序贯疗法治疗幽门螺杆菌阳性胃溃疡的临床分析

1、序贯疗法治疗幽门螺杆菌阳性胃溃疡的临床分析    【摘要】目的比较序贯疗法与传统三联疗法治疗幽门螺杆菌Hp阳性胃溃疡的疗效与安全性。方法选取84例经胃镜检测证实为Hp阳性胃溃疡病例，随机分为两组：治疗组，前5d予雷贝拉唑、阿莫西林,后5d予雷贝拉唑、替硝唑、克拉霉素治疗；对照组予雷贝拉唑、阿莫西林、克拉霉素治疗10d。随后两组均进行雷贝拉唑巩固治疗4周，疗程结束后均行胃镜复查检测。结果疗程结束时,治疗组溃疡愈合率87.8%,对照组溃疡愈合率86.05%，两组愈合率比较无显著性差异P0.05；治疗组HP阴转率为92.68%,对照组HP阴转率为83.72%，

2、两组HP阴转率比较具有显著性差异P【关键词】10d序贯疗法；三联疗法；幽门螺杆菌；胃溃疡 Sequential therapies for Helicobacter pylori-positive gastric ulcer clinical analysis 【Abstract】Objective To compare sequential therapy with the traditional triple therapies for Helicobacter pylori Hp-positive gastric ulcer and security. Methods 84 cases

3、detected by endoscopy confirmed Hp-positive patients with gastric ulcer were randomly divided into two groups: the treatment group，before the therapy of the combination of rabeprazole, amoxicillin and rabeprazole for 5d,tinidazole, clarithromycin mixture therapy of 5d;control group, rabeprazole, Amo

4、xicillin,clarithromycin treatment of 10d. Both groups were followed for consolidation therapy of rabeprazole for 4 weeks after treatment underwent endoscopy review test. Results at the end of treatment, the treatment group 87.8% ulcer healing rate, ulcer healing rate of the control group was 86.05%,

5、 the healing rate between the two groups there was no significant difference P>0.05; treatment group HP negative conversion rate was 92.68%, control Group HP negative conversion rate was 83.72%, compared two groups of HP negative rate was significant difference P 【Keywords】10d sequential triple t

6、herapy for Helicobacter pylori in gastric ulcer treatment 幽门螺杆菌Helicobacter pylori, Hp是消化性溃疡、胃癌、胃黏膜相关淋巴组织MALT淋巴瘤等疾病的重要致病因子, 对消化性溃疡患者的治疗必须根除Hp。目前，随着细菌耐药率的逐年升高, Hp根除的一线方案的Hp根除率也在下降, 已有文献报道标准三联疗法Hp根除率已下降至66.6%1。因此,需要寻找一种更理想的Hp根除的一线方案。由意大利DeFrancesco et al2发现的根除Hp的新方案-序贯疗法,可以取得更高的H pylor第一阶段的阿莫西林治疗能通过破坏

7、细胞壁而阻止克拉霉素流出通道的形成,故可能提高了第二阶段克拉霉素的治疗效果5。近年来克拉霉素的耐药率较以前有明显升高,达17 %44 % 6、7 ；2序贯疗法适当地延长了疗程,使根除Hp治疗更彻底;3种抗生素短期联合应用,达到了强强联合抑制Hp,又能减少Hp耐药机会。 本研究发现序贯疗法较经典三联疗法在胃溃疡的根治Hp感染一线治疗有较好的前景。我们的研究发现，虽在胃溃疡治愈率方面无明显差别，但Hp阴转率达92.68，较传统标准治疗方案优越，这与国外Zullo博士发表了有关序贯疗法根除Hp的研究报告的98的Hp根除率8较接近，也与国内赵大国等研究结果一致10，他们发现，前5d给奥美拉唑克拉霉素，

8、后5d给奥美拉唑阿莫西林呋喃唑酮的10d序贯疗法治疗Hp 感染的成人患者，Hp 根除率为90.7，与标准7d三联疗法（Hp根除率为71.4）比较，Hp根除率高，患者的耐受性和依从性好；与一项荟萃分析得出总的Hp根除率93.5相似9，他们还发现，针对克拉霉素耐药患者Hp根除率也高，且两种方案副作用的发生率无明显差别。但我们发现序贯疗法不良反应明显少于传统标准治疗方案。这可能与研究的对象、样本量、抗生素种类、质子泵抑制剂的差异等有关，有待进步研究。 参考文献 1Ojetti V, Migneco A, Zocco MA, Nista EC,Gasbarrini G, Gasbarrini A. B

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