目的：评价两种幽门螺杆菌(Helicobacter pylori, H. pylori)补救治疗方案的的疗效和安全性。方法选择我院消化内科规范根除H. pylori,三联方案治疗失败病例163例,随机分为四联方案组(奥美拉唑20 mg+阿莫西林1.0 g+替硝唑500 mg+胶体果胶铋200 mg)和序贯方案组(先奥美拉唑20 mg+阿莫西林1.0 g,后奥美拉唑20 mg+痢特灵0.1 g+克拉霉素500 mg),治疗结束至少4周后通过13C-尿素呼吸试验判断根除效果,评价安全性。结果四联方案组78例,H. pylori根除69例,根除率88.5%,不良反应发生率为14.1%(11例)；序贯方案组85例,H. pylori根除70例,根除率82.3%,不良反应发生率为32.9%(28例),两组根除率比较无显著差异,但四联方案组不良反应发生率低于序贯方案组,且有统计学意义(P<0.05)。结论四联方案及序贯方案均能有效根除H. pylori,序贯方案不良反应发生率相对较高。%Objective To compare the efficacy and safety of sequential and bismuth-based quadruple therapies as rescue therapy for H. pylori eradication. Methods One hundred and sixty-three patients, in whom the initial standard triple therapy had failed to eradicate H. pylori infection were included in this study. Patients were randomly assigned to two groups to receive either 10-day sequential therapy or 14-day bismuth-based quadruple therapy with omeprazole (20 mg Bid)), plus colloidal bismuth pectin capsules (200 mg bid), amoxi-cillin (1,000 mg bid), and tinidazole (500 mg bid), respectively. The eradication effect was assessed by the 13C-urea breath test 4 weeks after treatment, adverse events were recorded. Results The eradication rates of H. py-lori in bismuth-based quadruple therapy group and sequential therapy group were 88.5%and 82.3%, respec-tively (P>0.05). The rates of adverse events were 14.1%and 32.9%, respectively. The rate of adverse events in sequential therapy group was statistically significantly higher than that in bismuth-based quadruple therapy group (P<0.05). Conclusion Both bismuth-based quadruple therapy and the sequential therapy were effec-tive as rescue regimen for H. pylori eradication after failure of standard triple treatment. However, sequential therapy showed a higher rate of adverse effects.
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