三联疗法、序贯疗法及反向序贯疗法治疗儿童幽门螺杆菌感染的临床疗效

Effects of triple therapy,sequential therapy and reversed sequential therapy on Helicobacter pylori infection among children

目的探讨三联疗法、序贯疗法及反向序贯疗法治疗儿童幽门螺杆菌(Hp)感染的临床疗效。方法选取2017年3月至2019年3月汕头大学医学院第一附属医院儿科收治的96例13C尿素呼气实验阳性的Hp感染患儿为研究对象,随机数表法分为3组,分别给予10 d序贯疗法(序贯疗法组、35例)、反向序贯疗法(反向序贯疗法组、28例)和标准三联疗法(常规三联疗法组、33例)治疗,分别记录3组患儿治疗有效率、治疗前后临床症状积分、Hp根除率和不良反应发生率。结果序贯疗法组、反向序贯疗法组和标准三联疗法患儿治疗有效率分别为91.42%、89.29%和65.00%,差异有统计学意义(χ^2=6.784、P=0.034),其中序贯疗法组(χ^2=6.370、P=0.012)和反向序贯疗法组(χ^2=4.383、P=0.036)患儿治疗有效率显著高于标准三联疗法组,差异均有统计学意义,而序贯疗法组和反向序贯疗法组患儿治疗有效率差异无统计学意义(χ^2=0.083、P=0.773)。3组患儿反酸、腹痛的症状积分差异有统计学意义(F=14.288、15.506,P均<0.001),但恶心(F=0.053、P=0.948)和嗳气(F=0.496、P=0.610)症状的积分差异无统计学意义。序贯疗法组(χ^2=3.994、P=0.045)和反向序贯疗法组(χ^2=4.462、P=0.035)患儿的Hp根除率显著高于标准三联疗法组,差异有统计学意义;序贯疗法组和反向序贯疗法组出现反酸(t=4.680、P<0.001,t=3.457、P=0.010)和腹痛(t=4.407、P<0.001,t=6.310、P<0.001)症状积分显著低于标准三联疗法组,差异均有统计学意义。各组患儿的不良反应率差异无统计学意义(χ^2=0.331、P=0.848)。结论与标准三联疗法相比,反向序贯疗法和序贯疗法可有效改善Hp感染患儿的临床症状,提高Hp根除率和治疗有效率。

Objective To explore the clinical curative effect of triple therapy,sequential therapy and reversed sequential therapy on children with Helicobacter pylori(Hp)infection.Methods Total of 96 children with Hp infection diagnosed through 13 C urea breath test positive were enrolled in Pediatrics Department of First Affiliated Hospital of Shantou University Medical College from March 2017 to March 2019.According to random number table method,they were divided into three groups,10 d of sequential therapy(sequential therapy group,35 cases),reverse sequential therapy(reverse sequential therapy group,28 cases)and standard triple therapy(standard triple therapy group,33 cases)were administered,respectively.The effective rate,clinical symptom score,eradication rate of Hp and adverse reaction of the three groups were recorded,respectively.Results The effective rates of sequential therapy group,reverse sequential therapy group and standard triple therapy group were 91.42%,89.29%and 65.00%,respectively,with significant difference(χ^2=6.784,P=0.034).The effective rates of sequential therapy group and reverse sequential therapy group were significantly higher than that of standard triple therapy group(χ^2=6.370,P=0.012;χ^2=4.383,P=0.036);but there was no difference between sequential therapy group and reverse sequential therapy group(χ^2=0.083,P=0.773).After treatment,scores of acid reflux and abdominal pain among the three groups were significantly different(F=14.288,P<0.001;P=15.506,F=14.288,P<0.001),but scores of nausea and belching among the three groups were without significant differences(F=0.053,P=0.948;F=0.496,P=0.610).Hp eradication rates of sequential therapy group and reverse sequential therapy group after treatment were significantly higher than that of standard triple therapy group(χ^2=3.994,P=0.045;χ^2=4.462,P=0.035).After treatment,scores of acid reflux(t=4.680,P<0.001;t=3.457,P=0.010)and abdominal pain(t=4.407,P<0.001;t=6.310,P<0.001)of cases in sequential therapy group and reverse sequential therapy group were significantly lower than those of standard triple therapy group.There was no significant difference in incidence of adverse reactions among the three groups(χ^2=0.331,P=0.848).Conclusions Compared with standard triple therapy,reversed sequential therapy and sequential therapy could effectively improve the clinical symptoms,Hp eradication rate and effective rate of treatment of children with Hp infection.