不同添加时间、疗程及剂量益生菌根除幽门螺杆菌的临床疗效

发布时间：2018-08-15 18:03

【摘要】：目的 :探讨不同添加时间、疗程及剂量益生菌在根除幽门螺杆菌(helicobacter pylori,Hp)治疗中的临床疗效。方法:280例Hp阳性的患者随机分为5个治疗组:A组:兰索拉唑片30 mg+克拉霉素片500mg+阿莫西林胶囊1 000 mg,每日2次,疗程14 d;B组:双歧杆菌乳杆菌三联活菌片(2 000 mg,每日3次)服用14 d后,给予A组治疗方案治疗14 d,总疗程28 d;C_1组:A组治疗方案基础上加用双歧杆菌乳杆菌三联活菌片(2 000 mg,每日2次),疗程14 d;C_2组:A组治疗方案基础上加用双歧杆菌乳杆菌三联活菌片(2 000 mg,每日3次),疗程14 d;D组:C_2组方案根除治疗后,继续用双歧杆菌乳杆菌三联活菌片(2 000 mg,每日3次)14 d,总疗程28 d。疗程结束4周后复查~(13)C尿素呼气试验评估根除疗效。治疗期间记录患者的不良反应发生情况。结果:252例(90.0%)患者按方案完成治疗,A、B、C_1、C_2、D组治疗完成率分别为78.6%(44/56)、92.9%(52/56)、87.5%(49/56)、96.4%(54/56)和94.6%(53/56),B、C_2及D组显著高于A组(P0.05),而C_2略高于B及D组,但差异无统计学意义(P0.05)。A、B、C_1、C_2及D组按意向治疗(ITT)根除率分别为62.5%、80.4%、69.6%、85.7%和87.5%,B、C_2及D组显著高于A组(χ~2=4.375,P=0.036;χ~2=7.864,P=0.005;χ~2=9.333,P=0.002),且C_2组高于C_1组(χ~2=4.171,P=0.041),而D组稍高于B组及C_2组,但差异无统计学意义(P0.05);按方案治疗(PP)五组根除率分别为79.5%、86.5%、79.6%、88.9%和92.5%,各组间差异无统计学意义(P0.05)。不良反应包括恶心、腹胀、味觉异常(口苦、口腔异味)、厌食及便秘等。A、B、C_1、C_2及D组不良反应的发生率分别为67.9%(38/56)、26.8%(15/56)、35.7%(20/56)、21.4%(12/56)及17.9%(10/56),B、C_2及D组明显少于A组(P0.05),而B、C_2及D组各组间的差异无统计学意义(P0.05)。结论:三联疗法联合双歧杆菌乳杆菌三联活菌能够显著降低传统根除疗法的胃肠道不良反应,提高患者依从性,从而提高患者Hp的根除率,且随着益生菌剂量的增加,Hp的根除率也随之增加,同时服用益生菌14 d为最佳选择。
[Abstract]:Objective: to investigate the clinical efficacy of probiotics at different time, course and dose in the eradication of helicobacter pylorium-HP. Methods one hundred and twenty patients with HP positive were randomly divided into 5 groups: group A: lansoprazole 30 mg clarithromycin tablet 500mg amoxicillin capsule 1 000 mg twice a day. Group B was treated with bifidobacterium Lactobacillus triple live bacteria tablet (2 000 mg, 3 times a day) for 14 days. Group A was given the treatment regimen for 14 days, and the total course of treatment was 28 days. Group 1: group A was treated with bifidobacterium Lactobacillus triple live bacteria tablet (2 000 mg, twice a day) on the basis of the treatment plan of group 1: a, and bifidobacterium milk was added to the treatment plan of group C 2: a for 14 days. Three live bacilli tablets (2 000 mg, 3 times a day) for 14 days, group D, group 1: C, group C, group 2, after eradication treatment, Bifidobacterium Lactobacillus triplex live bacteria tablets (2 000 mg, 3 times a day) for 14 days, the total course of treatment was 28 days. The eradication effect was evaluated by ~ (13) C urea breath test after 4 weeks of treatment. Adverse reactions were recorded during treatment. Results among 252 patients (90.0%), the complete rate of treatment in group C was 78.6% (44 / 56) or 92.9% (5256), respectively, 87.5% (54 / 56) and 94.6% (53 / 56) of BC2 and group D were significantly higher than those of group A (P0.05), while the rate of C2C2 was slightly higher than that of group B and D. However, there was no significant difference between the two groups (P0.05). The eradication rates of (ITT) in group D and group C were 62.5 and 89.60.45%, respectively, which were significantly higher than those in group A (蠂 2 4.375P0.036; 蠂 2 7.864 P 0.005; 蠂 2 9.333P 0.002), and in group C2 higher than those in group C1 (蠂 24.171P0. 041), while group D was slightly higher than those in group B and group C2, and in group D they were higher than those in group C (P < 0.05), but in group D were higher than those in group C (P < 0.05), but no significant difference was found between group C and group D (P 0.05). The eradication rate of (ITT) in group C was higher than that in group C 1 (P < 0.05), but that in group D was slightly higher than that in group C and group B (P 0.036; P 0.036; 蠂 2 9.333P 0.002). But the difference was not statistically significant (P0.05); the eradication rate of the five groups of (PP) was 79.5% and 92.5%, respectively. There was no significant difference among the five groups (P0.05). The incidence of adverse reactions including nausea, abdominal distension, abnormal taste (bitter mouth, mouth odour), anorexia and constipation were 67.9% (38 / 56), 26.8% (15 / 56) and 35.7% (20 / 56), respectively. The incidence of adverse reactions in group B and D was significantly lower than that in group A (P0.05). Conclusion: triple therapy combined with living bacteria of Lactobacillus bifidobacterium can significantly reduce gastrointestinal adverse reactions of traditional eradication therapy, improve compliance of patients, and thus improve the eradication rate of HP in patients. The eradication rate of HP increased with the increase of probiotic dose, and the best choice was to take probiotics for 14 days.
【作者单位】：广东药学院附属第二医院(广州新海医院)消化内科;广东省医学科学院广东省人民医院消化内科;
【基金】：广东省医学科学技术研究基金项目(编号:A2016406)
【分类号】：R57

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