胃舒散联合呋喃唑酮和阿莫西林根除幽门螺杆菌阳性十二指肠溃疡及抗复发疗效观察

Efficacy of Weishusan Combined with Furazolidone and Amoxycillin in the Eradication of Helicobacter pylori and Prevention of Recurrent Duodenal Ulcer

目的 :观察胃舒散、呋喃唑酮和阿莫西林对幽门螺杆菌 (Hp)阳性十二指肠溃疡 (DU)的疗效及根除Hp对溃疡复发的影响。方法 :73例 Hp阳性 DU患者随机分为两组 :三联组 4 1例 ,服用胃舒散 2 .0 g,呋喃唑酮 0 .1g,阿莫西林 0 .5 g,各 3次 /d ,2周后再继服胃舒散 4周。雷尼替丁组 32例 ,服用雷尼替丁 0 .15 g,3次 /d,共 6周。治疗前后均记录胃痛症状 ,内镜观察溃疡情况 ,并进行 2年随访。Hp检测采用 Warthin- Starry银染色法 ,1 4C-尿素呼气试验或快速尿素酶试验 ,2项阳性为 Hp感染 ,阴性为 Hp根除。结果 :6周治疗结束后 ,两组溃疡愈合率均为10 0 %。三联组临床症状缓解率、副反应发生率为 97.6 %和 18.8% ,雷尼替丁组为 93.8%和 9.4 % (均 P >0 .0 5 )。三联组 Hp根除率 (92 .7% )显著高于雷尼替丁组 (0 % ,P <0 .0 1)。 Hp根除的 38例中 ,1年及 2年溃疡复发率为(5 .3% ,10 .5 % )均显著低于 Hp持续感染者 (2 8.1% ,4 6 .9% ,P <0 .0 1)。结论 :以胃舒散为主的三联疗法具有疗效高、副作用少、溃疡复发率低的优点 ,是一种根除 Hp的较好方案。

Objective: To evaluate the effect of Weishusan combined with furazolidone and amoxycillin in the eradication of Helicobacter pylori (Hp) in patients with duodenal ulcer (DU) and on the recurrence of DU. Methods: Seventy-three patients with Hp infection and active DU confirmed by endoscopy were randomized into two groups: group A with 41 patients receiving Weishusan 2.0g tid, furazolidone 0.1g tid, amoxycillin 0.5g tid for 2 weeks, and receiving Weishusan 2.0g tid for 4 more weeks; group B with 32 patients receiving ranitidine 0.15g bid for 6 weeks. The eradication of Hp and ulcer healing were assessed by endoscopy at the end of the treatment. Results: The DU healing rates of both groups were 100 %. The clinical symptom relief rate and the incidence of side effect were 97.6 % and 18.8 % respectively in group A,93.8 % and 9.4 % in group B (both P>0.05). The percentage of Hp eradication was 92.7 % (38/41) in group A and none in group B (p<0.001). Ulcers recurred in 2 (5.3 %) within 1 year and 4 (10.5 %) within 2 years in 38 patients in whom Hp had been eradicated, as compared with 9 (28.1 %) within 1 year and 15 (46.9 %) within 2 years in 32 patients in whom Hp persisted. The probability of recurrence in Hp-eradicated patients was significantly lower than that in persistently Hp positive patients (P<0.01). Conclusion: The combined therapy of Weishusan, furazolidone and amoxicillin was highly effective in both the eradication of Hp and prevention of DU recurrence and it was a safe, cheaper alternative in developing countries.