西安地区不同药物治疗方案对幽门螺杆菌根除疗效的分析
发布时间：2019-01-23 21:05
【摘要】：目的:1分析不同药物治疗方案对幽门螺杆菌(Helicobacter pylori,Hp)根除疗效的影响。2分析不同性别、年龄、上消化道疾病类型对幽门螺杆菌根除疗效的影响。方法:1研究对象:收集2014年6月1日-2016年6月1日于陕西省人民医院门诊就诊的经胃镜下快速尿素酶试验或13C-呼气试验确诊Hp阳性且检查前28天内未使用抗生素、抑酸药及铋剂的患者共316例。227例治疗结束28天后复查评估疗效(设为研究组);89例失访(设为失访组),即未能按医嘱说明复查评估疗效。收集316例患者的性别、年龄、疾病的临床诊断及胃镜下诊断、Hp根除方案及疗效。2研究方法:在研究组的227例患者中,依治疗分案分为6个不同的治疗组,分别为RAN+AMO+CLA 14d组(雷尼替丁+阿莫西林+克拉霉素14天疗法)、PAN+AMO+CLA 14d组(泮托拉唑+阿莫西林+克拉霉素14天疗法)、PAN+AMO+CLA+BIS 14d组(泮托拉唑+阿莫西林+克拉霉素+胶体酒石酸铋14天疗法)、PAN+AMO+CLA+BIS 10d组(泮托拉唑+阿莫西林+克拉霉素+胶体酒石酸铋10天疗法)、OME+AMO+MET+BIS 14d组(奥美拉唑+阿莫西林+甲硝唑+胶体酒石酸铋14天疗法)、PAN+AMO+LEV+BIS 10d组(泮托拉唑+阿莫西林+左氧氟沙星+胶体酒石酸铋10天疗法),对比不同治疗方案下的Hp根除疗效。分别对比男女之间、各年龄段、不同上消化道疾病类型在PAN+AMO+CLA+BIS 10d或14d组的Hp根除疗效。在研究组的227例患者中,多因素的Logistic回归分析不同治疗方案、性别、年龄、上消化道疾病类型对Hp根除疗效的影响。3统计学分析:采用SPSS19.0统计软件进行数据的整理与分析,多因素分析采用二分类的logistic回归分析方法,单因素分析用卡方检验或Fisher′s检验,P0.05为差异有统计学意义。结果:1在失访组的89例患者中,30~39岁的比例最高,为30.3%。2研究组中不同治疗方案下的Hp根除疗效比较2.1 PAN+AMO+CLA+BIS 14d组的Hp根除率较PAN+AMO+CLA 14d组和RAN+AMO+CLA 14d组高,差异有统计学意义。2.2 OME+AMO+MET+BIS14d组的Hp根除率较RAN+AMO+CLA 14d组高,差异有统计学意义。2.3在铋剂四联方案中,OME+AMO+MET+BIS14d组的Hp根除率最高,为94.12%,PAN+AMO+LEV+BIS 10d组的Hp根除率最低,为64.71%,但差异无统计学意义。2.4 PAN+AMO+CLA+BIS 10d组与PAN+AMO+CLA+BIS 14d组的Hp根除率比较差异无统计学意义。3 PAN+AMO+CLA+BIS 10d和14d组的中,男女性别之间的Hp根除率比较无显著性差异;但40以下人群Hp根除率在各年龄段中最低,为75.7%,60岁以上为93.3%,但差异无统计学意义;慢性萎缩性胃炎、慢性非萎缩性胃炎与消化性溃疡患者之间Hp根除率比较,差异均无统计学意义。4 Logistic逐步回归分析显示性别、年龄及上消化道疾病不是Hp根除疗效的影响因素,而治疗方案是Hp根治疗效的影响因素。结论:1不同治疗方案可影响Hp根除疗效,而性别、年龄、上消化道疾病类型对Hp根除疗效影响不大。2本研究发现泮托拉唑+阿莫西林+克拉霉素14天的标准三联疗法和雷尼替丁+阿莫西林+克拉霉素14天疗法的根除疗效差,联合铋剂后将会有效提高Hp根除率;包含甲硝唑的铋剂四联方案疗效较好,其原因可能为随着给药剂量和给药次数的增加,甲硝唑的耐药可被完全或部分抵消。包含左氧氟沙星的铋剂四联方案Hp根除疗效较差,其原因可能与本地区左氧氟沙星高耐药有关。3在成年幽门螺杆菌感染者中,40岁以下在治疗失访人群中所占比例最高,且Hp根除率较其他年龄段低。
[Abstract]:Objective: To study the effect of different drug treatment on the eradication of Helicobacter pylori (Hp). Method: 1 Study object: collected from June 1, 2014 to June 1, 2016 in the outpatient department of the People's Hospital of Shaanxi Province, the rapid urease test or the 13C-exhale test was confirmed to be positive for Hp and no antibiotics were used in the first 28 days. A total of 316 patients were treated with acid-inhibiting and anti-inflammatory agents. The efficacy of the assessment (set as the study group) was reviewed after 28 days after the end of the treatment, and 89 cases of lost-to-follow-up (set to the lost-to-follow-up group), that is, the evaluation efficacy could not be reviewed according to the doctor's order. A total of 316 patients with sex, age, and disease were collected for clinical diagnosis and under gastroscopy, and the eradication of Hp and its effect were collected. Methods: In the 227 patients of the study group, 6 different treatment groups were divided into six different treatment groups according to the treatment. For RAN + AMO + CLA 14d group (ranitidine + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA 14d group (tortotolizumab + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA + BIS 14d group (Tortolizumab + amoxicillin + clarithromycin + colloidal tartaric acid and 14-day therapy), PAN + AMO + CLA + BIS 10d (Tortolizumab + Amoxicillin + Clarithromycin + Colloidal Tartrate for 10 days), OME + AMO + MET + BIS 14d (Omeirah + Amoxicillin + Nitrocin + Colloidal Tartrate 14-Day Therapy), PAN + AMO + LEV + BIS 10d (Amoxicillin + amoxicillin + levofloxacin + colloidal tartaric acid for 10 days), and compared with the curative effect of Hp eradication under different treatment protocols. The efficacy of Hp eradication in the group of PAN + AMO + CLA + BIS 10d or 14d was compared between men and women, all ages and different upper gastrointestinal diseases. In the 227 patients of the study group, the effects of different treatment schemes, sex, age and upper gastrointestinal disease type on the curative effect of Hp eradication were analyzed