瑞巴派特促进胃溃疡愈合及根除Hp的疗效

发布时间：2018-05-01 08:20

本文选题：瑞巴派特 + 铋剂　；参考：《第二军医大学》2017年硕士论文

【摘要】：目的:对比不使用黏膜保护剂、使用铋剂和使用瑞巴派特的三组胃溃疡患者在治疗后溃疡愈合情况、胃黏膜组织学变化、临床症状变化、幽门螺旋杆菌(Hp)根除情况和药物不良反应,综合评价瑞巴派特在治疗胃溃疡中的安全性、有效性,以及在根除Hp中的作用,从而为优化胃黏膜保护剂的选择,寻找可替代铋剂进行根除Hp的胃黏膜保护剂做出探索。方法:选取海军总医院消化内科胃溃疡患者共180名,其中纳入Hp(+)、Hp(-)者各90名。Hp(+)胃溃疡患者随机分为三联组(30人)、B四联组(30人)、R四联组(30人)。三组用药方案分别是泮托拉唑钠肠溶片40mg 2/日+阿莫西林克拉维酸钾片1500mg 2/日+克拉霉素片500mg 2/日;泮托拉唑钠肠溶片40mg 2/日+阿莫西林克拉维酸钾片1500mg 2/日+克拉霉素片500mg 2/日+枸橼酸铋钾胶囊0.3g 3/日;泮托拉唑钠肠溶片40mg 2/日+阿莫西林克拉维酸钾片1500mg 2/日+克拉霉素片500mg 2/日+瑞巴派特片100mg 3/日。第0天开始服药,第14天停用抗生素,第28天复查胃镜。记录第0天、第28天的症状、溃疡形态、胃黏膜组织形态;记录第28天药物不良反应症状;复查13C呼气实验并记录Hp根除情况,对比三组之间上述指标的差异。Hp(-)胃溃疡患者随机分为PPI组(31人)、PPI+B组(26人)、PPI+R组(33人)。三组用药方案分别是泮托拉唑钠肠溶片40mg 2/日;泮托拉唑钠肠溶片40mg 2/日+枸橼酸铋钾胶囊0.3g 3/日;泮托拉唑钠肠溶片40mg2/日+瑞巴派特片100mg 3/日。第0天开始服药,第28天复查胃镜。记录第0天、第28天的症状、溃疡形态、胃黏膜组织形态;记录第28天药物不良反应症状,对比三组之间上述指标的差异。结果:1、Hp(+)胃溃疡患者治疗28天后,在残留溃疡数量、崎田三轮(AHS)分类、S期溃疡患者例数、溃疡愈合情况等指标上,三组之间差异显著(P0.05)。在溃疡直径、Forrest分级、总有效率等指标上无显著差异(P0.05)。两两组间对比:在残留溃疡数量上,R四联组(0.30±0.53)、B四联组(0.40±0.72)分别少于三联组(0.83±0.87),差异显著(P0.05,P0.05);在AHS分期上,R四联组和三联组差异显著(P0.05),前者溃疡脱离急性期的情况优于后者;在S期溃疡患者例数占比上,R四联组(73.73%)高于三联组(40%),差异显著(P0.017);在溃疡愈合情况上,R四联组和三联组差异显著(P0.05),前者愈合情况优于后者。2、Hp(+)胃溃疡患者在Hp根除率上,三组之间差异显著(P0.05)。两两组间对比:B四联组(96.67%)高于三联组(73.33%),差异显著(P0.017)。R四联组(86.67%)分别和三联组(73.33%)、B四联组(96.67%)相比,均无显著差异(P0.017,P0.017)。3、Hp(+)胃溃疡患者治疗28天后,三组之间在黏膜损伤积分上差异显著(P0.05)。两两组间对比:R四联组(1.13±0.35)、B四联组(1.40±0.56)分别低于三联组(1.87±0.78),差异显著(P0.05,P0.05)。4、Hp(+)胃溃疡患者治疗28天后,三组之间在腹痛、烧心、总积分上差异显著(P0.05),在嗳气、腹胀、少食积分上无显著差异(P0.05)。两两组间对比:在腹痛积分上,R四联组(0.17±0.38)、B四联组(0.20±0.41)分别低于三联组(0.57±0.68),差异显著(P0.05,P0.05);在烧心积分上,R四联组(0.10±0.31)低于三联组(0.60±0.67)和B四联组(0.40±0.56),差异显著(P0.05,P0.05);在总积分上,R四联组(0.93±0.98)低于三联组(1.93±1.87),差异显著(P0.05)。5、Hp(+)胃溃疡患者治疗28天后,三联组3名腹泻,1名恶心;B四联组1名腹泻,2名恶心,2名口苦;R四联组1名恶心。三组间不良反应积分无显著差异(P0.05)。6、Hp(-)胃溃疡患者治疗28天后,在残留溃疡数量、AHS分期、S期溃疡患者例数、溃疡愈合情况等指标上,三组之间差异显著(P0.05)。在溃疡直径、Forrest分级、总有效率等指标上,三组间无显著差异(P0.05)。两两组间对比:在残留溃疡数量上,PPI+R组(0.39±0.70)、PPI+B组(0.35±0.63)分别少于PPI组(0.74±0.63),差异显著(P0.05,P0.05);在AHS分期上,PPI+R组和PPI组差异显著(P0.05),PPI+R组溃疡脱离急性期的情况优于PPI组;在S期溃疡患者例数占比上,PPI+R组(69.70%)、PPI+B组(73.08%)分别高于PPI组(35.48%),差异显著(P0.017,P0.017);在溃疡愈合情况上,PPI+R组和PPI组差异显著(P0.05),PPI+R组的愈合情况优于PPI组。7、Hp(-)胃溃疡患者治疗28天后,三组之间在黏膜损伤积分上差异显著(P0.05)。两两组间对比:PPI+R组(1.18±0.39)、PPI+B组(1.23±0.51)分别低于PPI组(1.71±0.78),差异显著(P0.05,P0.05)。8、Hp(-)胃溃疡患者治疗28天后,三组间在腹痛、烧心积分、总积分上显著差异(P0.05),而在嗳气、腹胀、少食积分上无显著差异(P0.05)。两两组间对比:在腹痛积分上,PPI+R组(0.21±0.48)、PPI+B组(0.23±0.43)分别低于PPI组(0.61±0.72),差异显著(P0.05,P0.05);在烧心积分上,PPI+R组(0.15±0.36)、PPI+B组(0.15±0.37)分别低于PPI组(0.52±0.68),差异显著(P0.05,P0.05);在总积分上,PPI+R组(0.94±1.54)低于PPI组(2.00±1.81),差异显著(P0.05)。9、Hp(-)胃溃疡患者治疗28天后,PPI组1名腹泻,PPI+B组1名口苦。各组患者间不良反应积分无显著差异(P0.05)。结论:Hp(+)和Hp(-)的胃溃疡患者,按照治疗效果是否显著排序,在胃镜表现、临床症状方面均为瑞巴派特铋剂无黏膜保护剂,在黏膜组织形态方面为瑞巴派特≈铋剂无黏膜保护剂。Hp根除率上,B四联组R四联组三联组,但仅有B四联组与三联组之间有统计学差异,其他两两相比无显著差异,提示瑞巴派特可能有根除Hp作用,但缺乏显著性。所有患者不良反应均较轻微,且组间无明显差别。
[Abstract]:Objective: To compare the ulcer healing, the histological changes of the gastric mucosa, the changes of the clinical symptoms, the eradication of Helicobacter pylori (Hp) and the adverse drug reactions, and to evaluate the safety and effectiveness of rebacon in the treatment of gastric ulcers without mucous membrane protectants and three groups of gastric ulcers using bismuth and rebacat. And in the eradication of Hp, in order to optimize the selection of gastric mucosal protective agents, search for the replacement of bismuth agent for the eradication of Hp gastric mucosal protective agent to explore. Methods: selected Navy General Hospital gastropeptic ulcer patients 180, including Hp (+), Hp (-) 90.Hp (+) gastric ulcer patients were randomly divided into triad group (30), B quadruple group ( 30 people), R quadruple group (30 people). The three groups are Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day + Amoxicillin and Clavulanate Potassium Tablets 