重庆地区1088例幽门螺杆菌感染患者根治疗效回顾性研究

Helicobacter pylori eradication efficacy among 1088 patients in Chongqing area:a retrospective study

目的评估重庆地区四种常用抗幽门螺杆菌(H.plyori)根治方案的疗效。方法回顾性分析2019年1月至2019年9月于我院诊断为H.plyori感染患者的资料,将1088例患者根据治疗方案不同分为4组,分别为:CT-quad组(铋剂四联克拉霉素+替硝唑+雷贝拉唑)、AO-quad组(铋剂四联阿莫西林+奥硝唑+雷贝拉唑)、AL-quad组(铋剂四联阿莫西林+左氧氟沙星+雷贝拉唑)及AO-trip组(三联阿莫西林+奥硝唑+雷贝拉唑)。各组疗程均2周,4周后复查13 C尿素呼气试验,比较各组患者H.pylori根治率。此外分析根治失败危险因素及成本-效果比。结果各组根治率分别为:CT-quad组54.5%,AO-quad组78.5%,AL-quad组80.6%,AO-trip组65.7%。其中AO-quad组疗效优于CT-quad组(OR=3.226,95%CI:2.337~4.453,P<0.001),优于AO-trip组(OR=1.972,95%CI:1.266~3.07,P=0.003)。AL-quad组疗效优于CT-quad组(OR=3.155,95%CI:2.288~4.351,P<0.001),但同AO-quad组疗效比较,差异无统计学意义(P=0.743)。AO-quad组中≥60岁患者较<40岁患者根治失败率更高(OR=2.762,95%CI:1.214~4.628,P=0.015)。AO-quad成本-效果比最佳。结论重庆地区首选铋剂四联阿莫西林+奥硝唑方案,其根治率同铋剂四联阿莫西林+左氧氟沙星方案疗效相似但具有成本-效果优势。不宜选用铋剂四联克拉霉素+替硝唑方案。年龄可能是根治失败的影响因素。

Objective To evaluate the efficacy of four different H.pylori eradication regimens in Chongqing area.Methods Data were collected for patients diagnosed with H.pylori infection from Jan.2019 to Sep.2019.1088 patients were divided into four groups based on eradication regimens,including CT-quad group(Clarithromycin+Tinidazole+Rabeprazole+Bismuth),AO-quad group(Amoxicillin+Ornidazole+Rabeprazole+Bismuth),AL-quad group(Amoxicillin+Levofloxacin+Rabeprazole+Bismuth)and AO-trip group(Amoxicillin+Ornidazole+Rabeprazole).A 13 C-urea breath test were perform 4 weeks later after the 2 weeks treatment for all patients.The efficacy among each regimens were compared,the risk factors for eradication failure and cost-effectiveness ratio were analyzed in the same time.Results The eradication efficacy for CT-quad group was 54.5%,AO-quad group was 78.5%,AL-quad group was 80.6%,and AO-trip group was 65.7%.The efficacy of AO-quad was superior to CT-quad(OR=3.226,95%CI:2.337-4.453,P<0.001),AO-quad to AO-trip(OR=1.972,95%CI:1.266-3.07,P=0.003),AL-quad to CT-quad(OR=3.155,95%CI:2.288-4.351,P<0.001).However,there was no statistical difference between AO-quad and AL-quad(P=0.743).Patients older than 60 years old had a higher eradication failure rate than patients younger than 40 years old(OR=2.762,95%CI:1.214-4.628,P=0.015).The AO-quad cost-effectiveness ratio was superior than other groups.Conclusion In Chongqing area,Bismuth containing Amoxicillin plus Ornidazole quadruple therapy is the prefer choice for H.pylori eradication,for its comparable efficacy than that of Amoxicillin plus Levofloxacin quadruple therapy,but with a cost-effective advantage.Bismuth containing Clarithromycin plus Tinidazole regimen should not be used empirically.Age may be a factor for eradication failure.