by logistic regression of multiple factors. The multi-factor analysis is a two-class logistic regression analysis method. The single-factor analysis is used for either the card-side test or the Fisher's test, and the difference is significant. Results: 1 In the 89 patients of the lost-to-follow-up group, the proportion of the 30 to 39-year-old group was the highest, which was 30.3%. The Hp eradication rate of the group was higher than that of the PAN + AMO + CLA 14-d group and the RAN + AMO + CLA 14-d group, and the difference was statistically significant. The results showed that the eradication rate of Hp in the group of OME + AMO + MET + BIS14d was the highest, the lowest of the eradication rate of Hp was 94.2%, the lowest in the group of PAN + AMO + LEV + BIS 10d was 64. 71%, but the difference was not statistically significant. The difference of Hp eradication rate in the group of PAN + AMO + CLA + BIS 10d and PAN + AMO + CLA + BIS 14d was not statistically significant. The eradication rate of Hp between male and female was no significant difference, but the eradication rate of Hp in the following groups was the lowest in all age groups, 75.7% and 93.3%, but the difference was not significant; chronic atrophic gastritis, There was no significant difference in the eradication rate of Hp between chronic non-atrophic gastritis and the patients with digestive ulceration. Logistic regression analysis showed that the effect of sex, age and upper gastrointestinal disease was not the effect of Hp eradication. Conclusion: 1 Different treatment options can affect the curative effect of Hp eradication, while sex and age, The effect of the type of upper gastrointestinal disease on the eradication of Hp was not great. The results of this study found that the standard triple therapy of the 14-day treatment of the amoxicillin + amoxicillin + clarithromycin and the 14-day treatment of the ranitidine + amoxicillin + clarithromycin were poor, and the eradication rate of Hp was effectively improved after the combination of the therapeutic agent. The results of the tetralogy of the tetralogy of tetralogy of nitroprusis better, and the cause may be to be completely or partially offset with the increase in the dose of administration and the number of doses administered. The results of Hp eradication in the four-tetralogy of tetratetralogy of levofloxacin may be related to the high resistance of levofloxacin in the region. In the case of adult H. pylori, the proportion of patients under the age of 40 is the highest among those who have been lost to follow-up, and the eradication rate of Hp is lower than that of other age groups.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R57
本文编号：2414190
[Abstract]:Objective: To study the effect of different drug treatment on the eradication of Helicobacter pylori (Hp). Method: 1 Study object: collected from June 1, 2014 to June 1, 2016 in the outpatient department of the People's Hospital of Shaanxi Province, the rapid urease test or the 13C-exhale test was confirmed to be positive for Hp and no antibiotics were used in the first 28 days. A total of 316 patients were treated with acid-inhibiting and anti-inflammatory agents. The efficacy of the assessment (set as the study group) was reviewed after 28 days after the end of the treatment, and 89 cases of lost-to-follow-up (set to the lost-to-follow-up group), that is, the evaluation efficacy could not be reviewed according to the doctor's order. A total of 316 patients with sex, age, and disease were collected for clinical diagnosis and under gastroscopy, and the eradication of Hp and its effect were collected. Methods: In the 227 patients of the study group, 6 different treatment groups were divided into six different treatment groups according to the treatment. For