摘要
目的:评价10 d含铋剂序贯疗法与常规序贯疗法及四联疗法对初次根除幽门螺杆菌(H.pylori)失败后补救治疗的疗效。方法:经胃镜下快速尿素酶试验或14C-尿素呼气试验确诊为H.pylori阳性的患者,用标准一线治疗方案进行H.pylori根除治疗,停药4周后行14C-尿素呼气试验,结果仍为阳性者判定为H.pylori根除失败。将初次根除失败的患者随机分为3组,A组:前5 d,雷贝拉唑10 mg、阿莫西林1 g、果胶铋300 mg;后5 d,雷贝拉唑10 mg、克拉霉素0.5 g、奥硝唑0.5 g、果胶铋300 mg。B组:前5 d,雷贝拉唑10 mg、阿莫西林1 g;后5 d,雷贝拉唑10 mg、克拉霉素0.5 g、奥硝唑0.5 g。C组:雷贝拉唑10 mg、果胶铋300 mg、阿莫西林1 g、呋喃唑酮0.1 g,疗程10 d,所有药物均口服,bid。治疗结束4周后复查14C-尿素呼气试验。结果:采用按意向性治疗(intention-to-treat,ITT)分析和按符合方案(per protocol,PP)分析对H.pylori根除率进行评价。A、B、C 3组H.pylori ITT根除率分别为92.3%、74.4%、75.0%,PP根除率分别为94.7%、78.4%、78.9%,2种分析方法均显示A组H.pylori根除率明显高于B、C 2组,差异有统计学意义(P<0.05),而B组与C组间根除率差异无统计学意义(P>0.05)。A组和B组不良反应发生率(5.3%、5.4%)低于C组(21.1%),但差异无统计学意义(P>0.05)。结论:10 d含铋剂序贯疗法可作为H.pylori一线根除治疗失败后安全有效的补救治疗方案。
OBJECTIVE To evaluate the curative efficacy of ten days bismuth-containing sequential therapy, ten days sequential therapy and quadruple therapy for patients who failed on first-line Helicobacter pylori （H. pylori） eradication thera py. METHODS Patients who were diagnosed with H. pylori infection by rapid urease test and HC-urea breath test and failed on first line eradication therapy were enrolled. Failure of the initial treatments was defined if the patient was positive in the ^14C-urea breath test after 4 weeks initial treatment. The patients were divided into three groups randomly： group A received bis- muth-containing sequential therapy, rabeprazole 10 mg plus amoxicillin 1 g, colloidal bismuth pectin 300 mg, twice daily at the first 5 days, followed rabeprazole 10 mg, clarithromycin 500 mg, ornidazole 500 mg and colloidal bismuth pectin 300 mg, twice daily at the last 5 days; group B received ten days sequential therapy, rabeprazole 10 mg plus amoxicillin 1 g, twice daily at the first 5 days, rabeprazole 10 mg, clarithromycin 500 mg and ornidazole 500 mg, twice daily at the last 5 days; group C received quadruple therapy, rabeprazole 10 mg plus colloidal bismuth pectin 300 mg, amoxicillin 1.0 g and {urazolidone 1. 0 g twice daily within 10 days. After 4 weeks therapy, the ^14C-urea breath test was performed to detect H. pylori infection status. RESULTS The intention-to treat （ITT） analysis and per protocol （PP） analysis were used to compare the eradication rates of H. pylori. ITT eradication rate and PP eradication rate of group A, group B , group C were 92. 3%, 74. 4%, 75.0% and 94. 7%,78. 4%, 78. 9%, respectively. Two analysis methods showed that H. pylori eradication rates of group A was significantly higher than group B and group C （P〈0. 05）. No significant difference was found between group B and group C （P〉0. 05）. The incidence of adverse reactions in group A and group B were lower than group C （5.3 %,5.4% vs. 21.1% ）, but the difference between the three groups was not statistically significant （P〉0.05）. CONCLUSION Ten days bismuth containing sequential therapy is an effective and safe rescue therapy after a failed first-line triple therapy.
出处
《中国医院药学杂志》
CAS
CSCD
北大核心
2012年第11期876-879,共4页
Chinese Journal of Hospital Pharmacy
关键词
幽门螺杆菌
序贯疗法
补救治疗
根除率
Helicobacter pylori
sequential therapy
rescue therapy
eradication rate
