兰索拉唑、阿莫西林和依卡倍特钠三联根除幽门螺杆菌的临床观察

  本文关键词：兰索拉唑、阿莫西林和依卡倍特钠三联根除幽门螺杆菌的临床观察，由笔耕文化传播整理发布。

        目的：探讨兰索拉唑、阿莫西林、依卡倍特钠三联根除幽门螺杆菌(Hp)的有效性，旨在减少抗生素副作用、降低耐药性和抗生素不良反应发生率、提高患者依从性，并探讨其对细胞毒素相关蛋白(CagA)+Hp患者和CagA-Hp患者幽门螺杆菌根除疗效的影响，观察幽门螺杆菌根除治疗前后患者血清胃蛋白酶原含量的变化。方法：选取2010年9月至2012年1月期间在长沙市第一医院消化科门诊及住院部就诊行14碳呼气试验（14C—UBT）及胃镜确诊的194例Hp感染的糜烂性胃炎患者作为观察对象。采用ELISA法测定患者血清CagA蛋白抗体后分成2组，即CagA+Hp患者组98例，CagA-Hp患者组96例，将CagA+Hp患者分成3组：A组（32例）：兰索拉唑片（30mg Bid）+阿莫西林胶囊（1.0g Bid）+克拉霉素缓释片（0.5g Bid），疗程7天；B组（30例）：兰索拉唑片（30mg Bid）+阿莫西林胶囊（1.0g Bid）+克拉霉素缓释片（0.5g Bid）+依卡倍特钠颗粒（1.0gBid），疗程7天；C组（36例）：兰索拉唑片（30mg Bid）+阿莫西林胶囊（1.0gBid）+依卡倍特钠颗粒（1.0g Bid），疗程7天；将CagA-Hp患者分成3组：D组（31例）：兰索拉唑片（30mg Bid）+阿莫西林胶囊（1.0g Bid）+克拉霉素缓释片（0.5g Bid），疗程7天；E组（33例）：兰索拉唑片（30mg Bid）+阿莫西林胶囊（1.0g Bid）+克拉霉素缓释片（0.5g Bid）+依卡倍特钠颗粒（1.0g Bid），疗程7天；F组（32例）：兰索拉唑片（30mg Bid）+阿莫西林胶囊（1.0g Bid）+依卡倍特钠颗粒（1.0g Bid），疗程7天。予停药后1个月复查14C—UBT以了解Hp根除情况。分别予用药前、停药后1个月抽血测定血清中胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）含量并计算PGⅠ/PGⅡ比值，比较治疗前后PGⅠ、PGⅡ含量的变化，同时完善治疗前后血常规、肝肾功能检查，记录治疗期间及之后患者的不良反应。结果：各组Hp根除疗效：通过治疗后A组的Hp根除率为71.9%，B组的Hp根除率为86.7%，C组的Hp根除率为69.4%，D组的Hp根除率为77.4%，，E组的Hp根除率为90.9%，F组的Hp根除率为75.0%。C组与A组相比较无统计学意义，C组与B组相比较有统计学意义，F组与D组相比较无统计学意义，F组与E组相比较有统计学意义。说明兰索拉唑、阿莫西林、依卡倍特钠三联疗法组在Hp感染根除治疗中能有效的根除Hp，其疗效相当于传统三联疗法组，但低于兰索拉唑、阿莫西林、克拉霉素、依卡倍特钠四联疗法组。C组与F组相比较有统计学意义，B组与E组相比较有统计学意义，A组与D组相比较无统计学意义。说明兰索拉唑、阿莫西林、依卡倍特钠三联疗法组与兰索拉唑、阿莫西林、克拉霉素、依卡倍特钠四联疗法组对CagA-Hp患者的根除疗效优于CagA+Hp患者。不良反应情况：194例患者在根除Hp过程中出现不同程度恶心、呕吐、腹痛、血常规异常、腹泻、头晕、皮疹、金属味觉、肝肾功能异常等不良反应。A组的不良反应率为43.8%，B组的不良反应率为36.7%，C组的不良反应率为13.9%，D组的不良反应率为41.9%，E组的不良反应率为36.4%，F组的不良反应率为18.9%。C组与A组比较有统计学意义，C组与B组比较有统计学意义，F组与D组比较有统计学意义，F组与E组比较有统计学意义。说明兰索拉唑、阿莫西林、依卡倍特钠三联疗法组的不良反应发生率低于传统三联疗法组与兰索拉唑、阿莫西林、克拉霉素、依卡倍特钠四联疗法组。各组治疗前后血清PGⅠ／PGⅡ比值升高程度：A组治疗前后血清PGⅠ／PGⅡ比值升高程度有统计学意义（P=0.034）；B组的有统计学意义（P=0.030）；C组的有统计学意义（P=0.016）；D组的有统计学意义（P=0.040）；E组的有统计学意义（P=0.035）；F组的有统计学意义（P=0.029）。说明各组药物根除Hp前后血清胃蛋白酶原均有不同程度的特异性改变，表现为PGⅠ下降、PGⅡ明显下降、PGⅠ／PGⅡ升高。结论：（1）兰索拉唑、阿莫西林、依卡倍特钠三联疗法组在Hp根除治疗中能有效根除Hp，可减少抗生素耐药性和不良反应发生率，同时提高患者依从性；（2）兰索拉唑、阿莫西林、依卡倍特钠三联疗法组对CagA-Hp患者的Hp根除疗效优于CagA+Hp患者；（3）抗Hp药物根除Hp前后血清胃蛋白酶原均有不同程度的特异性改变，表现为PGⅠ下降、PGⅡ明显下降、PGⅠ／PGⅡ升高。

