四联疗法根除幽门螺杆菌感染对肝源性溃疡的影响

Effect of eradication of Helicobacter pylori with quadruple therapy on posthepatitic cirrhosis accompanied with peptic ulcer

目的 研究肝硬化合并消化性溃疡 (Hepatogeniculcer ,HU)的临床特点和四联疗法的治疗效果。方法 肝硬化合并消化性溃疡 10 5例 ,内镜检查了解溃疡合并出血发生情况及四联疗法治疗后溃疡愈合情况 ,并与同期消化性溃疡(Pepticulcer,PU)疗效对比分析。同时胃粘膜活检作尿素酶实验检测幽门螺杆菌。结果 HU患者溃疡部位以十二指肠溃疡居多 ,合并出血率高。HU组和PU组溃疡愈合率分别为 65 7%和 88 5 %。随访 2年后 ,HU组溃疡复发率为 68 4% ,再出血率为 3 0 2 % ,PU组溃疡复发率为 48 9% ,再出血率为 16 6% ,两组溃疡复发率与再出血率比较有显著性差异 (P <0 0 1)。HU患者Hp阳性率为 72 4%。根除Hp可明显提高肝硬化合并消化性溃疡的愈合率 ,降低溃疡复发率与再出血率。结论 肝硬化合并消化性溃疡较难治愈 ,且易合并出血 。

Objective To explore the clinical characteristics of posthepatitic cirrhosis accompanied with peptic ulcer (called as hepatogenic ulcer, HU) and the effect of quadruple therapy in this event Methods A total of 105 cases of PU were subjected in this study, and 126 patients with simple peptic ulcer (PU) served as control Endoscopy was carried out to observe the peptic ulcer, bleeding, and healing after treatment Urease testing was employed to detect Helicobacter pylori (Hp) in gastric mucosa All patients were followed up for 2 years Results Most cases of PU were confirmed to have duodenal ulcer The positive rate of Hp was 72 4% in HU group before treatment Ulcer healing rates of quadruple therapy were 65 7% and 88 5% respectively in HU group and PU group During the follow up, the rates of recurrence and rebleeding were 68 4% and 30 2% in HU group, and 48 9% and 16 6% in PU group,with very significant difference between them ( P <0 01) HP eradication raised the rate of ulcer healing and reduced the rates of recurrence and rebleeding significantly in PU group Conclusion Posthepatitic cirrhosis concurrent with peptic ulcer is refractory and easy to hemorrhage due to portal hypertension Administration of propranolol with goal of Hp eradication suggests to be helpful in the treatment of this disease