早期半夏泻心汤后期香砂六君子汤联合中药地榆与三联疗法分阶段治疗难治性幽门螺杆菌感染

Early Banxia Xiexin decoction and late Xiangsha Liujunzi decoction combined with chinese medicine Diyu and triple therapy for treatment of refractory Helicobacter pylori infection in stages

目的应用分阶段综合疗法治疗难治性幽门螺杆菌感染(refractory Helicobacter pylori infection,RHPI)患者的临床疗效观察。方法共纳入2018-2020年按共识推荐方案运用三联疗法治疗反复失败≥3次的RHPI患者88例,随机分为治疗组45例和对照组43例,其中治疗组采用分阶段综合疗法,即:早期(半夏泻心汤加减)×7 d;标准三联抗菌治疗(艾司奥美拉唑+阿莫西林+克拉霉素)+中药地榆×10 d;后期(香砂六君子汤加减)×7 d。对照组予以标准四联抗菌治疗(艾司奥美拉唑+阿莫西林+克拉霉素+胶体酒石酸铋)×14 d。2组患者均停药1个月后复查~(13)C或~(14)C呼气试验,比较两组患者在Hp根除率、治疗前后中医症状评分及1年后Hp复感率的疗效差异,并记录不良反应。结果治疗组和对照组的Hp根除率为93.33%和81.40%,1年后Hp复感率为13.33%和25.58%,治疗组的Hp根除率明显高于对照组,1年后Hp复感率明显低于对照组,差异有统计学意义(P<0.05);两组治疗前后中医症状评分均有改善,治疗组显效率为62.22%,对照组的显效率为37.21%,治疗组明显高于对照组(P<0.05);治疗期间未发生严重不良事件。结论早期半夏泻心汤后期香砂六君子汤联合中药地榆与三联疗法的分阶段治疗能够显著提高RHPI的根除率,降低复感率,症状缓解明显,疗效确切,不良反应少。

Objective Observation on the clinical efficacy of staged comprehensive therapy for patients with refractory Helicobacter pylori infection(RHPI).Methods A total of 88 patients with refractory Hp infection who had repeated failures of≥3 times with triple therapy were included from 2018 to 2020 according to the consen⁃sus recommendation.They were randomly divided into treatment group(45 cases)and control group(43 cases),of which the treatment group adopt staged comprehensive therapy,namely:early stage(Chinese medicine Banxia Xiexin Decoction plus or minus symptomatic treatment)×7 days;standard triple antibacterial treatment(esomepra⁃zole+amoxicillin+clarithromycin)+Chinese medicine Sanyu×10 Days;late stage(Chinese medicine Xiangsha Liujunzi Decoction plus or minus treatment)×7 days The control group received standard quadruple antibacterial treatment(esomeprazole+amoxicillin+clarithromycin+colloidal bismuth tartrate)×14 days.Both groups of patients were rechecked for 13C or 14C breath test after stopping the drug for 1 month.The differences in the efficacy of Hp eradication rate,TCM symptom score before and after treatment,and Hp resuscitation rate after 1 year were compared between the two groups,and adverse reactions were recorded.Results In the treatment group and the control group,the eradication rate of Hp was 93.33%and 81.40%,respectively,and the Hp relapse rate after 1 year was 13.33%and 25.58%,respectively.The Hp eradication rate in the treatment group was significantly higher than that in the control group,the Hp relapse rate after 1 year was significantly lower than that in the control group,and the difference was statistically significant(P<0.05);the scores of TCM symptoms in the two groups were improved before and after treatment,and the treatment group had a significant rate of 62.22%.The efficiency was 37.21%,and the treatment group was significantly higher than that in the control group(P<0.05);no serious adverse events occurred during the treatment period,and the adverse reactions in the treatment group during the radical cure of Hp were significantly less than those in the control group(P<0.05).Conclusion Early Banxia Xiexin Decoction and later stage Xiangsha Liujunzi Decoction combined with Chinese medicine Diyu and triple therapy can significantly increase the eradication rate of RHPI,reduce the relapse rate,relieve symptoms obviously,have definite curative effect and have fewer adverse reactions.