RAN + AMO + CLA 14d group (ranitidine + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA 14d group (tortotolizumab + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA + BIS 14d group (Tortolizumab + amoxicillin + clarithromycin + colloidal tartaric acid and 14-day therapy), PAN + AMO + CLA + BIS 10d (Tortolizumab + Amoxicillin + Clarithromycin + Colloidal Tartrate for 10 days), OME + AMO + MET + BIS 14d (Omeirah + Amoxicillin + Nitrocin + Colloidal Tartrate 14-Day Therapy), PAN + AMO + LEV + BIS 10d (Amoxicillin + amoxicillin + levofloxacin + colloidal tartaric acid for 10 days), and compared with the curative effect of Hp eradication under different treatment protocols. The efficacy of Hp eradication in the group of PAN + AMO + CLA + BIS 10d or 14d was compared between men and women, all ages and different upper gastrointestinal diseases. In the 227 patients of the study group, the effects of different treatment schemes, sex, age and upper gastrointestinal disease type on the curative effect of Hp eradication were analyzed by logistic regression of multiple factors. The multi-factor analysis is a two-class logistic regression analysis method. The single-factor analysis is used for either the card-side test or the Fisher's test, and the difference is significant. Results: 1 In the 89 patients of the lost-to-follow-up group, the proportion of the 30 to 39-year-old group was the highest, which was 30.3%. The Hp eradication rate of the group was higher than that of the PAN + AMO + CLA 14-d group and the RAN + AMO + CLA 14-d group, and the difference was statistically significant. The results showed that the eradication rate of Hp in the group of OME + AMO + MET + BIS14d was the highest, the lowest of the eradication rate of Hp was 94.2%, the lowest in the group of PAN + AMO + LEV + BIS 10d was 64. 71%, but the difference was not statistically significant. The difference of Hp eradication rate in the group of PAN + AMO + CLA + BIS 10d and PAN + AMO + CLA + BIS 14d was not statistically significant. The eradication rate of Hp between male and female was no significant difference, but the eradication rate of Hp in the following groups was the lowest in all age groups, 75.7% and 93.3%, but the difference was not significant; chronic atrophic gastritis, There was no significant difference in the eradication rate of Hp between chronic non-atrophic gastritis and the patients with digestive ulceration. Logistic regression analysis showed that the effect of sex, age and upper gastrointestinal disease was not the effect of Hp eradication. Conclusion: 1 Different treatment options can affect the curative effect of Hp eradication, while sex and age, The effect of the type of upper gastrointestinal disease on the eradication of Hp was not great. The results of this study found that the standard triple therapy of the 14-day treatment of the amoxicillin + amoxicillin + clarithromycin and the 14-day treatment of the ranitidine + amoxicillin + clarithromycin were poor, and the eradication rate of Hp was effectively improved after the combination of the therapeutic agent. The results of the tetralogy of the tetralogy of tetralogy of nitroprusis better, and the cause may be to be completely or partially offset with the increase in the dose of administration and the number of doses administered. The results of Hp eradication in the four-tetralogy of tetratetralogy of levofloxacin may be related to the high resistance of levofloxacin in the region. In the case of adult H. pylori, the proportion of patients under the age of 40 is the highest among those who have been lost to follow-up, and the eradication rate of Hp is lower than that of other age groups.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R57
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