对含奥美拉唑三联疗法耐药的幽门螺杆菌感染的治疗

Therapy of helicobactor pylori infection resistant to triple-therapy with omeprazole

目的 探讨对含奥美拉唑三联疗法耐药的幽门螺杆菌 (Hp)感染的治疗方法。方法 选择 13 5例经13 C尿素呼吸试验 (13 C UBT)及血清Hp IgG证实为Hp感染的腹痛患儿 ;男 73例 ,女 62例 ;平均年龄 6.8± 2 .6岁。接受克拉霉素 15mg/ (kg·d) ,2次 /d ;奥美拉唑 0 .8mg/ (kg·d) ,1次 /d ;阿莫西林 3 0mg/ (kg·d) ,3次 /d ,联合治疗 1周 ,于停药后 4周复查13 C UBT ,了解腹痛治疗效果及Hp根除率 ;如果Hp仍为阳性 ,再改为胶态次枸橼酸铋钾 (CBS) 8mg/ (kg·d) ,2次 /d ,疗程 4周 ;甲硝唑 2 0mg/ (kg·d) ,3次 /d ;奥美拉唑剂量同前 ,疗程 1周。停药后 4周再复查13 C UBT。结果 13 5例中腹痛完全消失者 56例 ,好转 71例 ,无效 8例 ,总有效率 94.1% ;119例Hp转阴 ,Hp根除率 88.2 % ;16例Hp阳性者改方案后仅 3例Hp转阴。结论 本疗法治疗儿童Hp感染临床效果显著 ,不良反应少 ;一旦Hp对某一治疗方案耐药 ,可能也对其他方案耐药 。

Objective To study the therapy for Helicobactor py lo ri(Hp) infection resistant to triple-therapy containing Omeprazole.Meth ods One hundred and thirty-five children with Hp present infection iden tified by 13 C-UBT and Hp-IgG were given one-week therapy of clarithrom ycin 15 mg/(kg·d), po, twice daily,omeprazole 0.8 mg/(kg·d),po,once daily,amo xillin 30 mg/(kg·d),po, three times daily;The patients were followed up for th e therapeutic efficacy and the side effects of the drugs 4 weeks later when they finished the regimen.If the Hp remained positive ,the patient would take other drugs: CBS 8 mg/(kg·d), twice a day for 4 weeks;metronidazole 20 mg/(kg·d),th ree times daily,omeprazole 0.8 mg/(kg·d),once daily for a week. Result s The recurrent abdominal pain (RAP) disappeared in 127 of 135 patients with Hp present infection, and the total efficiency was 94.1 % ;Hp became negat ive in 19 cases after therapy and the Hp eradiation rate was 88.2 %; the 13 of 1 6 cases remained Hp positive after the second course. Conclusions The treatment of Hp infection in children using cla rithromycin,omeprazole,amoxillin is very effective and the side effects are tole rable; if Hp is resistant to a treatment scheme, it may be also resistant to an other scheme.