布拉氏酵母菌散剂联合三联疗法对儿童幽门螺杆菌感染的治疗

Saccharomyces boulardii combined with triple therapy in treatment of Helicobacter pylori infection in children:A clinical observation

目的观察布拉氏酵母菌散剂联合以质子泵抑制剂(PPI)为基础的标准三联疗法对儿童幽门螺杆菌(H.pylori)感染的疗效,以探索根除率高且不良反应少的H.pylori根除方案。方法采用前瞻性随机对照研究,从确诊为H.pylori感染的患儿中选取120例作为研究对象,再随机分为布拉氏组和标准三联疗法组,每组各60例。标准三联疗法组口服阿莫西林[50mg/(kg·d),饭后分两次服]、克拉霉素[20mg/(kg·d),饭后分两次服]和奥美拉唑[0.7～0.8mg/(kg·d),饭前半小时一次服完]治疗,布拉氏组在标准三联疗法的基础上加服布拉氏酵母菌散剂(250mg/次,2次/d)。两组患者均治疗14d,由患儿家属记录治疗过程中发生不良反应的情况。停药后4周内不再口服任何抗生素,后行14 C呼气试验以评估H.pylori根除情况。比较两组患者根除率及不良反应发生率。结果治疗后三联疗法组H.pylori根除率为76.7%(46/60),布拉氏组为90.0%(54/60),二者差异有统计学意义(P<0.05)。治疗过程中布拉氏组患者腹泻发生率低于三联疗法组,差异有统计学意义(P<0.05)。结论布拉酵母联合三联疗法能提高H.pylori的根除率,降低治疗过程中的不良反应。

Objective To observe the effect of proton pump inhibitor(PPI)-based standard triple therapy combined with Saccharomyces boulardii in the eradication of Helicobacter pylori(H.pylori)in children,and explore an eradication program with high eradication rate and less adverse reactions.Methods Using prospective randomized controlled study,120 children diagnosed as H.pylori infection were randomly divided into the Boulardii group or Standard triple therapy group,with 60 cases in each group.The standard triple therapy group were given per os Amoxicillin 50 mg/(kg·d)in two divided doses after meal,Clarithromycin 20 mg/(kg·d)in two divided doses after meal and Omeprazole 0.7-0.8 mg/(kg·d)in one dose half an hour before meal,while the Boulardii group received the same therapy combined with Saccharomyces boulardii 250 mg bid.All the patients were treated for 14 days,and the adverse reactions during the treatment were recorded by the families of the children.No antibiotics were taken orally within 4 weeks after discontinuation.The H.pylori eradication was evaluated with 14 C breath test;the rates of eradication and adverse reactions were compared between the two groups.Results After treatment,the H.pylori eradication rate was 76.7%(46/60)in triple therapy group vs 90.0%(54/60)in Boulardii group,with statistically significant difference(P<0.05).The incidence of diarrhea in the Boulardii group was significantly lower than that in the triple therapy group(P<0.05).Conclusion Saccharomyces boulardii combined with triple therapy can improve the eradication rate of H.pylori and reduce adverse reactions.