内镜下不同分期消化性溃疡的幽门螺杆菌根除率的比较
发布时间：2018-09-11 16:02
【摘要】：研究背景:消化性溃疡是全球性常见的疾病,为多因素疾病。其中最主要的病因是幽门螺杆菌感染(Helicobacter pylori,H.pylori)和非甾体抗炎药(non-steroidal anti-inflammatory drug,NSAID)的服用。其他因素还包括吸烟,遗传,应激等。上腹痛是本病的主要症状。但也有一部分患者无症状或者症状比较轻,而以出血,穿孔为首发症状就诊。消化性溃疡是慢性过程,发作常有季节性,多发生在秋冬或冬春交替之时。腹痛常有节律性。出血是最常见的并发症。还可发生穿孔,幽门梗阻甚至少部分胃溃疡可发生癌变。所以早期发现溃疡,对于溃疡的病因如H.pylori进行根除治疗是治愈溃疡,防止复发,防治并发症是有极大意义的。目前消化性溃疡根据病因的不同,治疗方案也不一样。无论是否存在H.pylori的感染,均应服用质子泵抑制剂,抑制胃酸分泌。对于H.pylori阳性的患者中,首先是根除H.pylori。但我国目前克拉霉素,甲硝唑,左氧氟沙星的耐药率在逐年上升,应用标准三联疗法根除H.pylori根除率低于80%。目前我国仍推荐使用含铋剂的四联方案根除H.pylori。在消化性溃疡的治疗中提出无论消化性溃疡是否为活动期,都应根除H.pylori。但消化性溃疡在内镜下的不同分期中的H.pylori的根除率尚无大量研究,国外有学者认为H.pylori根除可能与胃黏膜不同程度的炎症相关,还有待进一步的研究证明。研究目的:处于内镜下不同分期的消化性溃疡的患者,给予H.pylori的根除治疗,观察不同分期的根除率是否一致,从中找出规律,指导进一步的H.pylori相关性的消化性溃疡的治疗。材料与方法:2015年7月至2015年12月就诊于吉林大学第一医院,符合纳入标准的127例消化性溃疡(胃溃疡(gastric ulcer,GU)44例,十二指肠溃疡(duodenal ulcer,DU)83例)患者。其中男性77例,女性50例,平均年龄为46.26±12.82。内镜下将消化性溃疡分为活动期(A)、愈合期(H)、瘢痕期(S)。分为活动阶段(A)和非活动阶段(H+S)。其中A期73例,H期33例,S期21例。14碳尿素呼气试验均为阳性,统一给予含铋剂四联方案(PPI+丽珠维三联(枸橼酸铋钾片110mg,替硝唑片500mg,克拉霉素片250mg,一天2次,14天))根除H.pylori。GU患者治疗8周,DU患者治疗6周后停药2-4周复查14碳尿素呼气试验,观察内镜下不同分期的消化性溃疡的H.pylori的根除率。结果:在GU中不同分期的H.pylori根除率有显著差异(活动期vs愈合期vs瘢痕期;80.0%vs 44.4%vs 40.0%,P=0.01),但DU中不同分期的H.pylori根除率无显著差异(活动期vs愈合期vs瘢痕期;72.9%vs 70.8%vs 36.4%,P=0.215)。在多变量分析中,活动溃疡是成功消灭H.pylori的显著的独立预测因素(优势比;2.660,95%CI;1.223-5.784,P=0.014)。结论:内镜下不同分期的GU的H.pylori根除率有显著差异。活动溃疡是根除H.pylori的独立预测因素。
[Abstract]:Background: peptic ulcer is a common disease in the world. It is a multivariate disease. The leading causes are Helicobacter pylori infection (Helicobacter pylori,H.pylori) and non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drug,NSAID). Other factors include smoking, heredity, stress and so on. Epigastric pain is the main symptom of the disease. But there are also some patients asymptomatic or mild symptoms, and bleeding, perforation as the first symptoms. Peptic ulcer is a chronic process, attacks often seasonal, more in autumn and winter or spring alternate time. Abdominal pain is often rhythmic. Bleeding is the most common complication. Perforation can also occur, pyloric obstruction or even a few gastric ulcers can cause cancer. Therefore, early detection of ulcers, for the causes of ulcers such as H.pylori eradication therapy is to cure ulcers, prevent recurrence, prevention and treatment of complications is of great significance. Current peptic ulcer is different according to the etiology, the treatment plan is also different. Proton pump inhibitors should be taken to inhibit gastric acid secretion regardless of H.pylori infection. For H.pylori positive patients, the first step is to eradicate H. pylori. However, the drug resistance rate of clarithromycin, metronidazole and levofloxacin is increasing year by year in China. The eradication rate of H.pylori by standard triple therapy is lower than 80%. At present, China still recommends the use of bismuth-containing tetralogy to eradicate H. pylorius. H. pylorius should be eradicated in the treatment of peptic ulcer, regardless of whether the peptic ulcer is active or not. However, the eradication rate of H.pylori in different stages of peptic ulcer under endoscope has not been studied. Some foreign scholars believe that H.pylori eradication may be related to different degrees of inflammation of gastric mucosa, which needs further study. Objective: patients with peptic ulcer at different stages under endoscope were given H.pylori eradication therapy to find out the regularity of eradication rate in different stages and to guide the further treatment of peptic ulcer associated with H.pylori. Materials and methods: from July 2015 to December 2015, a total of 127 patients with peptic ulcer (44 gastric ulcer (gastric ulcer,GU) and 83 duodenal ulcer (duodenal ulcer,DU) were admitted to the first Hospital of Jilin University. There were 77 males and 50 females with an average age of 46.26 卤12.82. Endoscopic classification of peptic ulcer into active (A), healing (H), scar (S). Divided into active (A) and inactive (H S). Of the 73 cases in stage A, 33 cases were in stage S, 21 cases were positive for carbamide breath test. PPI Lizhuwei triple regimen (bismuth potassium citrate tablet 110 mg, tinidazole tablet 500 mg, clarithromycin tablet 250 mg, twice a day for 14 days) was given to eradicate H.pylori.GU patients for 8 weeks after 6 weeks treatment and 2 to 4 weeks for 14 carbon urea breath test. To observe the eradication rate of H.pylori in different stages of peptic ulcer under endoscope. Results: there was significant difference in H.pylori eradication rate among different stages in GU (active vs healing stage, vs scar stage vs 44.4%vs 40.0, P0.01), but there was no significant difference in H.pylori eradication rate in different stages of DU (active vs healing vs scar stage 72.9 vs 70.8%vs 36.4% P0.215). In multivariate analysis, active ulcer was a significant independent predictor of successful elimination of H.pylori (odds ratio was 2.66095 CI 1.223-5.784P0. 014). Conclusion: there is significant difference in H.pylori eradication rate among different stages of GU under endoscopy. Active ulcer is an independent predictor of H.pylori eradication.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.1
