摘要
背景:在功能性消化不良(FD)患者中,以铋剂为基础的治疗方案根除幽门螺杆菌(H.pylori)的疗效优于以质子泵抑制剂(PPI)为基础的治疗方案。目的:观察在常规1周三联疗法结束后继续单独应用胶体次枸橼酸铋(CBS)3周对H.pylori根除率的影响,评估以铋剂为基础的治疗方案在FD患者中根除H.pylori的疗效和安全性。方法:165例 H.pylori阳性FD患者随机分为3组,治疗方案分别为:A组:CBS220mgbid7天、克拉霉素250mgbid7天和呋喃唑酮100mgbid7天;B组:CBS220mgbid28天、克拉霉素250mgbid7天和呋喃唑酮100mgbid7天;C组:法莫替丁20mgbid7天、CBS220mgbid7天、克拉霉素250mgbid7天和呋喃唑酮100mgbid7天。H.pylori阳性由快速尿素酶试验结合组织学检查证实。疗程结束后4～6周行13C鄄尿素呼气试验以判断H.pylori是否已根除。结果:3种治疗方案均获得较好的疗效,按意图治疗(ITT)[方案(PP)]分析,H.pylori总根除率达87.3%(90.0%),B组和C组的根除率分别为89.1%(94.2%)和92.7%(94.4%),均较A组的80.0%(81.5%)提高约10%(P<0.05)。3组总的副反应发生情况无显著差异。结论:3种以铋剂为基础的治疗方案在FD患者中均能有效根除H.pylori,且安全性较高。在常规以铋剂为基础的1周三联疗法结束后继续单独应用铋剂3周,或在三联疗法的基础上加用H2?
Bismuth-based treatment regimens are preferable to proton pump inhibitors (PPI)-based ones in eradication of Helicobacter pylori (H. pylori) in patients with functional dyspepsia (FD). Aims: To investigate the effect of prolonged use of colloidal bismuth subcitrate (CBS) for 3 weeks following the typical one-week triple therapy on the eradication of H. pylori, so as to evaluate the efficacy and safety of bismuth-based treatment regimens on the eradication of H. pylori in patients with FD. Methods: One hundred and sixty-five H. pylori positive patients with FD were included, and randomly divided into three groups. The regimens were: Group A: CBS 220 mg bid for 7 days, clarithromycin 250 mg bid for 7 days and furazolidone 100 mg bid for 7 days; Group B: CBS 220 mg bid for 28 days, clarithromycin 250 mg bid for 7 days and furazolidone 100 mg bid for 7 days; Group C: famotidine 20 mg bid for 7 days, CBS 220 mg bid for 7 days, clarithromycin 250 mg bid for 7 days and furazolidone 100 mg bid for 7 days. Patients were defined as positive for by rapid urease test and histology. 13C-urea breath test was performed to detect the status of H. pylori 4～6 weeks after completion of the treatment. Results: The results of all three treatment regimens were satisfactory. The overall H. pylori eradication rate was 87.3% for intention-to-treat (ITT) analysis and 90.0% for per-protocol (PP) analysis. The eradication rates (ITT and PP) in group B were 89.1% and 94.2%, and in group C were 92.7% and 94.4%, respectively, all were statistically significant and about 10% superior to that in group A (80.0% and 81.5%, P<0.05). There were no significant differences in the frequency and severity of side-effects among the three groups. Conclusions: All three bismuth-based treatment regimens are effective and safe in the eradication of in FD patients. Additional use of CBS for 3 weeks or adding H2-receptor antagonists (quadruple therapy) may improve the efficacy of the traditional bismuth-based one-week triple therapy for eradication.
出处
《胃肠病学》
2004年第4期217-220,共4页
Chinese Journal of Gastroenterology
