布拉氏酵母菌联合四联疗法作为根除幽门螺杆菌补救疗法的临床观察

Clinical observation for Brady's yeast joint quadruple therapy for helicobacter pylori eradication remedial treatment

目的比较布拉氏酵母菌联合四联疗法与四联补救疗法作为根除幽门螺杆菌(helicobacterr pylori,H.pylori)补救疗法的临床疗效及不良反应发生率。方法将112例经传统标准三联疗法(7d)根除H.pylori失败的患者,随机分为两组:对照组(56例):兰索拉唑30mg bid+盐酸左氧氟沙星200mg bid+阿莫西林克拉维酸钾914mg bid+胶体果胶铋200mg bid,疗程共10d;治疗组(56例):在上述四联治疗基础上加用布拉氏酵母菌0.5bid口服,疗程10d。治疗结束后至少停药4周后复查14 C呼气试验或13 C呼气试验以确定是否根除H.pylori。评估2种根除H.pylori补救治疗方案的疗效及安全性。结果 109例患者按方案完成治疗。意愿性治疗原则分析显示,对照组H.pylori根除率为76.8%(43/56),低于治疗组的83.9%(47/56);符合方案及分析显示,对照组H.pylori根除率为79.6%(43/54),也低于治疗组的85.4%(47/55),但均无统计学意义(P>0.05)。对照组和治疗组在治疗期间的不良反应的发生率治疗组显著低于对照组,其中腹泻治疗组发生率3.64%(2/55),对照组发生率16.67%(9/54),两组腹泻发生率具有统计学差异(P <0.05);治疗组上腹不适发生率1.82%(1/55),对照组上腹不适发生率14.81%(8/54),两组具有统计学差异(P <0.05);其他副作用如恶心、味觉异常、腹痛虽然治疗组的发生率低于对照组,但在两组间差异均无统计学意义(均P>0.05)。结论对于标准三联7d疗法根除H.pylori失败的患者,布拉氏酵母菌联合四联疗法方案与单纯四联疗法相比,H.pylori根除率较高,但无明显统计学差异;布拉氏酵母菌联合应用可减少用药过程中不良反应发生率,提高患者用药依从性。

Objective To compare Saccharomyces boulardii combination quadruple therapy and quad remedy therapy for helicobacter pylori eradication(helicobacterr pylori,H.pylori)remedy therapy clinical curative effect and adverse reaction rates.Methods 112 cases without successful traditional standard triple therapy(7 d)eradication for H.pylori were randomly divided into two groups:control group(56 cases):LAN sola azole 30 mg bid plus levofloxacin hydrochloride 200 mg bid+amoxicillin clavulanic acid potassium 914 mg bid+colloidal bismuth pectin200 mg bid,period of treatment,a total of 10 d;The treatment group(56 cases):on the basis of the above quadruple therapy combined with brady′s 0.5 bid oral yeast,treatment of 10 d.At least 4 weeks after treatment,to determine whether the eradication of H.pylori,with 14 C breath test or 13 C breath test.Evaluate the efficacy and safety of two kinds of remedial treatment programs for eradication of H.pylori.Results 109 patients completed treatment by program.The principle analysis of willingness to treat show that H.pylori eradication rate 76.8%(43/56)in the control group was less than the treatment group 83.9%(47/56);Consistent program and analysis shows that H.pylori eradication rate in the control group 79.6%(43/54)was lower than the treatment group 85.4%(47/55),but had no statistical significance(P >0.05).Incidence of adverse reactions in the treatment group was significantly lower than control group,the incidence of diarrhea between treatment group 3.64%(2/55)and the control group 16.67%(9/54)have significant difference(P <0.05);Incidence of epigastric discomfort between treatment group 1.82%(1/55)and control group 14.81%(8/54)have significant difference(P <0.05);Other side effects such as nausea,taste abnormalities,abdominal pain,although the incidence rate of treatment group werelower than the control group,but there were no statistically significant difference between the two groups(P >0.05).Conclusion For the patients with failure 7 dstandard triple therapy to eradicate H.pylori,brady′s yeast joint quadruple therapy comparing with pure quadruple therapy,H.pylori eradication rate is higher,but no significant statistical difference;jointing application Brady’s yeast can reduce the incidence of adverse reaction during the process and improve the patients′medication compliance.