分阶段综合治疗难治性幽门螺杆菌感染63例临床观察
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摘要
目的观察分阶段综合治疗难治性幽门螺杆菌感染(H.pylori)者的效果。方法共纳入2年内按共识推荐方案治疗反复失败≥3次的难治性H.pylori感染者63例,采用分阶段综合疗法治疗,即:治疗前准备(对症治疗);标准抗菌治疗(雷贝拉唑+阿莫西林+呋喃唑酮+枸橼酸铋钾)×10天;巩固治疗(双歧杆菌+荆花胃康)×14天+(双歧杆菌+枸橼酸铋钾)×14天。停药1个月复查13C呼气试验,观察H.pylori根除率;停药后及停药1个月观察主要症状缓解情况。结果 63例患者中56例成功根除H.pylori,总根除率为94.92%(56/59,PP)和88.89%(56/63,ITT)。治疗后上腹痛、腹胀、烧心、便秘等症状较治疗前明显缓解(P<0.05,P<0.01)。治疗期间未见严重不良事件。结论分阶段综合疗法能够显著提高难治性H.pylori感染的根除率。
Objective To observe the effect of 'step-by-step and synthetic therapy' in treatment of participants with refractory H.pylori infection,who had failed in consensus based treatment.Methods A total of 63 participants,with more than 3 times of eradication failure within 2 years treated by consensus recommendations,were recruited in this cohort study.They received' step-by-step and synthetic therapy' [preliminary preparation(symptomatic treatment);standard antibiotic treatment(Rabeprazole plus Amoxicillin,Furazolidone and Bismuth Potassium Citrate for 10 days);consolidation therapy(Jinghua Weikang Capsule and Bismuth Potassium Citrate for 2 weeks) plus(Bacillus bifidus and Bismuth Potassium Citrate for 2 weeks)].13 C breath test was rechecked after one month withdrawal.The eradition rate of H.pylori was observed.The relief of main symptoms were observed after withdrawal and one month after withdrawal.Results Totally 56 of 63 cases got negative conversion of H.pylori.Per protocol(PP) was 94.92%(56/59) and intention to treat(ITT) was 88.89%(56/63).Digestive symptoms,such as epigastric pain,bloating,heartburn,and constipation were obviously relieved after treatment(P<0.05,P<0.01).No serious adverse event occurred during the treatment course.Conclusion This new strategy(step-by-step and synthetic therapy) could significantly improve the eradication rate of refractory H.pylori infection.
Objective To observe the effect of 'step-by-step and synthetic therapy' in treatment of participants with refractory H.pylori infection,who had failed in consensus based treatment.Methods A total of 63 participants,with more than 3 times of eradication failure within 2 years treated by consensus recommendations,were recruited in this cohort study.They received' step-by-step and synthetic therapy' [preliminary preparation(symptomatic treatment);standard antibiotic treatment(Rabeprazole plus Amoxicillin,Furazolidone and Bismuth Potassium Citrate for 10 days);consolidation therapy(Jinghua Weikang Capsule and Bismuth Potassium Citrate for 2 weeks) plus(Bacillus bifidus and Bismuth Potassium Citrate for 2 weeks)].13 C breath test was rechecked after one month withdrawal.The eradition rate of H.pylori was observed.The relief of main symptoms were observed after withdrawal and one month after withdrawal.Results Totally 56 of 63 cases got negative conversion of H.pylori.Per protocol(PP) was 94.92%(56/59) and intention to treat(ITT) was 88.89%(56/63).Digestive symptoms,such as epigastric pain,bloating,heartburn,and constipation were obviously relieved after treatment(P<0.05,P<0.01).No serious adverse event occurred during the treatment course.Conclusion This new strategy(step-by-step and synthetic therapy) could significantly improve the eradication rate of refractory H.pylori infection.
引文
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[9]马继征,冯硕,胡伏莲.分阶段治疗难治性幽门螺杆菌感染1例报告[J].北京医学,2015,37(4):332-342.
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[13]Mendonca S,Ecclissato C,Sartori MS,et al.Prevalence of Helicobacter pylori resistance to Metronidazole,Clarithromycin,Amoxicillin,Tetracycline,and Furazolidone in Brazil[J].Helicobacter,2000,5(2):79-83.
