序贯疗法与三联疗法根除幽门螺杆菌疗效分析

发布时间：2018-11-19 15:36

【摘要】：目的：慢性胃炎是临床的常见病和多发病，在各种胃病中居于首位，约占接受胃镜检查患者的90%以上。幽门螺杆菌（Helicobacter pylori, Hp）感染是慢性胃炎的主要致病因素，长期感染后，部分患者可发生胃黏膜萎缩，可进一步发展为肠化、异型增生，发生癌变的可能性增高。根除Hp可使胃黏膜炎症消退，慢性炎症程度减轻，成为治疗慢性胃炎的关键环节之一。本研究采用序贯疗法和三联疗法治疗Hp相关性慢性胃炎，，观察序贯疗法与三联疗法根除Hp的初治疗效，随访根除Hp后患者的胃肠道症状缓解状况，分析其不良反应发生率，为临床选择高效、安全的根除方案提供依据。方法：将经胃镜检查确诊为慢性胃炎且Hp感染的患者随机分为序贯疗法组（简称序贯组）、三联疗法组（简称三联组）。序贯组150例，前5天给予埃索美拉唑20mg，阿莫西林1g，后5天给予埃索美拉唑20mg，克拉霉素0.5g，替硝唑0.2g，均每日2次口服；三联组150例，每天给予奥美拉唑20mg，克拉霉素0.5g，阿莫西林1g，每日2次口服，疗程10天。治疗结束后停药4周后，复查Hp，观察Hp根除效果，并分别对患者入组时、治疗结束停药4周后随访时的胃肠道症状评分，比较两组患者在根除过程中的症状改善情况、药物不良反应发生情况。结果： 1.序贯疗法、三联疗法的Hp根除率分别为82.7%、69.3%，序贯疗法高于三联疗法（P＜0.05）。 2.序贯组的治疗前与治疗结束停药4周后胃肠道症状总积分，分别为19.17分、12.56分，治疗后的胃肠道症状总积分小于治疗前（P＜0.001）；三联组的治疗前与治疗结束停药4周后胃肠道症状总积分，分别为19.23分、12.69分，治疗后的胃肠道症状总积分小于治疗前（P＜0.001）。 3.治疗前，序贯组与三联组的胃肠道症状总积分差异不显著（P＞0.05）；治疗结束停药4周后，序贯组与三联组的胃肠道症状总积分差异不显著（P＞0.05）；治疗前与治疗结束停药4周后的胃肠道症状总积分差，序贯组为6.61分，三联组为6.54分，差异无统计学意义（P＞0.05）；序贯组与三联组的疗效指数分别为0.34和0.34，无统计学差异（P＞0.05）。 4.药物不良反应发生率，序贯组与三联组分别为11.3%、10.0%，差异不明显（P＞0.05）。结论： 1.序贯疗法的Hp根除率＞80%，高于三联疗法。 2.序贯疗法与三联疗法均能明显缓解Hp相关性慢性胃炎患者的胃肠道症状。 3.序贯疗法与三联疗法的不良反应发生率基本接近。 4.对有铋剂禁忌而不能采用铋剂四联方案者，可考虑应用10d序贯疗法进行Hp相关性胃炎的治疗。有必要进行多中心、大样本、随机双盲的临床研究，进一步研究序贯疗法有效性。
[Abstract]:Objective: chronic gastritis is one of the most common and frequent diseases in clinical practice, which accounts for more than 90% of the patients undergoing gastroscopy. Helicobacter pylori (Helicobacter pylori, Hp) infection is the main pathogenic factor of chronic gastritis. After long-term infection, gastric mucosal atrophy can occur in some patients, which can be further developed into intestinal metaplasia, dysplasia, and the possibility of carcinogenesis is increased. Eradication of Hp can attenuate the inflammation of gastric mucosa and reduce the degree of chronic inflammation, which becomes one of the key links in the treatment of chronic gastritis. In this study, sequential therapy and triple therapy were used to treat chronic gastritis associated with Hp. The initial therapeutic effects of sequential therapy and triple therapy on Hp eradication were observed. The symptoms of gastrointestinal tract after Hp eradication were followed up and the incidence of adverse reactions was analyzed. To provide evidence for clinical selection of effective and safe eradication programs. Methods: patients with chronic gastritis and Hp infection diagnosed by gastroscopy were randomly divided into sequential therapy group (Sequential group) and triple therapy group (triplex group). 150 patients in the sequential group were given esomeprazole 20mg in the first 5 days, amoxicillin 1g, esomeprazole 20mg, clarithromycin 0.5g, tinidazole 0.2g after 5 days. 150 patients in the triple group were given omeprazole 20 mg, clarithromycin 0.5 g and amoxicillin 1 g daily for 10 days. Four weeks after the end of treatment, Hp, was re-examined to observe the eradication effect of Hp, and the gastrointestinal symptoms of the patients at the time of entering the group and 4 weeks after the end of the treatment were evaluated, and the improvement of the symptoms in the eradication process was compared between the two groups. Adverse drug reactions occurred. Results: 1. The Hp eradication rates of sequential therapy and triple therapy were 82.7% and 69.3%, respectively, which were higher than that of triple therapy (P < 0. 05). 2. The total scores of gastrointestinal symptoms before treatment and 4 weeks after treatment were 19.17 and 12.56, respectively. The total scores of gastrointestinal symptoms after treatment were lower than those before treatment (P < 0.001). The total scores of gastrointestinal symptoms before treatment and 4 weeks after treatment were 19.23 and 12.69, respectively. The total scores of gastrointestinal symptoms after treatment were lower than those before treatment (P < 0.001). 3. Before treatment, there was no significant difference in the total scores of gastrointestinal symptoms between the sequential group and the triple group (P > 0.05), but there was no significant difference in the total score of the gastrointestinal symptoms between the sequential group and the triple group after 4 weeks (P > 0.05). The total scores of gastrointestinal symptoms before treatment and 4 weeks after withdrawal were 6.61 in sequential group and 6.54 in triple group (P > 0.05). The curative effect index of sequential group and triple group were 0.34 and 0.34 respectively, there was no statistical difference (P > 0.05). 4. The incidence of adverse drug reactions in sequential group and triple group were 11.3and 10.0, respectively, with no significant difference (P > 0.05). Conclusion: 1. The Hp eradication rate of sequential therapy was more than 80, higher than that of triple therapy. 2. Sequential therapy and triple therapy can significantly alleviate the gastrointestinal symptoms in patients with chronic gastritis associated with Hp. 3. The incidence of adverse reactions in sequential therapy and triple therapy was similar. 4. For those who have contraindications of bismuth and can not use the quadruple regimen of bismuth, we can consider the treatment of Hp associated gastritis with sequential therapy for 10 days. There is a need for multicenter, large-sample, randomized double-blind clinical studies to further study the efficacy of sequential therapy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573.1

【参考文献】