不同治疗方案根除幽门螺杆菌感染的疗效比较

Efficacy comparison of different therapeutic regimens for the eradication of Helicobacter pylori infection

目的比较不同治疗方案根除幽门螺杆菌的疗效。方法将180例合并幽门螺杆菌感染的慢性胃炎或消化性溃疡患者随机分为RCA组、RBCA组、RBiCA组,每组60例。RCA组给予雷贝拉唑+克拉霉素+阿莫西林治疗,RBCA组给予雷贝拉唑+克拉霉素+阿莫西林+铋剂治疗,RBiCA组给予雷贝拉唑+克拉霉素+阿莫西林+双歧杆菌三联活菌治疗,疗程均为14 d。比较3组患者的依从性,评价所有患者幽门螺杆菌根除率以及消化性溃疡患者溃疡愈合情况。观察不良反应发生率。结果根据意向治疗分析,RCA组、RBCA组及RBiCA组根除率分别为71. 67%、80. 00%、88. 33%,差异无统计学意义(P> 0. 05);根据完成治疗分析,RCA组、RBCA组及RBiCA组根除率分别为74. 14%、84. 21%、91. 38%,RBiCA组的根除率高于RCA组(P <0. 05)。3组的溃疡愈合率及患者依从性比较,差异均无统计学意义(均P> 0. 05)。3组均无严重不良反应发生。结论标准三联疗法及其联合铋剂或益生菌疗法应用于根除幽门螺杆菌患者的溃疡愈合率、依从性及副作用无明显差别,但RBiCA方等的根除率最佳,值得临床推广应用。

Objective To compare the efficacy for eradication of Helicobacter pylori infection among different therapeutic regimens. Methods A total of 180 chronic gastritis or peptic ulcer patients complicated with Helicobacter pylori infection were randomly divided into RCA group,RBCA group,or RBiCA group,with 60 cases in each group.The RCA group,RBCA group and RBiCA group were administered with rabeprazole + clarithromycin + amoxicillin,rabeprazole + clarithromycin + amoxicillin + bismuth,rabeprazole + clarithromycin + amoxicillin + bifidobacterium triple viable,respectively. The course of treatment was 14 days in all groups. The compliance of patients was compared among the three groups,the eradication rate of Helicobacter pylori in all patients and the ulcer healing in the patients with peptic ulcer were assessed. The incidence rate of adverse reactions was observed. Results According to the intention-to-treat analysis,the eradication rates of the RCA group,RBCA group and RBi CA group were 71. 67%,80. 00% and 88. 33%,respectively,but no statistical difference was observed( P > 0. 05);according to the per-protocol analysis,the rates were 74. 14%,84. 21% and 91. 38%,respectively,and the eradication rate of the RBiCA group was higher than that of the RCA group( P < 0. 05). There were no statistical differences in the ulcer healing rate or the compliance of patients among the three groups( P > 0. 05). No severe adverse reactions occurred in the three groups. Conclusion There exist no obvious differences in the ulcer healing rate,compliance,or adverse reactions between standard triple therapy alone and combined with bismuth or probiotics,but the 14-day RBiCA scheme obtains the optimal eradication rate and is worthy of clinical promotion.