摘要
目的 比较三种常用四联疗法根除幽门螺杆菌( H.pylori )的疗效,从而筛选效价比较高的根除方案。方法 回顾性分析2016年8月至2018年7月就诊于中国医科大学附属盛京医院消化科门诊,经 13 C尿素呼气试验确诊 H.pylori 阳性且为首次行 H.pylori 根除治疗的慢性胃炎、消化性溃疡且无并发症的386例患者,年龄15~74岁,男164例,女222例。根除方案:A组:埃索美拉唑20 mg、阿莫西林1 000 mg、克拉霉素500 mg、枸橼酸铋钾胶囊600 mg,2次/d;B组:雷贝拉唑20 mg、阿莫西林1 000 mg、克拉霉素500 mg、枸橼酸铋钾胶囊600 mg,2次/d;C组:埃索美拉唑20 mg、阿莫西林1 000 mg、呋喃唑酮100 mg、枸橼酸铋钾胶囊600 mg,2次/d;所有方案的疗程均为14 d,患者停药至少4周后复查 13 C尿素呼气试验,判断 H.pylori 根除情况。结果 (1) H.pylori 根除率分别为A组86.41%、B组76.16%、C组87.12%,C组较A组 H.pylori 根除率高,但差异无统计学意义( P >0.05),A组和C组的 H.pylori 根除率较B组明显升高,差异均有统计学意义( P 分别为0.044和0.018);(2)A组、B组、C组的不良反应发生率分别为 4.85%、5.30%、6.82%,各组间比较,差异无统计学意义( P >0.05);(3)A组、B组、C组的成本-效果比依次为5.38、4.73、 3.97 ,C组成本-效果比最低。结论 铋剂联合埃索美拉唑、阿莫西林、克拉霉素方案和铋剂联合埃索美啦唑、阿莫西林、呋喃唑酮方案均可达到良好的根除效果,且安全性较高,考虑作为根除 H.pylori 的一线方案,但铋剂联合埃索美拉唑、阿莫西林、呋喃唑酮方案成本更低。
Objective To compare the efficacy of three commonly used quadruple therapies for eradication of H.pylori, so as to select a higher titer eradication plan.Methods The study retrospectively analyzed the visit to the Department of Gastroenterology, Shengjing Hospital of China Medical University from Aug. 2016 to Jul. 2018, whose 13C urea breath tests were confirmed positive and were the first H.pylori eradication therapy. There were 386 patients participated in the research who suffered from chronic gastritis, peptic ulcer and had no complications, aged 15-74 years old, including 164 males and 222 females. Eradication schemes included: group A: Esomeprazole 20 mg, Amoxicillin 1 000 mg, Clarithromycin 500 mg, Bismuth potassium citrate capsule 600 mg, 2 times a day;group B: Rabeprazole 20 mg, Amoxicillin 1 000 mg, Clarithromycin 500 mg, Bismuth potassium citrate capsule 600 mg, 2 times a day;group C: Esomeprazole 20 mg, Amoxicillin 1 000 mg, Furazolidone 100 mg, Bismuth potassium citrate capsule 600 mg, 2 times a day. The duration of treatment for all regimens was 14 days. After stopping treatment for at least 4 weeks, the 13C urea breath test was reviewed to determine the eradication of H.pylori. Results(1) H.pylori eradication rate was 86.41% in group A, 76.16% in group B, and 87.12% in group C. The H.pylori eradication rate in group C was higher than group A, but there was no statistical difference(P>0.05), the H.pylori eradication rates of group A and group C were significantly higher than group B(P=0.044 and 0.018, respectively).(2) The incidences of adverse reactions in group A, group B, and group C were 4.85%, 5.30%, 6.82%, respectively. There was no statistical difference among three groups(P>0.05).(3) The cost-effectiveness ratios of group A, group B and group C were 5.38, 4.73 and 3.97, respectively, and group C had the lowest ratio.Conclusion Bismuth combined with Esomeprazole, Amoxicillin, Clarithromycin regimen, Bismuth combined with Esomeprazole, Amoxicillin, Furazolidone regimen, both can be considered
作者
张启宇
李岩
ZHANG Qiyu;LI Yan(Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110000, China)
出处
《胃肠病学和肝病学杂志》
CAS
2019年第8期886-889,共4页
Chinese Journal of Gastroenterology and Hepatology
关键词
幽门螺杆菌
四联疗法
根除率
Helicobacter pylori
Quadruple therapy
Eradication rate
