四联药物联合牙周非手术治疗对胃幽门螺杆菌根除率的影响

The effect of quadruple drug therapy combined with periodontal nonsurgical treatment on the eradication rate of Helicobacter pylori

目的探讨四联药物联合牙周非手术治疗对胃幽门螺杆菌(Helicobacter pylori,Hp)根除率的影响。方法选择有慢性牙周炎且胃镜活检、13C阳性及病理诊断为慢性非萎缩性胃炎、胃溃疡、十二指肠溃疡患者116人,随机分为4组:A组:36人牙周探诊深度小于4 mm,仅接受四联药物治疗;B组:24人牙周探诊深度小于4 mm,接受四联药物治疗及牙周非手术治疗;C组:30人牙周探诊深度大于等于4 mm,仅接受四联药物治疗;D组:26人牙周探诊深度大于等于4 mm,接受四联药物治疗及牙周非手术治疗。四组患者分别于治疗后12周和1年复查13C观察胃Hp根除率以及B组D组治疗后胃Hp根除率与患者牙周临床指数的关系。结果牙周探诊深度小于4 mm时,A、B组治疗后12周HP根除率为86.11%vs91.67%,差异无统计学意义(P>0.05);1年后HP根除率为66.67%vs79.17%,差异有统计学意义(P<0.05)。牙周探诊深度大于等于4mm时,C、D组治疗后12周HP根除率为80.00%vs88.46%,差异无统计学意义(P>0.05);1年后HP根除率为60.00%v76.92%,差异有统计学意义(P<0.05)。结论四联药物结合牙周非手术治疗能够有效提高胃内Hp的远期根除率,提示口腔内龈下菌斑中的Hp可能是胃内Hp再次感染的重要原因之一。

Objective To investigate the effect of quadruple drug combined with periodontal nonsurgical treatment on the eradication rate of Helicobacter pylori(Hp).Methods A total of 116 patients with chronic periodontitis and endoscopic biopsy,13C positive and pathological diagnosis of chronic non-atrophic gastritis,gastritis ulcer and duodenal ulcer were randomly divided into 4 groups:Group A:36 periodontal probing Depth less than 4mm,only to receive quadruple drug treatment;Group B:24 people with periodontal probing depth less than 4mm,receiving quadruple drug treatment and periodontal non-surgical treatment;Group C:30 people with periodontal probing depth greater than or equal to 4mm,Only received quadruple drug treatment;D group:26 people with periodontal probing depth greater than or equal to 4mm,quadruple drug treatment and periodontal non-surgical treatment.In the four groups of patients,13C was observed at 12 weeks and 1 year after treatment respectively to observe the eradication rate of gastric Hp and the relationship between the eradication rate of gastric Hp and the periodontal clinical index in group B after treatment.Results When the periodontal probing depth was less than 4mm,the HP eradication rate was 86.11%vs 91.67%at 12 weeks after treatment in group A and B,P>0.05;after one year HP eradication rate was 66.67%vs 79.17%,P<0.05.When the periodontal probing depth was greater than or equal to 4mm,the HP eradication rate was 80.00%vs 88.46%in group C and D after 12 weeks of treatment,P>0.05;HP eradication rate was 60.00%v76.92%after one year,P<0.05.Conclusion Quadruple drug combined with periodontal non-surgical treatment can effectively increase the long-term eradication rate of Hp in the stomach,suggesting that Hp in the subgingival plaque of the oral cavity may be one of the important causes of recurrent Hp infection in the stomach.