改良序贯疗法与不同四联疗法根除幽门螺杆菌的疗效分析

摘要

Objective To evaluate the efficacy and safety of modified sequential therapy versus different quadruple therapy for the helicobacter pylori (H .pylori) eradication .Methods A total of 240 H .pylori infected patients with non atrophic gastritis accompanies erosion and peptic ulcer diagnosed by gastroscopy ,were evenly divided into sequential therapy group (A group) ,con-comitant therapy group(B group) ,7 days bismuth-containing quadruple therapy group(C group) and 10 days bismuth-containing quadruple therapy group(D group) .A group :rabeprazole 10 mg ,amoxicillin 1 000 mg were taken twice daily for 5 days firstly ,then rabeprazole 10 mg ,clarithromycin 500 mg ,furazolidone 100 mg were taken twice daily for 5 days .B group :rabeprazole 10 mg , amoxicillin 1 000 mg ,clarithromycin 500 mg ,furazolidone 100 mg were taken twice daily for 7 days .C group and D group :rabe-prazole 10 mg ,bismuth 220 mg ,amoxicillin 1 000 mg ,clarithromycin 500mg were taken twice daily for 7 and 10 days respectively . H .pylori status was re-assessed with 14C-urea breath test after 4-weeks therapy .Results Among them ,224 cases completed the study .According to the analysis of intention-to-treat (ITT ) ,the H .pylori eradication rates of A ,B ,C ,D group were 88 .33% , 83 .33% ,73 .33% ,81 .67% respectively ,and according to per-protocol (PP )analysis which were 92 .98% ,90 .90% ,78 .57% , 87 .50% .The difference between A and C group was statistically significant (χ2 = 4 .36 ,4 .83 ,P= 0 .037 ,0 .028) .Conclusion Fura-zolidone-containing sequential therapy provide provide high H .pylori eradication rates ,which could be the first-line treatment option .%目的：评价含呋喃唑酮的改良序贯疗法根除幽门螺杆菌（H ．pylori）的疗效和安全性。方法收集 H ．pylori 阳性的非萎缩性胃炎伴糜烂和消化性溃疡患者240例，均分为序贯疗法组（A 组）、伴同疗法组（B 组）、铋剂四联7 d 组（C 组）、铋剂四联10 d 组（D 组）。 A 组：先予雷贝拉唑10 mg ＋阿莫西林1000 mg ，每天2次，5 d ，再予雷贝拉唑10 mg ＋克拉霉素500 mg ＋呋喃唑酮100 mg ，每天2次，5 d ；B 组：雷贝拉唑10 mg ＋阿莫西林1000 mg ＋克拉霉素500 mg ＋呋喃唑酮100 mg ，每天2次，7 d ；C 组：雷贝拉唑10 mg ＋枸椽酸铋钾220 mg ＋阿莫西林1000 mg ＋克拉霉素500mg ，每天2次，7 d ；D 组：方案同 C 组，疗程10 d 。治疗结束停药至少4周后空腹行14C-尿素呼气试验，结果阴性者判为 H ．pylori 根除成功。结果224例患者完成治疗，A 、B 、C 、D 组H ．pylori 根除率按意向性（ITT ）分析分别为88．33％、83．33％、73．33％、81．67％，按方案（PP）分析分别为92．98％、90．90％、78．57％、87．50％。 A 组与 C 组 ITT 和 PP 分析比较差异均有统计学意义（χ2＝4．36、4．83，P＝0．037、0．028）。结论含呋喃唑酮的改良序贯疗法对 H ．pylori 根除率较高，是一种可供选择的一线治疗方案。