[14]Sun QJ,Liang X,Zheng Q,et al.Resistance of Helicobacter pylori to antibiotics from 2000 to 2009 in Shanghai[J].World J Gastroenterol,2010,16(40):5118-5121.
[15]Sugano K,Tack J,Kuipers EJ,et al.Kyoto Global Consensus Report on Helicobacter pylori Gastritis[J].Gut,2015,64(9):1-15.
[16]Fallone CA,Chiba N,van Zanten SV,et al.The Toronto Consensus for the treatment of Helicobacter pylori infection in adults[J].Gastroenterology,2016,151(1):51-69.
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[18]胡伏莲.幽门螺杆菌研究聚焦和进展[J].胃肠病学,2015,20(12):705-707.
[19]Zhang MM,Qian W,Qin YY,et al.Probiotics in Helicobacter pylori eradication therapy:a systematic review and meta-analysis[J].World J Gastroenterol,2015,21(14):4345-4357.
[20]Emara MH,Elhawari SA,Yousef S,et al.Emerging role of probiotics in the management of Helicobacter pylori infection:Histopathologic perspectives[J].Helicobacter,2016,21(1):3-10.
[21]Ge R,Chen Z,Zhou Q.The actions of bismuth in the treatment of Helicobacter pylori infections:an update[J].Metallomics,2012,4(3):239-243.
[22]Dore MP,Lu H,Graham DY.Role of bismuth in improving Helicobacter pylori eradication with triple therapy[J].Gut,2016,65(5):870-878.
[23]成虹,李江,胡伏莲.枸橼酸铋钾对幽门螺杆菌耐药菌株体外抗菌活性研究[J].胃肠病学和肝病学杂志,2008,17(7):543-546.
[24]Liang J,Li J,Han Y,et al.Helicobacter pylori eradication with Ecabet Sodium,Meprazole,Amoxicillin,and Clarithromycinversus bismuth,Omeprazole,Amoxicillin,and Clarithromycin quadruple therapy:a randomized,open-label,phaseⅣtrial[J].Helicobacter,2012,17(6):458-465.
[25]李江,成虹,高文,等.不同中药提取物对幽门螺杆菌耐药菌株体外抗菌活性研究[J].现代中医临床,2015,21(2):21-23,28.
[26]于靖,叶晖,李江,等.复方清热化湿制剂对幽门螺杆菌的体外抗菌作用研究[J].中国中西医结合消化杂志,2016,24(4):245-248.
[27]陈炼,廖旺娣,李国华,等.江西蜂胶对幽门螺杆菌的体外抑菌作用研究[J].江西医学院学报,2009,49(12):27-28,32.
[28]汪红兵,张声生,李乾构.健脾清化法联合西药治疗幽门螺杆菌相关性胃炎34例[J].中国中西医结合消化杂志,2006,14(6):390-391.
[29]全国多中心临床研究科研协作组.温胃舒或养胃舒治疗幽门螺杆菌相关性慢性胃炎和消化性溃疡的全国多中心临床研究[J].中华医学杂志,2010,90(2):75-78.
[30]胡伏莲,成虹,张学智,等.多中心临床观察荆花胃康联合三联疗法治疗幽门螺杆菌相关性十二指肠溃疡和胃炎疗效及耐药分析[J].中华医学杂志,2012,92(10):679-684.
[31]黄星涛,张学智,李宁,等.荆花胃康胶丸对幽门螺杆菌耐药菌株体外抑菌作用的研究[J].中国中西医结合消化杂志,2010,18(5):290-293.
[2]Gao W,Cheng H,Hu F,et al.The evolution of Helicobacter pylori antibiotics resistance over 10 years in Beijing,China[J].Helicobacter,2010,15(5):460-466.
[3]Zhang YX,Zhou LY,Song ZQ,et al.Primary antibiotic resistance of Helicobacter pylori strains isolated from patients with dyspeptic symptoms in Beijing:a prospective serial study[J].World J Gastroenterol,2015,21(9):2786-2792.
