抗幽门螺杆菌感染二种三联疗法的临床比较

CLINIC COMPARISON OF TWO TRIPLE-METHODS ON THE ANTI-HELICOBATER PYLORI INFECTION

目的 选择高效安全价廉适宜基层医院应用推广的根除幽门螺杆菌 (Hp)的方案。观察二种三联疗法(洛赛克、克拉霉素、阿莫西林、简称LCA ;善胃得、替硝唑、阿莫西林、简称ZTA)抗Hp感染的疗效 ,并与对照组 (泰胃美、简称Tag;普瑞博思、简称Pre)作比较。方法 :对 165例确诊为Hp感染的胃炎及溃疡病者 ,随机分治疗组 83例 (A组 42例、B组 41例 )和对照组 82例 (A1 组 41例均为溃疡、B1 组 41例均为胃炎 )。A组用LCA方案共一周 ,B组用ZTA方案二周 ;A1 组用Tag四周 ,B1 组用Pre十天。除A1 组 1例B1 组 2例失访外 162例治疗后 6周作呼吸试验 ( 1 3C-UBT、部分1 4C -UBT)等以观察近期疗效 ;14 6例 (A组 40例B组 37例 ,A1 组 36例B1 年组 33例 )一年后作胃镜等复查 ,确定Hp根除率及评价远期疗效。结果 :近期Hp根除率治疗组 91.6% (A组 95 .2 %、B组 87.8% )比对照组 35 .4% (A1 组 40 .4%、B1 组 30 .8% )高 (P <0 .0 1) ;远期Hp根除率治疗组 81.8% (A组 85 .0 %、B组 78.4% )明显高于对照组 30 .4% (A1 组 33.3%、B1 组 2 7.3% ) (P <0 .0 1) ;溃疡组 ,治疗A组Hp根除率 82 .6% ,B组 76.5 %均明显高于A1组 33.3% (P <0 .0 1) ;溃疡愈合率治疗组 87.5 % (A组 91.3%、B组 82 .4% )明显高于对照组 5 2 .8% (P <0 .0 1)

Objective: To select the high effectiveness,safety,and inexpensiveness regimen of eradication H.phlori,twotriple methods(Losec,Clarithromycin,Amoxicillin,asLCA,and Zantac,Metronidozole,Amoxicillin,asZTA) of anti-Hp infection were compared to the control group(Tagmei,as Tag,Prepulsid,as Pre.).Methods:165 cases of gastritis and ucler with Hp infection were randomized 83therapeutic group(42cases in group A,41 cases in group B)and 82 comparable group (41 cases with ulcer in group A1,and in group B1 with41 cases with gastritis).The periods of therapy were group A with LCA regimen,one week,group B with ZTA,two weeks,while group A1 with Tag and group B1 with Pre,four weeks and ten days respectively.162 cases were given respiratory test( 13 C-UBT, 14 C-UBT)for observation the near future effects on six weeks after treatments,and 146 cases(40cases in group A,for group B37 cases,group A1 36,group B1 33)were re-examed endoscopy after one year for identification of Hp eradicative rate and evaluation long-future effects. Results:Hp eradicative rate were 91.6% in the therapeutic group(95.2% in groupA,87.8% grouopB)higher than compatable group 35.4%(40.0% in group A1,30.8% group B1)on near-future effects,while long-future effercts were 81.8%(85.0% in group A,78.4% groupB),30.4%(33.3% in group A1,27.3% group B1)respectively(P<0.01).Hp eradicative rate,therapeutic groupA 82.6%,groupB 76.5% in uler cases and for gastritis 88.2%,80.0%,both high than comparable group 33.3% and 27.3%(P<0.01).Ulcer recovery rate 87.5% versus 52.8%(P<0.01).Side effectsA to B,A1 to B1 were 19:35,20:18.The costs were 820.78,418.04 to 117.0,40.35 yuan.Conclusion:The effects were good in therapeutic group than comparable group for gastritis and uler related th Hp infection.LCA regimen was better ZTA.But the costness was cheap for ZTA regimen.