本文编号：2237161
[Abstract]:Background: peptic ulcer is a common disease in the world. It is a multivariate disease. The leading causes are Helicobacter pylori infection (Helicobacter pylori,H.pylori) and non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drug,NSAID). Other factors include smoking, heredity, stress and so on. Epigastric pain is the main symptom of the disease. But there are also some patients asymptomatic or mild symptoms, and bleeding, perforation as the first symptoms. Peptic ulcer is a chronic process, attacks often seasonal, more in autumn and winter or spring alternate time. Abdominal pain is often rhythmic. Bleeding is the most common complication. Perforation can also occur, pyloric obstruction or even a few gastric ulcers can cause cancer. Therefore, early detection of ulcers, for the causes of ulcers such as H.pylori eradication therapy is to cure ulcers, prevent recurrence, prevention and treatment of complications is of great significance. Current peptic ulcer is different according to the etiology, the treatment plan is also different. Proton pump inhibitors should be taken to inhibit gastric acid secretion regardless of H.pylori infection. For H.pylori positive patients, the first step is to eradicate H. pylori. However, the drug resistance rate of clarithromycin, metronidazole and levofloxacin is increasing year by year in China. The eradication rate of H.pylori by standard triple therapy is lower than 80%. At present, China still recommends the use of bismuth-containing tetralogy to eradicate H. pylorius. H. pylorius should be eradicated in the treatment of peptic ulcer, regardless of whether the peptic ulcer is active or not. However, the eradication rate of H.pylori in different stages of peptic ulcer under endoscope has not been studied. Some foreign scholars believe that H.pylori eradication may be related to different degrees of inflammation of gastric mucosa, which needs further study. Objective: patients with peptic ulcer at different stages under endoscope were given H.pylori eradication therapy to find out the regularity of eradication rate in different stages and to guide the further treatment of peptic ulcer associated with H.pylori. Materials and methods: from July 2015 to December 2015, a total of 127 patients with peptic ulcer (44 gastric ulcer (gastric ulcer,GU) and 83 duodenal ulcer (duodenal ulcer,DU) were admitted to the first Hospital of Jilin University. There were 77 males and 50 females with an average age of 46.26 卤12.82. Endoscopic classification of peptic ulcer into active (A), healing (H), scar (S). Divided into active (A) and inactive (H S). Of the 73 cases in stage A, 33 cases were in stage S, 21 cases were positive for carbamide breath test. PPI Lizhuwei triple regimen (bismuth potassium citrate tablet 110 mg, tinidazole tablet 500 mg, clarithromycin tablet 250 mg, twice a day for 14 days) was given to eradicate H.pylori.GU patients for 8 weeks after 6 weeks treatment and 2 to 4 weeks for 14 carbon urea breath test. To observe the eradication rate of H.pylori in different stages of peptic ulcer under endoscope. Results: there was significant difference in H.pylori eradication rate among different stages in GU (active vs healing stage, vs scar stage vs 44.4%vs 40.0, P0.01), but there was no significant difference in H.pylori eradication rate in different stages of DU (active vs healing vs scar stage 72.9 vs 70.8%vs 36.4% P0.215). In multivariate analysis, active ulcer was a significant independent predictor of successful elimination of H.pylori (odds ratio was 2.66095 CI 1.223-5.784P0. 014). Conclusion: there is significant difference in H.pylori eradication rate among different stages of GU under endoscopy. Active ulcer is an independent predictor of H.pylori eradication.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.1
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