三种方案初始治疗幽门螺杆菌感染的疗效观察
发布时间：2019-04-17 10:30
【摘要】：1.研究背景和目的:我国属于发展中国家,H.pylori感染率高,H.pylori感染与上胃肠道疾病关系密切,同时还与某些胃肠道外疾病具有相关性,世界卫生组织已经把H.pylori列为胃癌的I类致癌因子,所以H.pylori感染治疗是H.pylori研究领域中的重点课题。在幽门螺杆菌的治疗中仍然存在着许多问题,要彻底根除H.pylori依旧很困难,主要是因为幽门螺杆菌对抗生素的耐药性问题,导致H.pylori根除率越来越低。近年来为了提高幽门螺杆菌的根除率国际上推荐了一些根除方案,序贯疗法(sequential therapy)、伴同疗法(concomitant therapy)、包括左氧氟沙星的三联疗法等,我国多中心随机对照研究显示序贯疗法与标准三联疗法相比并未显示优势。本研究目的通过比较含铋剂四联方案、含克拉霉素三联方案、含呋喃唑酮三联方案对H.pylori的根除率,筛选出本地区有效、安全、简便、经济的治疗方案。2.方法:将2013年11月至2014年10月在天津港口医院消化内科门诊经14C尿素呼气试验检测方法诊断为H.pylori感染的212名初治患者随机分为三组,A组(72例):埃索美拉唑(20mg 2/日)+枸橼酸铋钾220mg+克拉霉素500mg+阿莫西林1.0g,10天;B组(71例):埃索美拉唑20mg+阿莫西林1.0g+克拉霉素500mg,10天;C组(69例):埃索美拉唑20mg+阿莫西林1.0g+呋喃唑酮100mg,10天,停药4周后应用14C-UBT检测幽门螺杆菌,比较各组的幽门螺杆菌根除率。3.结果不同方案根除率的比较:212名患者中完成治疗和随访的202例,未完成的10例。按意向治疗(ITT)分析A、B、C三组根除率分别为83.3%、67.6%、82.6%,三组患者根除率相比差异有统计学意义,其中A组与B组、B组与C组根除率相比差异有统计学意义(P㩳0.05),A组和C组根除率相比差异无统计学意义(P㧐0.05)。按符合方案集(PP)分析A、B、C三组根除率分别为87.0%、69.6%、89.1%,三组患者的根除率相比差异有统计学意义(P㩳0.05),其中A组与B组、B组与C组相比根除率差异有统计学意义(P㩳0.05),A组和C组根除率相比差异无统计学意义(P㧐0.05)。不良反应发生情况:三组的不良反应发生率分别为14.5%,11.6%和10.9%,三组间比较差异无统计学意义(P0.05)。三组治疗方案所需费用的比较:A组403.7元,B组370.9元,C组289.1 元,成本-效果分析显示C组取得的单位效果成本最低。4结论:含铋剂四联方案和含呋喃唑酮三联方案均比含克拉霉素三联方案能更有效的根除H.Pylori,但含呋喃唑酮组单位效果成本最低,所以在本地区临床工作中,10天含呋喃唑酮三联方案可作为经验性治疗H.Pylori感染的首选方案。
[Abstract]:1. Background and objective: China is a developing country with a high rate of H.pylori infection. H.pylori infection is closely related to upper gastrointestinal diseases, and it is also associated with some extragastrointestinal diseases. The World Health Organization (WHO) has listed H.pylori as a class I carcinogen of gastric cancer, so the treatment of H.pylori infection is a key topic in the field of H.pylori research. There are still many problems in the treatment of Helicobacter pylori. It is still difficult to eradicate H.pylori completely. It is mainly because of the antibiotic resistance of Helicobacter pylori that the eradication rate of H.pylori becomes lower and lower. In recent years, in order to improve the eradication rate of Helicobacter pylori, some eradication programs have been recommended internationally, such as sequential therapy of (sequential therapy), combined with (concomitant therapy), including triad therapy of levofloxacin, etc. Our multicenter randomized controlled study shows that sequential therapy has no advantage over standard triple therapy. The purpose of this study was to find out the effective, safe, simple and economical therapeutic regimen in this area by comparing the eradication rate of H.pylori with four regimen containing bismuth agent, three regimens containing clarithromycin and three regimens containing furazolidone. Methods: from November 2013 to October 2014, a total of 212 newly diagnosed patients with H.pylori infection were randomly divided into three groups, who were diagnosed as H.pylori infection by 14C urea breath test in the Department of Gastroenterology of Tianjin Port Hospital from November 2013 to October 2014. Group A (72 cases): Esomeprazole (20mg 2 / day) bismuth potassium citrate 220mg clarithromycin 500mg amoxicillin 1.0 g for 10 days; Group B (71 cases): Esomeprazole 20mg Amoxicillin 1.0 g clarithromycin 500 mg, 10 days; Group C (69 cases): Esomeprazole 20mg 1.0g furazolidone 100mg, 10 days. After 4 weeks of withdrawal, Helicobacter pylori was detected by 14C-UBT, and the eradication rate of Helicobacter pylori in each group was compared. 3. Results among 212 patients, 202 patients completed treatment and follow-up, and 10 patients did not. The eradication rates of group A, B and C were 83.3%, 67.6% and 82.6%, respectively, according to the intention-to-treat (ITT) analysis. There was a significant difference in the eradication rates among the three groups, among which group A and group B were significantly higher than those in group B. There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference between group B and C (P < 0.05). The eradication rates of group A, group B and group C were 87.0%, 69.6% and 89.1% respectively according to the concordance set (PP) analysis. There was significant difference in eradication rate among the three groups (P < 0.05), among which group A was significantly higher than group B (P < 0.05), and group B was significantly higher than that of group B (P < 0.05). There was a significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C. there was no significant difference in eradication rate between group B and group C (P < 0.05). The incidence of adverse reactions in the three groups was 14.5%, 11.6% and 10.9%, respectively. There was no significant difference among the three groups (P0.05). Comparison of the cost of treatment regimen among three groups: $403.7 in group A, $370.9 in group B, and $289.1 in group C. The cost-effectiveness analysis showed that group C achieved the lowest unit cost. 4 conclusion: both bismuth-containing quadruple regimen and furazolidone-containing triple regimen are more effective than clarithromycin-containing triad regimen in the eradication of H. Pylori. However, the unit cost of the group containing furazolidone was the lowest. Therefore, the triplex regimen containing furazolidone for 10 days could be used as the first choice for empirical treatment of H.Pylori infection in the clinical work of this area.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.1
