不同四联补救方案根除幽门螺杆菌疗效比较研究

发布时间：2018-11-02 18:58

【摘要】：目的分析3种含铋剂四联方案作为标准方案初治幽门螺杆菌(Helicobacter pylori,Hp)失败的补救治疗的疗效及安全性,并对成本-效果进行分析。方法以2012年1月至2013年12月四川省人民医院门诊经标准方案初治失败的Hp阳性慢性胃炎伴消化不良患者180例,将其随机分入A、B、C 3组。A组:雷贝拉唑10 mg+果胶铋200 mg+四环素750 mg+呋喃唑酮100 mg,每日2次,疗程14 d;B组:雷贝拉唑10 mg+果胶铋200 mg+阿莫西林1000 mg,每日2次,联合左氧氟沙星500 mg,每日1次,疗程14 d;C组:雷贝拉唑10 mg+果胶铋200 mg+阿莫西林1000 mg+呋喃唑酮100 mg,每日2次,疗程14 d。治疗结束至少停药4周后行14C尿素呼气试验确定Hp根除情况。对Hp根除率进行意向性分析(intention-to-test,ITT)和符合方案分析(per-protocol,PP)。分析3组方案的疗效、安全性及成本-效果。结果 A、B、C组Hp根除率分别为:ITT 83.33%(50/60)、PP 89.29%(50/56),ITT 85.0%(51/60)、PP 87.93%(51/58),ITT 80.0%(48/60)、PP 87.27%(48/55);3组的不良反应发生率分别为7.14%(4/56)、5.17%(3/58)、7.27%(4/55);组间差异均无统计学意义(P0.05)。成本及成本-效果比值显示A组C组B组。结论四环素或阿莫西林联合呋喃唑酮以及左氧氟沙星联合阿莫西林的含铋剂四联疗法可以作为标准方案初治Hp失败的有效安全的补救方案。其中四环素+呋喃唑酮的四联方案更具经济学优势,更为理想。
[Abstract]:Objective to evaluate the efficacy and safety of three bismuth tetralogy regimens as a standard regimen for the treatment of failed primary Helicobacter pylori (Helicobacter pylori,Hp). Methods from January 2012 to December 2013, 180 patients with Hp positive chronic gastritis and dyspepsia were randomly divided into two groups. Group C 3: group A: rabeprazole 10 mg pectin bismuth 200 mg tetracycline 750 mg furazolidone 100 mg, daily for 14 days; Group B: rabeprazole 10 mg pectin bismuth 200 mg amoxicillin 1000 mg, daily, combined with levofloxacin 500 mg, once a day for 14 days; Group C: rabeprazole 10 mg pectin bismuth 200 mg amoxicillin 1000 mg furazolidone 100 mg, daily for 14 days. 14 C urea breath test was performed at least 4 weeks after treatment to determine Hp eradication. The eradication rate of Hp was analyzed by intentionality analysis (intention-to-test,ITT) and coincidence analysis (per-protocol,PP). The efficacy, safety and cost-effect of the three groups were analyzed. Results the eradication rate of Hp in group C was: ITT 83.33% (50 / 60), PP 89.29%) (50 / 56), ITT 85.0%) (51 / 60), PP 87.93%) (51 / 58), ITT 80.0% (48 / 60). PP 87.27% (48 / 55); The incidence of adverse reactions were 7.14% (4 / 56), 5.17% (3 / 58) and 7.27% (4 / 55), respectively. There was no significant difference between the three groups (P0.05). Cost and cost-effect ratio showed A group C group B group. Conclusion Tetracycline or amoxicillin combined with furazolidone and levofloxacin combined with amoxicillin can be used as an effective and safe remedy for the failure of Hp. One of the tetracycline furazolidone tetracycline quadruple scheme is more economic advantages, more ideal.
【作者单位】：四川省医学科学院四川省人民医院消化内科;
【基金】：国家自然科学基金青年科学基金项目(81001083)
【分类号】：R573

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