胃溃疡患者幽门螺杆菌感染及不同治疗方法临床疗效分析

Clinical analysis of Helicobacter pylori infection in gastric ulcer patients and clinical efficacy of different treatment methods

目的分析胃溃肠患者幽门螺杆菌感染情况及对比不同治疗方法临床疗效。方法选取本院接诊的126例胃溃疡患者及同期90例体检健康者为研究对象。对所有患者进行Hp感染检测,对比Hp感染情况。将Hp阳性的胃溃疡患者随机分为两组,观察组采用传统铋剂四联疗法治疗,治疗组采用替普瑞酮改良四联疗法治疗,对比临床疗效、Hp根除率、溃疡愈合率、不良反应发生率及治疗前后肠道菌群、血清胃肠激素水平。结果胃溃肠患者中,Hp总感染率为69.84%,主要为Ⅰ型Hp感染。体检健康者中,Hp总感染率为52.22%,主要为Ⅰ型Hp感染。胃溃疡组患者Ⅰ型Hp率、Hp总感染率均高于体检健康组,中间型Hp感染率低于体检健康组,差异有统计学意义(P<0.05)。观察组患者经治疗后,总有效率为81.82%,治疗组患者经治疗后,总有效率为94.45%,两组患者总有效率差异有统计学意义(P<0.05)。观察组患者Hp根除率为68.18%,治疗组患者Hp根除率为93.18%,观察组患者溃疡愈合率为63.64%,治疗组患者溃疡愈合率为88.64%,差异有统计学意义(P<0.05)。观察组患者中总不良反应发生率为27.27%,主要为腹泻、乏力,治疗组患者中总不良反应发生率为9.09%,两组差异有统计学意义(P<0.05)。治疗前,观察组与治疗组患者肠道内肠球菌、肠杆菌、乳酸杆菌、双歧杆菌的水平对比差异无统计学意义;治疗后,两组患者肠道肠球菌、肠杆菌的水平均低于治疗前,肠道乳酸杆菌、双歧杆菌的水平高于治疗前,差异有统计学意义(P<0.05)。治疗前,观察组患者血清胃泌素为(105.25±15.71)μmol/L,胃动素为(309.43±60.89)ng/L,治疗组患者血清胃泌素为(105.86±17.22)μmol/L,胃动素为(308.14±59.60)ng/L,差异无统计学意义(P>0.05);治疗后,两组患者血清胃泌素、胃动素水平较治疗前显著下降(P<0.05)。结论胃溃疡患者幽门螺杆菌感染率较高,主要为Ⅰ型Hp感染。针对幽门螺杆菌感染胃溃肠患者,替普瑞酮改良四联疗法对比传统铋剂四联疗法的临床总有效率、Hp根除率、溃疡愈合率更高,不良反应发生率更低,可有效调节患者肠道菌群及胃肠激素水平。

Objective To analyze the infection status of Helicobacter pylori in patients with gastric ulcer and compare the clinical efficacy of different treatment methods.Methods 126 patients with gastric ulcers admitted to our hospital and 90 healthy individuals who underwent physical examinations during the same period were selected as the subjects of this study.Hp infection testing were performed on all patients and the Hp infection status were compared.Hp positive gastric ulcer patients were randomly divided into two groups.The observation group was treated with traditional bismuth quadruple therapy,while the treatment group was treated with modified quadruple therapy with teprenone.The clinical efficacy,Hp eradication rate,ulcer healing rate,incidence of adverse reactions,intestinal microbiota,and serum gastrointestinal hormone levels before and after treatment were compared.Results Among patients with gastric ulcer,the total infection rate of Hp was 69.84%,mainly type I Hp infection.Among healthy individuals undergoing physical examination,the total infection rate of Hp was 52.22%,mainly type I Hp infection.The type I Hp rate and total Hp infection rate of patients in the gastric ulcer group were higher than those in the physical examination healthy group,while the intermediate Hp infection rate was lower than that in the physical examination healthy group,with statistical significance(P<0.05).After treatment,the total effective rate of the observation group patients was 81.82%,while the total effective rate of the treatment group patients was 94.45%.The difference in total effective rate between the two groups was statistically significant(P<0.05).The Hp eradication rate in the observation group was 68.18%,while the Hp eradication rate in the treatment group was 93.18%.The ulcer healing rate in the observation group was 63.64%,while the ulcer healing rate in the treatment group was 88.64%.The difference was statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was 27.27%,mainly diarrhea and fatigue.The total incidence of adverse reactions in the treatment group was 9.09%,and the difference between the two groups was statistically significant(P<0.05).Before treatment,there was no statistically significant difference in the levels of Enterococcus,Enterobacterium,Lactobacillus,and Bifidobacterium in the intestines between the observation group and the treatment group patients;After treatment,the levels of Enterococcus and Enterobacterium in the intestines of both groups of patients were lower than before treatment,while the levels of Lactobacillus and Bifidobacterium in the intestines were higher than before treatment,with statistically significant differences(P<0.05).Before treatment,the serum gastrin of the observation group patients was(105.25±15.71)μmol/L,motilin was(309.43±60.89)ng/L,and serum gastrin of the treatment group was(105.86±17.22)μmol/L,motilin was(308.14±59.60)ng/L,and the difference was not statistically significant(P>0.05);After treatment,the levels of serum gastrin and motilin in the two groups of patients significantly decreased compared to before treatment,and the difference was statistically significant(P<0.05).Conclusion The infection rate of H.pylori in patients with gastric ulcers was relatively high,mainly due to type I Hp infection.For patients with gastric ulcer caused by Helicobacter pylori infection,the improved quadruple therapy with teprenone had a higher clinical total effective rate,Hp eradication rate,ulcer healing rate,and lower incidence of adverse reactions compared to traditional bismuth quadruple therapy.It can effectively regulate the patient's gut microbiota and gastrointestinal hormone levels.