1500mg 2/ day + Clarithromycin Tablets 500mg 2/ day, Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day + Amoxicillin and Clavulanate Potassium Tablets 1500mg 2/ day + Clarithromycin Tablets 500mg 500mg + Bismuth potassium Citrate Capsules + Bismuth potassium Citrate Capsules birthday day; 40mg 2/ days + Amoxicillin and Clavulanate Potassium Tablets 1500mg 2/ days + 1500mg 2/ day + Clarithromycin Tablets 500mg 2/ day + Rebamipide Tablets 100mg 3/ days. Start taking medicine, disuse antibiotics and review gastroscopy for twenty-eighth days. Record zeroth days, twenty-eighth days' symptoms, ulcer morphology, gastric mucous membrane morphology, and record twenty-eighth days of adverse drug reaction symptoms The 13C exhalation test and Hp eradication were reviewed, and the differences between the three groups were divided into PPI group (31 people), PPI+B group (26 people) and group PPI+R (33 people). The three groups were Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day, Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day + Bismuth potassium Citrate Capsules 0.3g 3/ day; pepo. Natriol sodium enteric coated tablets 40mg2/ days + Rebamipide Tablets 100mg 3/ days. Zeroth days to start taking medicine, twenty-eighth days reexamination of gastroscope. Record zeroth days, twenty-eighth days of symptoms, ulcer morphology, gastric mucosa tissue morphology, record twenty-eighth days of adverse drug reaction symptoms, compared the three groups between the indicators of the difference. Results: 1, Hp (+) gastric ulcer patients 28 days after treatment, in residual ulcer, in residual ulceration after 28 days. The number of ulcers, the three rounds of Yazaki (AHS), the number of S ulcers and the healing of ulcers were significant (P0.05). There were no significant differences in the diameter of the ulcer, the Forrest classification and the total efficiency (P0.05). The 22 groups were compared in the number of residual ulcers (0.30 + 0.53), and the B quadruple group (0.40 + 0.72) were less than those in the number of residual ulcers. In the triad group (0.83 + 0.87), the difference was significant (P0.05, P0.05), and in the AHS staging, the difference between the R quadruple group and the triple group was significant (P0.05). The former was superior to the latter in the acute phase of the ulcer, and in the number of cases of S ulcer patients, the R quadruple group (73.73%) was higher than the triple group (40%), and the difference was significant (P0.017); in the ulcer healing, the R quadruple group and the triple group were in the case of ulcer healing. The difference was significant (P0.05), the former was better than the latter.2, and the difference between the three groups in the Hp eradication rate was significant (P0.05). The 22 groups were compared: the B quadruple group (96.67%) was higher than the triad group (73.33%), and the difference was significant (P0.017) in the quadruple group (86.67%) and the triple group (73.33%) and the B quadruple group (96.67%), no significant difference (P0.01). 7, P0.017).3, Hp (+) gastric ulcer patients after 28 days of treatment, the difference between the three groups was significantly different (P0.05). The 22 groups were compared: R quadruple group (1.13 + 0.35), B quadruple group (1.40 + 0.56) were lower than the triad group (1.87 + 0.78), the difference was significant (P0.05, P0.05).4, Hp (+) gastric ulcer patients after 28 days of treatment, between three groups in abdominal pain, heartburn, total product between three groups. There was no significant difference (P0.05) in the scores of belching, abdominal distention and less food (P0.05). The 22 groups were compared: in the abdominal pain score, the R quadruple group (0.17 + 0.38), the B quadruple group (0.20 + 0.41) were lower than the triad group (0.57 + 0.68), the