三联联合益生菌与三联治疗幽门螺杆菌阳性十二指肠溃疡的疗效观察

发布时间：2018-10-17 20:03

【摘要】：目的：比较三联联合益生菌与三联疗法在根除幽门螺杆菌、改善消化道症状、药物副作用发生率及成本-效果分析方面的差异，为临床提供一个幽门螺杆菌根除率高、不良反应少及成本较低的治疗方案.。方法：选取来延安大学附属医院消化内科的门诊就诊有胃肠道症状（反酸、烧心、口苦、早饱、嗳气、上腹痛、腹胀、恶心、呕吐等）的患者，，经胃镜检查确诊为十二指肠球部溃疡活动期，且14C尿素呼气试验检查阳性的患者90例，年龄18岁以上者，随机分为治疗组（益生菌与三联：双岐四联活菌片1g＋阿莫西林克拉维酸钾分散片0.45g＋克拉霉素分散片0.25mg＋奥美拉唑肠溶胶囊20mg bid）、对照组（三联：阿莫西林克拉维酸钾分散片0.45g＋克拉霉素分散片0.25mg＋奥美拉唑肠溶胶囊20mg bid），两组疗程均为14天，根除Hp治疗2周结束后继续服用奥美拉唑肠溶胶囊20mg bid6周，双岐四联活菌片不与抗菌药同时服用，在服用抗生素2小时后再服用双岐四联活菌片，于门诊向患者说明服药剂量及次数，治疗期间告知按时服药，并电话随访病人的胃肠道症状改善情况及是否出现药物副作用，疗程结束后2周复查14C尿素呼气试验来判断Hp根除情况。结果：治疗过程中有4例患者失访，3例拒绝随访，1留的手机号码未打通，治疗组的Hp根除率意向性分析（ITT）与符合方案分析（PP）分别是86.67%、90.69%，而对照组的Hp根除率意向性分析（ITT）与符合方案分析（PP）分别是82.23%、86.04%。治疗组Hp根除率高于对照组，但无统计学意义，治疗组和对照组的药物副作用发生率分别为4.65%、20.93%，经过检验有统计学意义。治疗组和对照组根除Hp的成本分别为398.9元、302.3元，治疗组的成本比对照组低96.6元。结论： 1．三联联合益生菌与三联治疗Hp阳性的十二指肠溃疡相比，其药物副作用发生率低，提高了治疗的耐受性。 2.三联联合益生菌与三联都有可以接受的Hp根除率，且可以明显改善患者的胃肠道症状。 3.三联联合益生菌与三联在根除H.pylori感染上疗效、临床症状缓解及溃疡愈合情况相似。 4．三联联合益生菌依从性好，且成本无明显差别,效价比高，可考虑作为根除Hp的一种方案，为临床推广。
[Abstract]:Objective: to compare the differences between triple probiotics and triple therapy in eradication of Helicobacter pylori, improvement of gastrointestinal symptoms, incidence of side effects and cost-effect analysis. To provide a clinical high eradication rate of Helicobacter pylori, less adverse reactions and low cost of treatment. Methods: patients with gastrointestinal symptoms (acid reflux, heartburn, bitter mouth, early satiety, belching, upper abdominal pain, abdominal distension, nausea, vomiting, etc.) were selected. 90 patients with active duodenal ulcer diagnosed by gastroscopy and positive by 14C urea breath test were over 18 years old. They were randomly divided into treatment group (probiotics and triplet: bifidobacterium tablet 1g + amoxicillin clavulanate potassium dispersible tablet 0.45g + clarithromycin dispersible tablet 0.25mg + omeprazole enteric-coated capsule 20mg bid), control group) (triplex: amoxicillin carat) The course of treatment of 0.45g + clarithromycin dispersible tablets 0.25mg + omeprazole enteric-coated capsule 20mg bid), was 14 days. Omeprazole enteric-coated capsule 20mg bid6 was continued at the end of 2 weeks after eradication of Hp treatment. Bifidobacterium tetracycline tablets were not taken at the same time as antimicrobial agents, and then bifidobacterium tablets were taken 2 hours after taking antibiotics. To explain the dosage and times of medication to the patients in the outpatient clinic, to inform them of taking the medicine on time during the treatment period, and to follow up by telephone the improvement of gastrointestinal symptoms and the occurrence of side effects of the drugs. The 14 C urea breath test was performed 2 weeks after treatment to determine the eradication of Hp. Results: during the course of treatment, 4 patients lost a visit, 3 refused to follow up, and 1 cell phone number was not answered. Intentionality analysis of Hp eradication rate in treatment group (ITT) and coincidence analysis (PP) were 86.6767 and 90.69, respectively, while (ITT) in Hp eradication rate in control group and (PP) in conformance analysis were 82.230.04 and 86.04respectively. The eradication rate of Hp in the treatment group was higher than that in the control group, but there was no statistical significance. The side effects of the treatment group and the control group were 4.65 and 20.93, respectively. The cost of eradicating Hp in the treatment group and the control group was 398.9 yuan and 302.3 yuan respectively. The cost of the treatment group was 96.6 yuan lower than that of the control group. Conclusion: 1. The combination of probiotics and probiotics in the treatment of Hp positive duodenal ulcer, the incidence of drug side effects is lower, improved the tolerance of treatment. 2. The combination of probiotics and probiotics has an acceptable Hp eradication rate, and can significantly improve gastrointestinal symptoms in patients with 3. 3%. The efficacy of triple probiotics and triple probiotics in the eradication of H.pylori infection, clinical symptom relief and ulcer healing are similar. 4. The compliance of triple probiotics is good, and there is no significant difference in cost, and the titer ratio is high. It can be considered as a scheme to eradicate Hp for clinical promotion.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573.1

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