三联疗法与四联疗法治疗幽门螺杆菌相关性胃溃疡的疗效及对胃肠激素水平的影响

Efficacy of triple therapy versus quadruple therapy in the treatment of Helicobacter pyloriassociated gastric ulcer and its influence on gastrointestinal hormone levels

目的 比较三联疗法与四联疗法治疗幽门螺杆菌相关性胃溃疡的疗效及对胃肠激素水平的影响。方法 84例幽门螺杆菌相关性胃溃疡患者,按随机数字表法分为对照组和观察组,每组42例。对照组患者给予艾司奥美拉唑、阿莫西林、克拉霉素三联疗法治疗,观察组患者给予艾司奥美拉唑、阿莫西林、胶体果胶铋、克拉霉素四联疗法治疗。比较两组患者胃镜疗效、不良反应发生率、幽门螺杆菌根除率、复发情况及治疗前后消化道症状(胃脘胀痛、胃脘灼热、嗳气反酸、恶心呕吐、食少纳差)评分、胃肠激素(胃泌素、胃动素)水平。结果 治疗30 d后,两组胃脘胀痛、胃脘灼热、嗳气反酸、恶心呕吐、食少纳差评分均低于本组治疗前,且观察组胃脘胀痛、胃脘灼热、嗳气反酸、恶心呕吐、食少纳差评分分别为(1.28±0.26)、(1.03±0.24)、(1.58±0.22)、(1.04±0.18)、(1.56±0.20)分,均明显低于对照组的(1.88±0.42)、(1.63±0.30)、(2.02±0.28)、(1.52±0.21)、(1.92±0.24)分,差异具有统计学意义(P<0.05)。治疗30 d后,两组胃泌素、胃动素水平均高于本组治疗前,且观察组胃泌素(143.19±20.20)pg/ml、胃动素(236.22±24.04)pg/ml明显高于对照组的(127.65±20.33)、(218.43±23.12)pg/ml,差异具有统计学意义(P<0.05)。观察组胃镜总有效率为95.24%(40/42),明显高于对照组的80.95%(34/42),差异具有统计学意义(P<0.05)。观察组幽门螺杆菌根除率为92.86%(39/42),明显高于对照组的73.81%(31/42),差异具有统计学意义(P<0.05)。观察组1年复发率为7.69%(3/39),明显低于对照组的25.81%(8/31),差异具有统计学意义(P<0.05)。观察组不良反应发生率为7.14%(3/42),对照组不良反应发生率为4.76%(2/42);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 四联疗法治疗幽门螺杆菌相关性胃溃疡能更好地改善临床不适症状,提高幽门螺杆菌根除率及胃镜效果,进一步改善患者胃肠激素水平,降低疾病复发率,效果明显优于三联疗法。

Objective To compare the efficacy of triple therapy versus quadruple therapy in the treatment of Helicobacter pylori-associated gastric ulcer and its influence on gastrointestinal hormone levels.Methods A total of 84 patients with Helicobacter pylori associated gastric ulcer were randomly divided into control group and observation group,with 42 cases in each group.The control group was given triple therapy of esomeprazole,amoxicillin,and clarithromycin,and the observation group was given quadruple therapy of esomeprazole,amoxicillin,colloidal bismuth pectin,and clarithromycin.Both groups were compared in terms of therapeutic effects of gastroscopy,incidence of adverse reactions,eradication rate of Helicobacter pylori,recurrence,scores of gastrointestinal symptoms(epigastric pain,epigastric burning,belching and acid regurgitation,nausea and vomiting,loss of appetite)and levels of gastrointestinal hormones(gastrin and motilin)before and after treatment.Results After 30 d of treatment,the scores of epigastric pain,epigastric burning,belching and acid regurgitation,nausea and vomiting,and loss of appetite in both groups were lower than those before treatment in this group;in the observation group,the scores of epigastric distension pain,epigastric burning,belching and acid regurgitation,nausea and vomiting,and loss of appetite were(1.28±0.26),(1.03±0.24),(1.58±0.22),(1.04±0.18)and(1.56±0.20)points,which were significantly lower than those of(1.88±0.42),(1.63±0.30),(2.02±0.28),(1.52±0.21)and(1.92±0.24)points in the control group;the differences were statistically significant(P<0.05).After 30 d of treatment,the gastrin and motilin levels in the two groups were higher than those before treatment in this group;gastrin of(143.19±20.20)pg/ml and motilin of(236.22±24.04)pg/ml in the observation group were significantly higher than those of(127.65±20.33)and(218.43±23.12)pg/ml in the control group;the differences were statistically significant(P<0.05).The total effective rate of the observation group was 95.24%(40/42),which was significantly higher than that of 80.95%(34/42)of the control group,and the difference was statistically significant(P<0.05).The eradication rate of Helicobacter pylori was 92.86%(39/42)in the observation group,which was significantly higher than that of 73.81%(31/42)in the control group,and the difference was statistically significant(P<0.05).The 1-year recurrence rate of the observation group was 7.69%(3/39),which was significantly lower than that of 25.81%(8/31)of the control group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions was 7.14%(3/42)in the observation group and 4.76%(2/42)in the control group;there was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The effect of quadruple therapy in the treatment of Helicobacter pylori associated gastric ulcer is significantly better than that of triple therapy,which can better improve clinical discomfort symptoms,improve the eradication rate of Helicobacter pylori and the effect of gastroscopy,further improve the level of gastrointestinal hormone in patients,and reduce the recurrence rate of the disease.