    ObjectiveThe aim of the research is to explore a new treatment of helicobacter pylorieradication with lansoprazole amoxicillin and ecabet sodium, so as to reduce the resis-tance and clarithromycin antibiotics adverse reaction rate,to improve patients’com-pliance. And to further explore the influence of the treatment of Helicobacter pylori ofthe CagA+Hp patients and CagA-Hp patients, to observe the change of PG before and aftereradicate helicobacter pylori for patients.MethodsSubjects were these patients with erosive gastritis who infected by Hp.Those194cases were selected randomly from outpatient and inpatient in Gastroenterology deptin Changsha First Hospital during September2010to January2012(227cases wereselected,but33of them were removed).Do14C—UBT,Hp histological examination af-ter gastric mucous membrane live organization did HE staining before the treatment.The person who meets them were proved to be Hp positive.Do14C—UBT to confirmewhether Hp was eradicated after1month treatment.Each patient was used ELISA method to determine the patients’ serum CagAprotein antibody. Firstly, divided194patients into2groups (98CagA+Hp patientsand96CagA-Hp patients). And then divided98CagA+Hp patients randomly into3groups: Patients in the A group(32cases) were received treatment of lansoprazoletablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid)for7days.Patients in the B group(30cases) were received treatment of lansoprazoletablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid)+ecabet sodium (1.0g Bid)for7days.Patients in the C group(36cases) were received treatment of lansoprazole tablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+ecabetsodium (1.0g Bid)for7days.Divided96CagA-Hp patients randomly into3groups:Patients in the D group(31cases) were received treatment of lansoprazole tablets (30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid) for7days.Patients in the E group(33cases) were received treatment of lansoprazole tablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid)+ecabet so-dium(1.0g Bid)for7days.Patients in the F group(32cases)were received treatment oflansoprazole tablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+ecabet sodium (1.0gBid) for7days.Measured the content of PGⅠand PGⅡin blood serum before treatment and af-ter1month treatment separately,and calculated PGⅠ/PGⅡratio,compared the changeof PGⅠand PGⅡ’s content before and after the treatment,checked routine blood testsand liver and kidney function tests before and after the treatment,recorded patients’ ad-verse reactions during and after the treatment.ResultsThe Hp eradication curative effects:the group C’s Hp eradicate rate was69.4%,the group A’s Hp eradicate rate was71.9%, group C compared with group A was notstatistically significant; the group C’s Hp eradicate rate was69.4%, the group B’s Hperadicate rate was86.7%, group C compared with group B was statistically significant;the group F’s Hp eradicate rate was75.0%,the group D’s Hp eradicate rate was77.4%,group F compared with group D was not statistically significant;the group F’s Hp era-dicate rate was75.0%, the group E’s Hp eradicate rate was90.9%, group F comparedwith group E was statistically significant.It shown that triple therapy with lansoprazo-le,amoxicillin and ecabet sodium could play a certain