序贯疗法与标准四联疗法对幽门螺杆菌根除失败后补救治疗的疗效分析

摘要

Efficacy of standard triple therapy for eradication of Helicobacter pylori ( H. Pylori) is decreasing recently, and it is important to select effective rescue therapy for the patients with failure of H. Pylori eradication. Aims: To compare the eradication efficacy of sequential therapy and standard quadruple therapy for patients with failed H. Pylori eradication. Methods; Ninety-eight patients who had failed H. Pylori eradication were randomly assigned into sequential therapy group ( omeprazole 20 mg + amoxicillin 1000 mg bid for 5 days, followed by omeprazole 20 mg + levofloxacin 200 mg + clarithromycin 500 mg bid for 5 days) and standard quadruple therapy group ( omeprazole 20 mg + bismuth subcitrate 220 mg + amoxicillin 1000 mg + clarithromycin 500 mg bid for 7 days). Four weeks after the end of treatment, l4C-urea breath test was re-examined to assess H. Pylori eradication rate. Results; Ninety-five patients completed the study. H. Pylori eradication rates by ITT and PP analysis in sequential therapy group were significantly higher than those in standard quadruple therapy group (ITT; 89. 8% vs. 71. 4% , PP: 91. 7% vs. 74. 5% , P < 0. 05). The symptom remission of sequential therapy group was significantly higher than that of standard quadruple therapy group (95. 8% vs. 80. 9% , P < 0. 05). No significant difference in adverse effect rate was found between the two groups (P >0. 05). Conclusions; Both sequential therapy and standard quadruple therapy can be used as a rescue therapy for eradication of H. Pylori in patients with failed H. Pylori eradication. The efficacy of 10-day sequential therapy is superior to 7-day standard quadruple therapy-%背景:近年经典三联疗法的幽门螺杆菌(H.pylori)根除疗效明显降低,选择有效补救疗法对H.pylori根除失败者有重要意义.目的:比较序贯疗法与标准四联疗法对H.pylori根除失败者的疗效.方法:将98例H.pylori根除失败者随机分为序贯疗法组(前5d予奥美拉唑20 mg+阿莫西林1000 mg bid,后5d予奥美拉唑20 mg+左氧氟沙星200 mg+克拉霉素500 mg bid)和标准四联疗法组(予奥美拉唑20 mg+胶体次枸橼酸铋钾220 mg+阿莫西林1000 mg+克拉霉素500 mg bid,疗程7d).停药4周后复查14C-尿素呼气试验,评估H.pylori根除疗效.结果:共95例患者完成方案,序贯疗法组ITT和PP分析的H.pylori根除率均显著高于标准四联疗法组(ITT:89.8％对71.4％,PP:91.7％对74.5％,P＜0.05),序贯疗法组临床症状改善的总有效率亦显著高于标准四联疗法组(95.8％对80.9％,P＜0.05),两组不良反应发生率无明显差异(P＞0.05).结论:对H.pylori根除治疗失败的患者,序贯疗法和标准四联疗法均可作为有效的补救治疗方案,但10 d序贯疗法的疗效优于7d标准四联疗法.