组比较差异有统计学意义(P<0.05);不良反应发生率:A组发生不良反应为23.0%,B组药物不良反应为17.0%,2组比较差异无统计学意义。B组肠化、不典型增生病理积分均低于A组,且差异有统计学意义(P<0.05),而萎缩的病理积分2组差异无统计学意义。[结论]含呋喃唑酮的四联方案在不增高不良反应发生率的基础上,根除Hp疗效优于克拉霉素的四联方案,且胃癌前病变逆转疗效更好,提示含呋喃唑酮的四联方案联合中药对于干预胃癌前病变的进一步发展及预防胃癌的发生具有重要作用。

[Objective]To compare the curative effect of two quadruple therapies combined with traditional Chinese medicine(TCM)in the treatment of precancerous lesions of gastric cancer(PLGC)with helicobacter pylori(Hp)infection.[Methods]200 cases of PLGC with Hp infection patients in our hospital were randomly divided into two groups with 100 cases in each gruop,the control group adopted the routine treatment(rabeprazole,amoxicillin,clarithromycin and bismuth),while the observation group adopted the quadruple therapy of rabeprazole,amoxicillin furazolidone and bismuth,and the eradication efficacy of Hp and adverse reactions were compared between the two groups.After the treatment of Hp,TCM were given to both two groups for 6 months immediately.After that,all the patients took a gastroscopy and pathological examination.[Results]The differences in the eradication rate between the observation group and the control group had statistical significance(93.0%vs.79.0%,P<0.05).Otherwise,the incidence rate of adverse reactions in two groups had no statistical significance(17.0% vs.23.0%,P>0.05).In addition,after the therapy of TCM,the pathologic change of intestinal metaplasia and dysplasia in B group is better than thatin A group(P<0.05),while the change of atrophy had no statistical significance.[Conclusion]Containing furazolidone quadruple therapy is more effectively to kill the Hp in the stomach of PLGC patients,without obvious adverse reactions,and it can assist TCM to prevent the development of PLGC.