role in eradicate Hp, its curativeeffect were similar to traditional triple therapy group and lower than the group of lan-soprazole, amoxicillin, clarithromycin and ecabet sodium.The group C(Hp eradicate rate was69.4%) compared with group F (Hp eradicaterate was75.0%) was statistically significant;the group B (Hp eradicate rate was86.7%)compared with group E (Hp eradicate rate was90.9%) was statistically significant; the group A (Hp eradicate rate was71.9%) compared with group D(Hp eradicate rate was77.4%) was not statistically significant. It shown that CagA-Hp patients’ therapeuticeradication was better than CagA+Hp patients in lansoprazole,amoxicillin,ecabet sod-ium triple therapy group and the group of lansoprazole,amoxicillin,clarithromycin andecabet sodium.Reverse reaction:194patients in the the process of Hp eradication appeared naus-ea,vomiting, abdominal pain, diarrhea, abnormal blood routine, dizziness, skin rashes,metal taste,kidney and liver dysfunction adverse reactions in different degrees.The gr-oup C (adverse reaction rate was13.9%) compared with group A(adverse reaction ratewas43.8%) was statistically significant; the group C (adverse reaction rate was13.9%)compared with group B(adverse reaction rate was36.7%) was statistically significant;the group F (adverse reaction rate was18.9%) compared with group D(adverse reacti-on rate was41.9%) was statistically significant; the group F (adverse reaction rate was18.9%) compared with group E(adverse reaction rate was36.4%) was statistically sig-nificant.It shown that the incidence of adverse effects of lansoprazole,amoxicillin,eca-bet sodium triple therapy group was lower than traditional triple therapy group and thegroup of lansoprazole, amoxicillin, clarithromycin and ecabet sodium.The degree of the increase of PGⅠ/PGⅡ ratio before and after eradicate Hp in ea-ch group: the results of the PGⅠ/PGⅡ ratio in the groups from A to F before and afterthe treatment were that P<0.05respectively.It shown that PGⅠ decreased and PGⅡ dr-amatic declined,PGⅠ/PGⅡ increased before and after each group eradicate Hp.It sho-wn that its the degree of the increase of PGⅠ/PGⅡ ratio before and after each grouperadicate Hp was similar to traditional triple therapy group and lower than the groupof lansoprazole, amoxicillin, clarithromycin and ecabet sodium.Conclution(1)Triple therapy with lansoprazole,amoxicillin and ecabet sodium could eradic-ate Hp effectively, its curative effect were similar to traditional triple therapy groupand lower than the group of lansoprazole,amoxicillin,clarithromycin and ecabet sod-ium,could reduce antibiotic application,reduce the resistance and reduce clarithromy- cin antibiotics adverse reaction of incidence,improve patient compliance, improve Hperadication rates relatively.(2) Ecabet sodium could strengthen the CagA-Hp patients’curative effect.(3) The serum pepsinogen were specificity change in different degreebefore and after each group eradicate Hp:PGⅠ decreased and PGⅡ dramatic declined,PGⅠ/PGⅡ increased,PG content in serum could as one of Hp eradicate judgment inde-xes.

        兰索拉唑、阿莫西林和依卡倍特钠三联根除幽门螺杆菌的临床观察

主要英文缩略词4-5中文摘要5-7Abstract7-10前言11-14材料与方法14-21结果21-29讨论29-33结论33-34参考文献34-37综述37-44    参考文献（References）41-44攻读硕士学位期间发表的论文44-45致谢辞45

  本文关键词：兰索拉唑、阿莫西林和依卡倍特钠三联根除幽门螺杆菌的临床观察，由笔耕文化传播整理发布。