含多西环素的四联方案根除幽门螺杆菌的疗效

摘要

目的：观察多西环素、阿莫西林联合雷贝拉唑、胶体果胶铋方案根除幽门螺杆菌（Hp ）的疗效。方法选取初次治疗患者150例，随机分为观察组（阿莫西林胶囊＋多西环素胶囊）50例、对照组A 50例（阿莫西林胶囊＋克拉霉素分散片）和对照组B 50例（阿莫西林胶囊＋左氧氟沙星片），联合雷贝拉唑肠溶片、胶体果胶铋胶囊，左氧氟沙星为1次/d，其他药物均为2次/d，疗程14 d。根除治疗失败后补救治疗患者60例，随机分为观察组（阿莫西林胶囊＋多西环素胶囊）30例，对照组（根据药敏结果选择两组敏感抗生素）30例，联合雷贝拉唑肠溶片和胶体果胶铋胶囊，2次/d，疗程均为14 d。疗程结束4周以后复查13 C呼气试验，观察Hp根除率、不良反应和成本-效果比。结果初次治疗患者观察组、对照组 A、对照组 B 根除率分别为88．00％、70．00％、82．00％（ITT）和91．60％、74．47％、85．11％（PP），观察组与对照组A相比差异有统计学意义（P＜0．05）；观察组成本-效果比低于两组对照；根除治疗失败后补救治疗，观察组与对照组根除率为70．00％、77．78％（ITT）和66．67％、71．43％（PP），差异无统计学意义，但观察组成本-效果比高于对照组。不良反应均少见且轻微。结论多西环素、阿莫西林联合雷贝拉唑、胶体果胶铋方案根除幽门螺杆菌疗效较好。%Objective To assess the efficacy and feasibility of Doxycycline -based quadruple regimen for the eradication of Helicobacter pylori.Methods A total of 150 H.pylori-positive patients were randomly collected and divided into the treatment group(doxycycline and amoxicillin),the control group A (clarithromycin and amoxicil-lin)and the control group B(levofloxacin and amoxicillin).60 patients who had a failed course of initial eradication therapy were randomly divide into the treatment group(doxycycline and amoxicillin)and the control group(two sensi-tive antibiotics).All patients were treated with rabeprazole and colloidal bismuth pectin capsules,twice a day for 14 days.The adverse effects,efficacy and cost-effectiveness were recorded during the course of treatment,the eradica-tion rate of H.pylori was assessed by 13C-urea breath test (UBT)4 weeks after the therapy.Results The result of ITT and PP analysis showed that the eradication rates for patients with initial therapy were 88.00% and 91.60% in the treatment group,70.00% and 74.47% in the control A group,82.00% and 85.11% in the control B group.As for the rescue therapy,the eradication rate were 70.00%and 77.78%in the treatment group,66.67%and 71.42%in the control group.The eradication rate of treated group was significantly differenct from the control group A (P<0.05).As for the rescue therapy,the eradication rates were 70.00% and 77.78% in the treatment group,66.67%and 7 1 .42% in the control group.The efficacy and cost -effectiveness in treatment group was significantly higher than that in the control group.All side effects were slight and mild.Conclusion Doxycycline-based quadruple regi-men is a safe and effective eradication therapy for the initial treatment and patients who have failed eradication courses.