消化性溃疡患者幽门螺杆菌根除治疗时机选择的研究

Study on the timing of Helicobacter pylori eradication in patients with peptic ulcer

目的探讨根除治疗幽门螺杆菌(Hp)的启动时间对消化性溃疡治疗效果的影响。方法回顾性分析2019年10月至2021年3月于本院就诊的104例14C呼气试验阳性且经内镜检查下诊断为消化性溃疡患者的临床资料,根据根除治疗方案和时间不同分为对照组(n=30,泮托拉唑抑酸治疗8周)、早期组(n=38,Hp根除治疗2周+泮托拉唑抑酸治疗6周)、非早期组(n=36,泮托拉唑抑酸治疗6周+Hp根除2周),比较3组临床疗效、复发情况;比较早期组、非早期组Hp根除率及不良反应发生率;比较早期组、非早期组根除成功患者溃疡复发情况。结果早期组、非早期组十二指肠溃疡球部溃疡总有效率高于对照组,差异有统计学意义(P<0.05),早期组与非早期组十二指肠溃疡球部溃疡总有效率比较差异无统计学意义;3组胃溃疡总有效率比较差异无统计学意义,且各组间两两比较差异无统计学意义。随访1年,非早期组症状再发率低于早期组、对照组,差异有统计学意义(P<0.05);早期组与对照组症状再发率比较差异无统计学意义;疗程结束后,早期组、非早期组4、10个月溃疡总复发率均低于对照组,差异有统计学意义(P<0.05),早期组、非早期组溃疡总复发率比较差异无统计学意义。早期组与非早期组Hp根除率比较差异无统计学意义;早期组不良反应发生率为35.1%,高于非早期组的13.9%,差异有统计学意义(P<0.05)。早期组、非早期组Hp根除成功患者溃疡复发率比较差异无统计学意义。结论选择非早期根除Hp治疗方案不影响根除率、溃疡治疗效果,且能改善患者症状,减少不良反应发生及溃疡复发。

Objective To investigate the effect of initiation time of eradication of Helicobacter pylori(Hp)on the treatment of peptic ulcer.Methods The clinical data of 104 patients with positive 14C breath test who were diagnosed with ulcer under endoscopy in our hospital from October 2019 to March 2021 were retrospectively analyzed,they were divided into the control group(n=30,pantoprazole acid suppression for 8 weeks),early group(n=38,Hp eradication for 2 weeks+pantoprazole acid suppression for 6 weeks),and the non-early group(n=36,pantoprazole acid suppression for 6 weeks+Hp eradication for 2 weeks)according to the plan and time of eradication treatment,the clinical efficacy and recurrence among the three groups were compared;the Hp eradication rate and the incidence of adverse reactions were compared between the early group and the non-early group;the ulcer recurrence of patients with successful eradication in the early group and the non-early group was compared.Results The total effective rate of duodenal ulcer in the early group and non-early group was higher than that in the control group,the difference was statistically significant(P<0.05),but there was no significant difference in the total effective rate of duodenal ulcer between the early group and the non-early group.There was no significant difference in the total effective rate of gastric ulcer among the three groups,and there was no significant difference in pairto-pair comparison among the three groups.1 year of follow-up,the recurrence rate of symptoms in the non-early group was lower than that in the early group and control group,and the difference was statistically significant(P<0.05);there was no significant difference in the recurrence rate of symptoms between the early group and the control group.After treatment,the total ulcer recurrence rate of 4 and 10 months in the early group and nonearly group were lower than those in the control group,the differences were statistically significant(P<0.05),but there was no statistically significant difference in the total ulcer recurrence rate between the early group and non-early group.There was no significant difference in the Hp eradication rate between the early group and the non-early group.The incidence of adverse reactions in the early group was 35.1%,which was higher than 13.9%in the non-early group,and the difference was statistically significant(P<0.05).There was no significant difference in ulcer recurrence rate in patients with Hp eradication success between the early group and non-early group.Conclusion The choice of non-early Hp eradication treatment does not affect the eradication rate and ulcer treatment effect,and can improve symptoms,reduce the occurrence of adverse reactions and ulcer recurrence.