目的 比较3种不同用药方法治疗幽门螺旋杆菌感染(helicobacter pylori ，Hp)的临床效果及其不良反应发生情况。方法 选取420例Hp阳性患者，随机分成3组。A组标准四联组(埃索美拉唑+胶体果胶铋+阿莫西林+克拉霉素)，B组新四联组(埃索美拉唑+胶体果胶铋+阿莫西林+环丙沙星)，A、B两组用药疗程14d。C组序贯治疗组(埃索美拉唑+ 阿莫西林治疗5 d，随后埃索美拉唑+环丙沙星+替硝唑再治疗5 d)。比较3组患者Hp根除率，随访3、6个月的Hp再感染率及不良反应发生率。结果 B组、C组Hp根除率分别为92.9％、95.7％，优于A组的85.0％(P<0.05)，随访3个月A、B、C组再感染率分别为10.1％、6.2％、7.5％，3组比较差异无统计学意义。6个月A组Hp再感染率为26.9％，显著高于B、C两组的13.8％、11.9％(P<0.05)。不良反应发生率组间比较差异无统计学意义。结论 以环丙沙星为基础的新四联及10d序贯疗法高效、复发率低、安全、患者依从性好，可推荐作为抗Hp治疗的一线标准治疗方案。
Abstract
Objective To compare the clinical efficacy and adverse events of three different therapies for Helicobacter pylori (H. pylori) eradication. Methods Four hundred and twenty H. pylori positive patients were randomly assigned into three groups in this open-label, prospective, controlled study. Group A patients received 14-day standard quadruplet therapy (esomeprazole plus colloidal bismuth pectin, amoxicillin and clarithromycin). Group B received 14-day new quadruplet therapy (esomeprazole plus colloidal bismuth pectin, amoxicillin and ring ciprofloxacin). Group C received 10-day sequential therapy (esomeprazole plus amoxicillin for 5 days, followed by esomeprazole plus ciprofloxacin and tinidazole for 5 days). H. pylori eradication rate, reinfection rates and adverse events were assessed at three months and six months after treatment. Results H. pylori eradication rates in group B, group C were significantly higher than in the group A (92.9%, 95.7% vs 85.0%, P<0.05). H. pylori reinfection rates were 10.1%, 6.2%, 7.5%, respectively, with no significant difference between the three groups,at three months after treatment. Six months after treatment, H. pylori reinfection rate in group A was 26.9%, which was significantly higher than in groups B, and C, with a 13.8% and 11.9%, respectively (P<0.05). The incidence rate of adverse events between the three groups was not significantly different. Conclusions Ciprofloxacin-based new quadruple therapy and 10-day sequential therapy are both efficient and safe, with a low reinfection rate and high patient compliance, and can be recommended as first-line anti-H. pylori therapy.
关键词
幽门螺旋杆菌 /
标准四联疗法 /
新四联疗法 /
序贯疗法
Key words
Helicobacter pylori /
standard quadruplet therapy /
new quadruplet therapy /
sequential therapy
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Strugatsky D,McNulty R,Munson K,et al.Structure of the proton-gated urea channel from the gastric pathogen Helicobacter pylori[J]. Nature ,2013,493(7431):255-258.
[2] Fukamachi H, Mimata A,Tanaka I, et al. In vitro differentiation of Runx3-/- p53-/- gastric epithelial cells into intestinal type cells[J].Cancer Sci, 2008, 99(4):671-676.
[3] Martinde Argila C, Boixeda D,Canton R,et al.High seroprevalence of Helicobacterpylori infection in coronary heart disease[J].Lancet,1995, 346(8970):310.
[4] Gasbarrini A,Franceschi F,Tartaglione R,et al.Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori[J].Lancet,1998 ,352(9131):878.
[5] Hirata Y,Ohmae T,Yanai A, et al.Sitafloxacin resistance in Helicobacter pylori isolates and sitafloxacin-based triple therapy as a third-line regimen in Japan[J].Int J Antimicrob Agents ,2012 ,39(4):352-355.
[6] Tay CY,Windsor HM,Thirriot F, et al. Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations[J]. Aliment PharmacolTher, 2012,36(11-12):1076-1083.
[7] IARC. schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994 [J] . IARC MonogrEvalCarcinog Risks Hum,1994,61:1-241.
[8] Kokkola A, Sipponen P, Rautelin H, et al. The effect of Helicobacter pylori eradication on the natural course ofatrophic gastritis with dysplasia[J]. Alimentary Pharmacology and Therapeutics,2002,16:515-520.
[9] Venerito M,Malfertheiner P. Preneoplastic Conditions in the Stomach: Always a Point of No Return[J].Dig Dis,2015,33(1):5-10.
[10] Lee HJ,Kim JI,Cheung DY, et al.Eradication of Helicobacter pylori according to 23S ribosomal RNA point mutations associated with clarithromycin resistance[J]. J Infect Dis, 2013 ,208(7):1123-1130.
[11] Zhang S,DesrosiersJ,Aponte-Pieras JR, et al.Human immune responses to H. pylori HLA Class II epitopes identified by immunoinformatic methods[J].PLoS One,2014,9(4):e94974.
[12] Liou JM, Chen CC,Chen MJ, et al .Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial[J]. Lancet, 2013, 381(9862):205-213.
[13] Bago P1, Vcev A, Tomic M, et al. High eradication rate of H. pylori with moxifloxacin-based treatment: a randomized controlled trial [J]. Wien Klin Wochenschr,2007,119(11-12):372-378.
[14] Kwon AS, Park GC, Ryu SY, et al. Higher biofilm formation in multidrug-resistant clinical isolates of Staphylococcus aureus. [J]. Int J Antimicrob Agents, 2008, 32(1):33- 39.
PDF(755 KB)
