幽门螺旋杆菌根除治疗现状及影响因素分析

Current rate of Helicobacter pylori eradication and its influencing factors: a retrospective study

目的调查幽门螺旋杆菌的根除治疗现状及影响因素。方法选取2014年1月-2015年12月于北京大学人民医院门诊首次根除幽门螺旋杆菌的患者3 998例。所有患者均使用含有铋剂的四联方案,疗程7~14 d。治疗后停药4~12周通过^(13)C呼吸试验评价根除治疗效果。结果含有阿莫西林的方案总体根除率为77.6%,不含阿莫西林的方案总体根除率为69.8%,两方案根除率比较有差异(P<0.05)。结论目前临床上幽门螺旋杆菌根除率低。使用阿莫西林和适当延长疗程可提高疗效。

Objective To investigate the current eradication rate of Helicobacter pylori and its influencing factors in Peking University People’s Hospital.Methods A retrospective study was performed on 3,998 Helicobacter pylori-positive patients admitted to our hospital for initial eradication treatment between January 2014 and December 2015.All the patients were given quadruple therapy containing bismuth for a course of 7-14 d.The eradication effect was evaluated by 13C-urea Breath Test within 4-12 weeks after treatment.Results All of 3,998 patients received standard 7-14 day quadruple therapy:proton pump inhibitor(PPI)+2 antibiotics+bismuth.In total,the eradication rate was 74.9%.The eradication rates of regimens containing Amoxicillin plus Clindamycin,Amoxicillin plus Levofloxacin and Amoxicillin plus Metronidazole/Tinidazole were 77.8%,80.6%and 71.8%,respectively(P>0.05).The eradication rates of regimens containing Clindamycin plus Levofloxacin,Clindamycin plus Metronidazole/Tinidazole and Levofloxacin plus Metronidazole/Tinidazole were 70.5%,55.7%and 74.7%,respectively(P>0.05).Amoxicillin-containing regimens had a higher total eradication rate than the regimens without Amoxicillin(77.6%vs 69.8%,P<0.05).Multivariate logistic regression analysis showed that the duration of therapy and the choice of antibiotics were independent predictors of treatment failure.Conclusions The current quadruple therapy has a very high failure rate in Beijing,China.Amoxicillin-containing regimens and longer treatment duration may increase the eradication rate.