“四联”疗法后延长质子泵抑制剂和铋剂治疗对幽门螺杆菌阳性胃溃疡的疗效及安全性分析

目的分析“四联”疗法后延长质子泵抑制剂和铋剂治疗对幽门螺杆菌(H.pylori)阳性胃溃疡患者的疗效及安全性。方法纳入2017年1月至2018年12月内蒙古通辽市医院收治的H.pylori阳性胃溃疡患者312例,以随机数字表法分为对照组和观察组,各156例。对照组患者给予常规“四联”疗法治疗,即埃索美拉唑+复方铝酸铋颗粒+阿莫西林+甲硝唑,观察组患者在常规“四联”疗法后延长质子泵抑制剂和铋剂治疗,即使用埃索美拉唑+复方铝酸铋颗粒。比较两组治疗效果、H.pylori根除率、治疗前后临床症状评分、不良反应及复发情况。结果观察组ITT、PP分析H.pylori根除率分别为94.9%、96.7%,均高于对照组的87.8%、89.5%(P均<0.05)。观察组治疗总有效率为96.7%,高于对照组的90.2%(P<0.05)。治疗后,观察组反酸、腹胀、胃灼烧痛评分均低于对照组(P<0.05)。观察组不良反应发生率与对照组无显著差异(P>0.05),复发率低于对照组(P<0.05)。结论“四联”疗法后延长质子泵抑制剂和铋剂治疗可以提高H.pylori阳性胃溃疡患者治疗效果,减轻其反酸、腹胀、胃灼烧痛等症状,且复发率低。

苯丁酸氮芥结合“四联”疗法治疗激素依赖型难治性肾病

目的探讨苯丁酸氮芥结合“四联”疗法对激素依赖型难治性肾病的治疗作用。方法32例接受正规中西医结合“四联”疗法(地塞米松、盐酸氮芥、降纤酶、本院中药制剂)后病情仍有反复的患者,在原治疗基础上于病情缓解期口服苯丁酸氮芥,临床观察病情转归情况和服药后的副作用。结果32例患者中1例因经济困难中止治疗,余31例完全缓解,观察两年无复发。无严重骨髓抑制、严重感染及癫痫等副作用。结论苯丁酸氮芥结合“四联”疗法可以有效解决激素依赖型难治性肾病的复发问题,提高治愈率。

“四联”疗法治疗腰椎间盘突出症的疗效观察

目的:探索"四联"疗法对不同腰椎间盘突出症的临床疗效。方法:治疗组采用三维正脊仪、小针刀、中药熏蒸、针灸四种治法综合运用(称之为"四联疗法"),对980例腰椎间盘突出症患者进行治疗,对照组单用三维正脊治疗,按照腰椎间盘"膨出、突出、脱出"的分类分组进行临床疗效观察,依据Macnab’s腰间术后疗效评价标准进行评定。结果:在对照组中,单用三维正脊仪治疗的3组病例的临床疗效经统计学处理有统计学意义(P<0.01),对腰椎间盘膨出疗效最优,其次是突出,而脱出最差。而运用"四联"疗法治疗的3组病例的临床疗效差别不大,但突出和脱出的有效率明显提高。结论:"四联"疗法对不同突出程度腰椎间盘突出症的临床疗效没有统计学意义。因此,对不同腰椎间盘突出症,治疗方法上运用灵活,可以提高临床有效率。

解读Banting奖演讲

Banting科学成就奖是美国糖尿病学会科学年会的最高科学奖项,是以胰岛素发现者之一,曾获得诺贝尔奖的科学家Frederick Banting的名字命名的。今年第68届ADA科学年会的Banting奖颁给了来自德克萨斯糖尿病研究所的著名糖尿病学者Ralph A De Fronzo教授。在他的学术演讲中,DeFronzo教授深入浅出地全面阐述和深刻解析了糖尿病患者高血糖以及胰岛B细胞衰竭的形成原因，并提出了全新的临床治疗方案。

Low eradication rate of Helicobacterpyloriwith triple 7-14 days and quadriple therapy in Turkey

AIM:The eradication rate of Helicobacter pylori (H pylori) shows variation among countries and regimens of treatment. We aimed to study the eradication rates of different regimens in our region and some factors affecting the rate of eradication. METHODS:One hundred and sixty-four H pylori positive patients (68 males,96 females;mean age:48±12 years) with duodenal or gastric ulcer without a smoking history were included in the study.The patients were divided into three groups according to the treatment regimens.Omeprazole 20mg,clarithromycin 500mg,amoxicillin 1g were given twice daily for 1 week (Group Ⅰ) and 2 weeks (Group Ⅱ). Patients in Group Ⅲ received bismuth subsitrate 300mg, tetracyline 500mg and metronidazole 500mg four times daily in addition to Omeprazole 20mg twice daily.Two biopsies each before and after treatment were obtained from antrum and corpus,and histopathologically evaluated. Eradication was assumed to be successful if no H pylorus was detected from four biopsy specimens taken after treatment.The effects of factors like age,sex,H pylori density on antrum and corpus before treatment,the total H pylori density,and the inflammation scores on the rate of H pylori eradication were evaluated. RESULTS:The overall eradication rate was 42%.The rates in groups Ⅱ and Ⅲ were statistically higher than that in group Ⅰ (P<0.05).The rates of eradication were 24.5%, 40.7% and 61.5% in groups Ⅰ,Ⅱ and Ⅲ,respectively.The eradication rate was negatively related to either corpus H pylori density or total H pylori density (P<0.05).The median age was older in the group in which the eradication failed in comparison to that with successful eradication (55 yr vs 39 yr,P<0.001).No correlation between sex and H pylori eradication was found. CONCLUSION:Our rates of eradication were significantly lower when compared to those reported in literature.We believe that advanced age and high H pylori density are negative predictive factors for the rate of H pylori eradication.