序贯疗法和标准三联疗法根除儿童幽门螺杆菌的疗效观察

摘要

Objective To assessment the efficacy and feasibility of sequential therapy for Helicobacter pylori ( H. Pylori ) infection in children. Methods Children with upper gastrointestinal symptoms who tested positive for H. Pylori by 13C-urea breath test ( 13C-UBT ) were randomly divided into three groups, sequential therapy group, PAC group, and PAM group. The sequential group was treated by omeprazole and amoxicillin for the first five days, followed omeprazole, clarithromycin, and metronidazole for the next five days. The PAC group was treated by omeprazole, amoxicillin and clarithromycin for ten days. The PAM group was treated by omeprazole, amoxicillin, and metronidazole for ten days. The H. Pylori eradication was assessed by 13C-UBT 4 weeks after completion of the treatment. Results A total of 100 pediatric patients were recruited, 34 in sequential group, 33 in PAC grop and 33 in PAM group. Per-protocol (PP) eradication rates were respectively 91.18% for sequential therapy group, 68.97% for PAC group and 76.67% for PAM group. PP eradication rate was significantly higher in sequential therapy group than in PAC group ( x2 = 5.01, P < 0.05 ). There were no significant differences of PP eradication rate between sequential therapy group and PAM group ( x2 = 2.55, P> 0.05 ) and between PAC group and PAM group (x2 = 0.44, P > 0.05 ). Conclusions The 10-day sequential therapy is better than standard 10-day triple therapies in eradication of H. Pylori infection. It suggested that 10-day sequential therapy may be a new effective solution in treatment of H. Pylori infections in children.%目的 评估序贯疗法在儿童幽门螺杆菌感染根治治疗中的疗效及可行性.方法 将有上消化道症状,经13C-尿素呼气试验(13C-UBT)检测H.Pylori为阳性的患儿100例随机分为3组:序贯治疗组、PAC组和PAM组.序贯治疗组:前5 d二联疗法即奥美拉唑 + 阿莫西林,后5 d三联疗法即奥美拉唑 + 克拉霉素 + 甲硝唑;PAC组予以奥美拉唑 + 阿莫西林 + 克拉霉素,共10 d;PAM组予以奥美拉唑 + 阿莫西林 + 甲硝唑,共10 d.均为每日2次,早晚口服.所有患儿停药至少4周后复查13C-UBT,判断H.Pylori根除率.结果 三组患儿H.Pylori根除率的符合方案数据分析(PP)分别为:序贯治疗组91.18%,PAC组68.97%,PAM组76.67%;序贯治疗组和PAC组比较,差异有统计学意义(χ2 ＝ 5.01,P ＜ 0.05);序贯治疗组和PAM组比较,PAC组和PAM组比较,差异均无统计学意义(χ2 ＝ 2.55、0.44,P均＞ 0.05).结论 10日序贯疗法根除H.Pylori疗效明显优于10日标准三联疗法,10日序贯疗法可能为一有效的根除儿童H.Pylori感染的新方案.