不同治疗方案对幽门螺旋杆菌感染初次治疗的疗效影响及影响因素分析

Exploration on the treatment of patients with initial treatment of Helicobacter pylori allergic to penicillin

目的 探讨不同治疗方案对幽门螺旋杆菌感染患者初次治疗疗效的影响,并分析影响因素。方法 收集2022年1月至2023年12月使用含铋剂的四联方案初次治疗幽门螺旋杆菌感染的病例3 292例,根据使用药物不同分为阿莫西林+克拉霉素组(2 707例),呋喃唑酮+克拉霉素组(261例),头孢呋辛+克拉霉素组(150例)和左氧氟沙星+克拉霉素组(174例)。比较4组性别、年龄、治疗方案、幽门螺旋杆菌根除情况和疗效。结果 左氧氟沙星+克拉霉素组和阿莫西林+克拉霉素组治疗成功率比较,差异无统计学意义(P> 0.05);头孢呋辛+克拉霉素组和呋喃唑酮+克拉霉素组的治疗成功率均低于阿莫西林+克拉霉素组(P <0.05)。年龄(OR=1.013,95% CI 1.00~1.02,P <0.01)和治疗方案(OR=1.268,95% CI 1.11~1.46,P <0.01)是影响疗效的独立危险因素。结论 左氧氟沙星联合克拉霉素方案在部分幽门螺旋杆菌感染初次治疗患者中具有较高的治疗成功率,可用于幽门螺旋杆菌初次治疗的青霉素类药物过敏患者。年龄和治疗方案是幽门螺旋杆菌感染初次治疗患者疗效的影响因素。

AIM To investigate the effect of different treatment regimens on the initial treatment of Helicobacter pylori infection and analyze the influencing factors. METHODS A total of 3 292 patients with Helicobacter pylori infection were collected from January 2022 to December 2023, and divided into amoxicillin combined clarithromycin group(2 707 patients), furazolidone combined clarithromycin group(261 patients), cefuroxime combined clarithromycin group(150 patients) and levofloxacin combined clarithromycin group(174 patients). Gender, age, treatment regimen and treatment success rate were compared among the 4 groups. RESULTS There was no significant difference in treatment success rate between ofloxacin combined clarithromycin group and amoxicillin combined clarithromycin group(P>0.05). The treatment success rate in the cefuroxime combined clarithromycin group and furazolidone combined clarithromycin group was lower than that in the amoxicillin combined clarithromycin group(P < 0.05). Age(OR=1.013, 95%CI 1.00-1.02, P<0.01) and treatment regimen(OR=1.268, 95%CI 1.11-1.46, P<0.01) were independent risk factors for bacterial eradication. CONCLUSION Levofloxacin combined clarithromycin regimen demonstrates a higher success rate of eradication in some patients with initial treatment for Helicobacter pylori infection, and can be used for penicillin-allergic patients with initial treatment for Helicobacter pylori infection. Both age and treatment regimen influence the success rate of treatment in patients with initial treatment for Helicobacter pylori infection.