[Abstract]:1. Background and objective: China is a developing country with a high rate of H.pylori infection. H.pylori infection is closely related to upper gastrointestinal diseases, and it is also associated with some extragastrointestinal diseases. The World Health Organization (WHO) has listed H.pylori as a class I carcinogen of gastric cancer, so the treatment of H.pylori infection is a key topic in the field of H.pylori research. There are still many problems in the treatment of Helicobacter pylori. It is still difficult to eradicate H.pylori completely. It is mainly because of the antibiotic resistance of Helicobacter pylori that the eradication rate of H.pylori becomes lower and lower. In recent years, in order to improve the eradication rate of Helicobacter pylori, some eradication programs have been recommended internationally, such as sequential therapy of (sequential therapy), combined with (concomitant therapy), including triad therapy of levofloxacin, etc. Our multicenter randomized controlled study shows that sequential therapy has no advantage over standard triple therapy. The purpose of this study was to find out the effective, safe, simple and economical therapeutic regimen in this area by comparing the eradication rate of H.pylori with four regimen containing bismuth agent, three regimens containing clarithromycin and three regimens containing furazolidone. Methods: from November 2013 to October 2014, a total of 212 newly diagnosed patients with H.pylori infection were randomly divided into three groups, who were diagnosed as H.pylori infection by 14C urea breath test in the Department of Gastroenterology of Tianjin Port Hospital from November 2013 to October 2014. Group A (72 cases): Esomeprazole (20mg 2 / day) bismuth potassium citrate 220mg clarithromycin 500mg amoxicillin 1.0 g for 10 days; Group B (71 cases): Esomeprazole 20mg Amoxicillin 1.0 g clarithromycin 500 mg, 10 days; Group C (69 cases): Esomeprazole 20mg 1.0g furazolidone 100mg, 10 days. After 4 weeks of withdrawal, Helicobacter pylori was detected by 14C-UBT, and the eradication rate of Helicobacter pylori in each group was compared. 3. Results among 212 patients, 202 patients completed treatment and follow-up, and 10 patients did not. The eradication rates of group A, B and C were 83.3%, 67.6% and 82.6%, respectively, according to the intention-to-treat (ITT) analysis. There was a significant difference in the eradication rates among the three groups, among which group A and group B were significantly higher than those in group B. There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference between group B and C (P < 0.05). The eradication rates of group A, group B and group C were 87.0%, 69.6% and 89.1% respectively according to the concordance set (PP) analysis. There was significant difference in eradication rate among the three groups (P < 0.05), among which group A was significantly higher than group B (P < 0.05), and group B was significantly higher than that of group B (P < 0.05). There was a significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C. there was no significant difference in eradication rate between group B and group C (P < 0.05). The incidence of adverse reactions in the three groups was 14.5%, 11.6% and 10.9%, respectively. There was no significant difference among the three groups (P0.05). Comparison of the cost of treatment regimen among three groups: $403.7 in group A, $370.9 in group B, and $289.1 in group C. The cost-effectiveness analysis showed that group C achieved the lowest unit cost. 4 conclusion: both bismuth-containing quadruple regimen and furazolidone-containing triple regimen are more effective than clarithromycin-containing triad regimen in the eradication of H. Pylori. However, the unit cost of the group containing furazolidone was the lowest. Therefore, the triplex regimen containing furazolidone for 10 days could be used as the first choice for empirical treatment of H.Pylori infection in the clinical work of this area.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.1
【参考文献】
相关期刊论文 前10条
1 Cong He;Zhen Yang;Nong-Hua Lu;;Helicobacter pylori infection and diabetes:Is it a myth or fact?[J];World Journal of Gastroenterology;2014年16期
2 吴李培;宣世海;;幽门螺杆菌对左氧氟沙星耐药的研究进展[J];世界华人消化杂志;2014年02期
3 Han-Yi Song;Yan Li;;Can eradication rate of gastric Helicobacter pylori be improved by killing oral Helicobacter pylori ?[J];World Journal of Gastroenterology;2013年39期
4 祁小鸣;周步良;陈恕之;;~(14)C-尿素呼气试验检测幽门螺杆菌感染的临床应用[J];临床和实验医学杂志;2013年02期
5 梁洁;吴开春;杨云生;李闻;张澍田;吴咏冬;袁耀宗;李兆申;杜奕奇;陈e，
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