混合疗法与铋剂四联方案治疗H.pylori阳性消化性溃疡的疗效比较

Therapeutic effects of mixed treatment and bismuth quadruple therapy on H. pylori positive peptic ulcer

目的探讨混合疗法与铋剂四联方案治疗H.pylori阳性消化性溃疡的疗效。方法收治的H.pylori感染的消化性溃疡患者132例随机分为2组。混合疗法组71例,前7d服用泮托拉唑钠肠溶片+阿莫西林胶囊,后7d连续服用泮托拉唑钠肠溶片+阿莫西林胶囊+克拉霉素缓释片+甲硝唑。铋剂四联疗法组61例,服用枸橼酸铋钾胶囊+泮托拉唑钠肠溶片+阿莫西林+克拉霉素500mg,2次/d,口服;7d为1个疗程,治疗2个疗程后停用抗生素,继续服用枸橼酸铋钾胶囊、泮托拉唑钠肠溶片4周。比较2组临床疗效、H.pylori根除率、复发率及不良反应发生情况。结果混合疗法组总有效率为88.73%,铋剂四联疗法组为90.16%,2组差异无统计学意义(P>0.05)。2组腹痛缓解时间比较差异无统计学意义(P>0.05),而溃疡消失时间混合疗法组较对照组早(P<0.05)。混合疗法组H.pylori根除率为94.36%,铋剂四联疗法组为85.24%,混合疗法组高于铋剂四联疗法组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。对H.pylori阳性患者随访显示,3个月时复发率比较差异无统计学意义(P>0.05),6个月时铋剂四联疗法组复发率明显升高(P<0.05)。结论混合疗法治疗H.pylori感染的消化性溃疡疗效明显优于含铋剂四联疗法,且不良反应未见明显增加,是一种安全、有效的治疗方案。

Objective To explore the therapeutic effects of mixed treatment and bismuth quadruple therapy in treatment of H.pylori positive peptic ulcer. Methods A total of 132 patients with Hp-infected peptic ulcer were randomly divided into mixed treatment group ( n =71) and quadruple therapy group ( n =61). The patients in mixed treatment group were treated by pantoprazole sodium enteric-coated tablets combined with amoxicillin capsules for seven days and then treated by pantoprazole sodium enteric-coated tablets combined with amoxicillin capsules, clarithromycin slow-released tablet and metronidazole for another seven days. The patients in quadruple therapy group were treated by bismuth potassium citrate capsules combined with pantoprazole sodium enteric-coated tablets, amoxicillin capsules and 500 mg of clarithromycin slow-released tablet twice a day, for two weeks, with one week as a course. After treatment, The patients in quadruple therapy group were treated by bismuth potassium citrate capsules combined with pantoprazole sodium enteric-coated tablets for four weeks. The therapeutic effects, the eradication rate and recurrence rate of Hp and the incidence of adverse reactions were compared between the two groups. Results The total effective rate was 88.73% in mixed treatment group and 90.16% in quadruple therapy group, respectively, there was no significant difference in the total effective rate between the two groups ( P >0.05),and there was no significant difference in the remission time of abdominal pain between the two groups ( P >0.05).However the extinction time of ulcer in mixed treatment group was significantly earlier than that in quadruple therapy group ( P <0.05).The eradication rate of H.pylori in mixed treatment group (94.36%) was significantly higher than that (85.24%) in quadruple therapy group ( P <0.05). In addition, there was no significant difference in the incidence rate of adverse reaction between the two groups ( P >0.05). The follow up results showed that there was no significant difference in the relapse rate between the two groups ( P >0.05),however,which at the end of six months in quadruple therapy group was significantly increased ( P <0.05). Conclusion Mixed treatment is safe and effective in treating H.pylori positive peptic ulcer, with less adverse reaction, and the therapeutic effects of mixed treatment are superior to those of quadruple therapy.