摘要
目的探讨调整铋剂四联疗法联合益生菌对幽门螺杆菌(Helicobacter pylori,Hp)的根除疗效。方法选取2020年9月至2021年7月在成武县人民医院诊断为Hp感染的胃炎患者90例,随机将其分为三组,A组患者给予枸橼酸铋钾(200mg,2次/d)+雷贝拉唑+阿莫西林+克拉霉素,B组患者给予枸橼酸铋钾(110mg,3次/d)+雷贝拉唑+阿莫西林+克拉霉素,C组患者在B组用药基础上联合双歧杆菌活菌胶囊,疗程均为14d。停药4周后行^(13)C尿素呼气试验及组织病理检查评估Hp根除疗效。结果入组患者90例,86例完成试验。三组患者的Hp根除率意向性分析(intention-to-treat analysis,ITT分析)分别为86.67%、76.67%和90.00%,符合方案分析(per-protocol analysis,PP分析)分别为89.66%、82.14%和93.10%。无论是ITT分析还是PP分析,三组患者的Hp根除率比较差异均无统计学意义(P>0.05)。治疗后,三组患者的临床症状缓解率、组织病理评分比较差异均有统计学意义(P<0.05);三组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论调整铋剂频次、剂量联合双歧杆菌方案的Hp根除效果不低于常规治疗方案,可改善临床症状及组织病理慢性炎症,不增加不良反应,建议用于铋剂耐受性差或肝肾功能不全的患者。
Objective To investigate the eradication effect of adjusted bismuth quadruple therapy combined with probiotics on Helicobacter pylori(Hp).Methods A total of 90 patients with gastritis diagnosed as Hp infection in Chengwu County People’s Hospital from September 2020 to July 2021 were randomly divided into three groups.Group A was given bismuth potassium citrate(200mg,bid)+rabeprazole+amoxicillin+clarithromycin,group B was given bismuth potassium citrate(110mg,tid)+rabeprazole+amoxicillin+clarithromycin,and group C was combined with bifidobacterium live capsule on the basis of medication in group B.The course of treatment was 14 days.^(13)C urea breath test and histopathological examination were performed 4 weeks after withdrawal to evaluate the efficacy of Hp eradication.Results 90 patients were enrolled and 86 patients completed the study.The eradication rates of Hp in three groups were 86.67%,76.67%and 90.00%by intention-to-treat(ITT)analysis and 89.66%,82.14%and 93.10%by per-protocol(PP)analysis,respectively.There was no significant difference in the eradication rate of Hp among the three groups by either ITT analysis or PP analysis(P>0.05).After treatment,there were significant differences in clinical symptom remission rate and histopathologic score among the three groups(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion The Hp eradication effect of bifidobacteria combined with bismuth frequency and dose adjustment is no less than that of conventional treatment,which can improve clinical symptoms and histomathological chronic inflammation without increasing adverse reactions.It is recommended for patients with poor tolerance to bismuth or liver and kidney dysfunction.
作者
王立民
曹瑞珍
田字彬
郭涛
WANG Limin;CAO Ruizhen;TIAN Zibin;GUO Tao(Medical College of Qingdao University,Qingdao 266000,Shandong,China;Department of Gastroenterology,Chengwu County People’s Hospital,Chengwu 274200,Shandong,China;Department of Gastroenterology,Ordos Central Hospital,Ordos 017000,Inner Mongolia,China;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中国现代医生》
2023年第31期13-16,25,共5页
China Modern Doctor
基金
山东省医药卫生科技发展计划项目(202103030396)。
关键词
幽门螺杆菌
益生菌
铋剂四联方案
根除成功率
不良反应发生率
Helicobacter pylori
Probiotics
Bismuth quadruple scheme
Success rate of eradication
Incidence of adverse reaction
