不同剂量艾司奥美拉唑治疗幽门螺杆菌相关性胃炎复发的效果及幽门螺杆菌根除情况的影响因素

Effectiveness of Different Doses of Esomeprazole in Treating Recurrence of Helicobacter Pylori-associated Gastritis and Factors Influencing the Eradication of Helicobacter Pylori

目的:探讨不同剂量艾司奥美拉唑治疗幽门螺杆菌(Hp)相关性胃炎复发的效果,分析Hp根除情况的影响因素。方法:选取2021年1月—2022年1月在浙江大学医学院附属第二医院就诊的抗Hp治疗后复发的Hp相关性胃炎患者107例作为研究对象,按照双盲原则随机分为常规剂量组(n=55)和大剂量组(n=52)。两组均接受克拉霉素、阿莫西林和枸橼酸铋钾治疗,常规剂量组使用常规剂量艾司奥美拉唑,大剂量组使用大剂量艾司奥美拉唑。比较两组Hp根除率、不良反应发生率、远期疾病发生率及远期复发率,分析影响Hp根除效果的因素。结果:大剂量组Hp根除率高于常规剂量组(P=0.031)。两组不良反应发生率、远期疾病发生率比较,差异无统计学意义(P>0.05)。大剂量组远期复发率低于常规剂量组(P=0.034)。失败组吸烟史、饮酒史、Hp感染家族史率高于成功组,使用大剂量艾司奥美拉唑率、Hp治疗依从率低于成功组(P<0.05)。吸烟史是影响Hp根除效果的危险因素,使用大剂量艾司奥美拉唑是影响Hp根除效果的保护因素(P<0.001)。结论:大剂量艾司奥美拉唑治疗Hp相关性胃炎复发患者安全有效,可提高Hp根除率,降低远期复发率,是影响Hp根除效果的保护因素,吸烟史是危险因素。

Objective:To investigate the effect of different doses of esomeprazole in the treatment of Helicobacter pylori(Hp)-associated gastritis recurrence and to analyze the influencing factors of the eradication of Hp.Methods:One hundred and seven patients with Hp-associated gastritis who relapsed after anti-Hp treatment attending the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to January 2022 were selected as the study subjects,and were randomly divided into the conventional-dose group(n=55)and the high-dose group(n=52)in accordance with the principle of double-blindness.Both groups were treated with clarithromycin,amoxicillin and bismuth potassium citrate,and conventional-dose esomeprazole was used in the conventional-dose group and high-dose esomeprazole was used in the high-dose group.The Hp eradication rate,the incidence of adverse reactions,the incidence of distant disease and the rate of distant recurrence were compared between the two groups,and the factors affecting the effect of Hp eradication were analyzed.Results:The Hp eradication rate of the high-dose group was higher than that of the conventional-dose group(P=0.031);there were no statistically significant differences in the incidence rate of adverse reactions and the incidence rate of distant diseases between the two groups(P>0.05);the distant recurrence rate of the high-dose group was lower than that of the conventional-dose group(P=0.034);the rate of smoking history,drinking history,and family history of Hp infection in the failure group was higher than that in the success group,and the rate of using high-dose esomeprazole and the rate of adherence to Hp treatment were lower than those in the success group(P<0.05);smoking history was a risk factor affecting the effect of Hp eradication,and the use of high-dose esomeprazole was a protective factor affecting the effect of Hp eradication(P<0.001).Conclusion:High-dose esomeprazole is safe and effective in treating patients with recurrent Hp-associated gastritis,which can increase the Hp eradication rate and reduce the distant recurrence rate,and is a protective factor affecting the Hp eradication effect,and smoking history is a risk factor.