高剂量二联疗法与经典四联疗法根除幽门螺杆菌的疗效对比

Comparison of the efficacy of high dose double therapy and bismuth-containing quadruple therapy in the treatment of Helicobacter pylori infection

目的评价高剂量二联疗法对幽门螺杆菌(H.pylori)的根除率,并观察其在临床应用中的主要不良反应及其发生率。方法选择2020年1月至2020年12月四川省广元市第三人民医院收治的160例健康体检者,其H.pylori检查阳性且无临床症状,随机分为实验组(高剂量二联疗法)和对照组(经典四联疗法),各80例。实验组给予“艾司奥美拉唑20 mg/次、阿莫西林750 mg/次”,均为4次/d,疗程14 d。对照组给予“艾司奥美拉唑20 mg/次、枸橼酸铋钾220 mg/次、阿莫西林1000 mg/次、克拉霉素500 mg/次”,均为2次/d,疗程14 d。疗程结束4周后复查13C-尿素呼气试验或14C-尿素呼气试验,比较两组H.pylori根除率及在服药期间药物不良反应的发生情况。结果实验组H.pylori根除率为91.25%,对照组为88.75%(P=0.598)。实验组药物不良反应发生率为52.5%,显著低于对照组的76.25%(P=0.002)。实验组的药物不良反应主要有头晕、恶心、食欲减退、疲乏和腹泻;对照组的药物不良反应主要有恶心、呕吐、腹胀、腹痛、嗳气、食欲减退、口苦和口干。结论高剂量二联疗法在根除H.pylori的疗效上与经典四联疗法相当,但不良反应发生率更低。鉴于两组不同的药物不良反应,不建议盲目选用高剂量二联疗法,而应综合评估患者的基础疾病及已有的临床症状后选择恰当的个体化治疗方案。

Objective To compare the eradication rate of Helicobacter pylori(H.pylori)between the high dose double therapy(HDDT)and bismuth-containing quadruple therapy(BQT)and to observe the main adverse effects in clinical application.MethodsFrom January 2020 to December 2020,a total of 160 healthy subjects with H.pylori infection and no clinical symptoms in our hospital were randomly divided into the experimental group(HDDT,n=80)and control group(BQT,n=80).The experimental group was given“esomeprazole 20 mg and amoxicillin 750 mg”four times a day for 14 days.The control group was given“esomeprazole 20 mg,bismuth potassium citrate 220 mg,amoxicillin 1000 mg and clarithromycin 500 mg”twice a day for 14 days.After four weeks of treatment,13C-urea breath test or 14C-urea breath test was re-examined.The eradication rate of H.pylori and the occurrence of drug side effects in each group were observed.Results The eradication rate of H.pylori in the experimental group was 91.25%,compared with 88.75%in the control group(P=0.598).The incidence of drug side effects was 52.5%in the experimental group,while that in the control group was 76.25%(P=0.002).The main side effects in the experimental group were dizziness,nausea,loss of appetite,fatigue and diarrhea,while those in the control group were nausea,vomiting,abdominal distension,abdominal pain,belching,loss of appetite,bitter mouth and dry mouth.Conclusion There was no significant difference in the eradication rate of H.pylori between the two groups,but the incidence of drug side effects was lower and the compliance of patients was better in the HDDT group.However,it is not recommended to choose HDDT blindly due to the variation of drug side effects between the two groups.On the contrary,it is recommended to choose individualized treatment based on the combination of the comprehensive evaluation of patients′basic diseases and the existing discomfort symptoms.