difference was significant (P0.05, P0.05); in the heartburn integral, the R quadruple group (0.10 + 0.31) was lower than the triad group (0.60 + 0.67) and B four In the group (0.40 + 0.56), the difference was significant (P0.05, P0.05); in the total score, the R quadruple group (0.93 + 0.98) was lower than the triad group (1.93 + 1.87), the difference was significant (P0.05).5, the patients with Hp (+) gastric ulcer were treated for 28 days, 3 diarrhea in the triad group and 1 nausea, 1 diarrhea in the B group, 2 nausea and 2. The R quadruple group was nauseous. The scores of adverse reactions between the four groups were not significant. Difference (P0.05).6, Hp (-) gastric ulcer patients 28 days after treatment, the number of residual ulcers, AHS staging, the number of patients with S ulcers, ulcer healing and other indexes, the difference between the three groups was significant (P0.05). There was no significant difference between the three groups (P0.05) in the diameter of ulcers, Forrest classification, and the total efficiency (P0.05). In the 22 groups, the number of residual ulcers was in the number of residual ulcers. In group PPI+R (0.39 + 0.70) and group PPI+B (0.35 + 0.63) less than group PPI (0.74 + 0.63), the difference was significant (P0.05, P0.05). In AHS stage, there was a significant difference between group PPI+R and PPI group (P0.05), and the ulcer in PPI+R group was better than that in the PPI group; the number of cases in the S stage ulcer was higher than that in the S group (69.70%), and the group (73.08%) was higher than that of the group (35.48%), respectively. The difference was significant (P0.017, P0.017). In the ulcer healing, the difference between the group PPI+R and the PPI group was significant (P0.05), the healing of the group PPI+R was better than that of the PPI group.7. The difference of the mucosal damage score between the three groups was significantly different (P0.05) after 28 days of treatment. The 22 groups were compared: the PPI+R group (1.18 + 0.39) and the PPI+B group (1.23 + 0.51) were lower than those in the group (1). .71 + 0.78), the difference was significant (P0.05, P0.05).8, Hp (-) gastric ulcer patient 28 days after treatment, three groups of abdominal pain, heart score, total integral difference (P0.05), but in belching, abdominal distention, and less integral difference (P0.05). 22 groups of comparison: in the abdominal pain score, PPI+R group (0.21 + 0.48), PPI+B group (0.23 + 0.43) is lower than PPI group (0.61 The difference was significant (P0.05, P0.05), and in the heart score, group PPI+R (0.15 + 0.36), group PPI+B (0.15 + 0.37) were lower than group PPI (0.52 + 0.68), the difference was significant (P0.05, P0.05), PPI+R group (0.94 + 1.54) was lower than PPI group (2 + 1.81), and the difference was significant (P0.05).9. There was no significant difference in the score of adverse reactions between the patients in each group (P0.05). Conclusion: the patients with Hp (+) and Hp (-) gastric ulcer were classified according to the effect of the treatment, in the gastroscopy and the clinical symptoms, the regabpat bismuth non mucosa protectant was used in the clinical symptoms and the rate of the eradication rate of the regabpat bismuth free mucosal protective agent.Hp in the morphology of the mucosa. In the B quadruple group, the R quadruple group was in the triad group, but only the B quadruple group and the triad group had statistical difference. The other 22 had no significant difference, suggesting that ruiba pate might have the effect of eradicating Hp, but it was not significant. All the patients had less adverse reactions, and there was no significant difference between the groups.

【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573.1

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