比较以阿莫西林和呋喃唑酮为基础的抗幽门螺杆菌四联和三联方案

摘要

目的 比较以阿莫西林和呋喃唑酮为基础的四联、三联疗法根除幽门螺杆菌(H.pylori)的临床疗效.方法 对符合条件的816例H.pylori阳性的慢性胃炎、十二指肠球部炎及消化性溃疡患者,根据治疗方案的随机选择分组如下:(1)质子泵抑制剂(PPI)+枸橼酸铋钾+阿莫西林+呋喃唑酮(含PPI四联组);(2)枸橼酸铋雷尼替丁(RBC)+阿莫西林+呋喃唑酮(含RBC三联组);(3)PPI+阿莫西林+呋喃唑酮(含PPI三联组);(4)枸橼酸铋钾+阿莫西林+呋喃唑酮(含枸橼酸铋钾三联组).疗程结束4周后,复查快速尿素酶试验或13C呼气试验评判H.pylori根除情况.结果 (1)含PPI四联组与其他各组的H.pylori根除率比较均有显著性差异(P＜0.05);(2)将上述每组患者按照接受H.pylori根除治疗的时间(2004年-2006年、2007年-2009年、2010年-2012年)分为3个时间段,在相同治疗方案下比较H.pylori根除率.结果显示同一治疗组的H.pylori根除率在不同时间段无显著差异(P＞0.05).结论 含PPI四联疗法H.pylori根除率高,无与治疗相关的严重不良反应,在传统的一线含PPI三联疗法根除率H.pylori逐年下降的状况下,为克服原发耐药和避免继发耐药产生,值得进一步探讨作为根除H.pylori一线治疗选择方案的可能性.%Objective To evaluate the clinical effect of triple vs quadruple therapy based Amoxicillin and Furazolidone for the eradication of Helicobacter pylori (H.pylori) infection.Methods Patients with a diagnosis of H.pylori infection were confirmed by Biopsy-based rapid urease test or 13C urea breath test.Total of 816 eligible patients of H.pylori infection with chronic gastritis,duodenitis and peptic ulcer were enrolled from 2004 to 2012.Patients were randomly divided into 4 groups based on different treatment regimens for 7 days:(1) PPI + Bismuth potassium citrate +Amoxicillin + Furazolidone; (2) Ranitidine bismuth citrate + Amoxicillin + Furazolidone; (3) PPI + Amoxicillin +Furazolidone; (4) Bismuth potassium citrate + Amoxicillin + Furazolidone.Results The studied therapeutic regimens were completed by all patients and there were only minor side effects for these studied regimens.Statistical analysis revealed significant differences (P ＜ 0.05) in the eradication rate between the quadruple therapy and the rest groups.More importantly,we found that there were no differences in the H.pylori eradication rate among the patients treated with the same therapeutic regimens at differential time phase (2004 ～2006,2007 ～2009,2010 ～2012).Conclusion Our studies demonstrates that Amoxicillin and Furazolidone based quadruple therapy is a highly active regimen for the eradication of H.pylori infection in treatment-naive patients.A large randomized controlled trial is warranted to further evaluate the efficacy of this regimen.