[4]胡伏莲.幽门螺杆菌感染治疗的新路径[J].中华医学杂志,2012,92(10):649-651.
[5]胡伏莲.难治性幽门螺杆菌感染处理原则和策略[J].中华医学杂志,2017,97(10):721-723.
[6]中华医学会消化病学分会幽门螺杆菌学组/全国幽门螺杆菌研究协作组.第四次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2012,7(10):618-625.
[7]Malfertheiner P,Megraud F,O'Morain CA,et al.Management of Helicobacter pylori infection-the MaastrichtⅤ/Florence Consensus Report[J].Gut,2017,66(1):6-30.
[8]刘文忠,谢勇,陆红,等.第五次全国幽门螺杆菌感染处理共识报告[J].胃肠病学,2017,22(6):346-360.
[9]马继征,冯硕,胡伏莲.分阶段治疗难治性幽门螺杆菌感染1例报告[J].北京医学,2015,37(4):332-342.
[10]蒋晓玲,袁蕙芸.我国幽门螺杆菌感染处理共识推荐的铋剂四联方案根除率分析[J].胃肠病学,2014,19(9):531-536.
[11]De Francesco V,Giorgio F,Hassan C,et al.Worldwide H.pylori antibiotic resistance:a systematic review[J].J Gastrointestin Liver Dis,2010,19(4):409-414.
[12]Su P,Li Y,Li H,et al.Antibiotic resistance of Helicobacter pylori isolated in the Southeast Coastal Region ofChina[J].Helicobacter,2013,18(4):274-279.
[13]Mendonca S,Ecclissato C,Sartori MS,et al.Prevalence of Helicobacter pylori resistance to Metronidazole,Clarithromycin,Amoxicillin,Tetracycline,and Furazolidone in Brazil[J].Helicobacter,2000,5(2):79-83.
[14]Sun QJ,Liang X,Zheng Q,et al.Resistance of Helicobacter pylori to antibiotics from 2000 to 2009 in Shanghai[J].World J Gastroenterol,2010,16(40):5118-5121.
[15]Sugano K,Tack J,Kuipers EJ,et al.Kyoto Global Consensus Report on Helicobacter pylori Gastritis[J].Gut,2015,64(9):1-15.
[16]Fallone CA,Chiba N,van Zanten SV,et al.The Toronto Consensus for the treatment of Helicobacter pylori infection in adults[J].Gastroenterology,2016,151(1):51-69.
[17]Malfertheiner P,Megraud F,O'Morain CA,the European Helicobacter and Microbiota Study Group and Consensus panel.Management of Helicobacter pylori infection-the MaastrichtⅤ/Florence Consensus Report[J].Gut,2016Oct 5.[Epub ahead of print]
[18]胡伏莲.幽门螺杆菌研究聚焦和进展[J].胃肠病学,2015,20(12):705-707.
[19]Zhang MM,Qian W,Qin YY,et al.Probiotics in Helicobacter pylori eradication therapy:a systematic review and meta-analysis[J].World J Gastroenterol,2015,21(14):4345-4357.
[20]Emara MH,Elhawari SA,Yousef S,et al.Emerging role of probiotics in the management of Helicobacter pylori infection:Histopathologic perspectives[J].Helicobacter,2016,21(1):3-10.
[21]Ge R,Chen Z,Zhou Q.The actions of bismuth in the treatment of Helicobacter pylori infections:an update[J].Metallomics,2012,4(3):239-243.
[22]Dore MP,Lu H,Graham DY.Role of bismuth in improving Helicobacter pylori eradication with triple therapy[J].Gut,2016,65(5):870-878.
[23]成虹,李江,胡伏莲.枸橼酸铋钾对幽门螺杆菌耐药菌株体外抗菌活性研究[J].胃肠病学和肝病学杂志,2008,17(7):543-546.
[24]Liang J,Li J,Han Y,et al.Helicobacter pylori eradication with Ecabet Sodium,Meprazole,Amoxicillin,and Clarithromycinversus bismuth,Omeprazole,Amoxicillin,and Clarithromycin quadruple therapy:a randomized,open-label,phaseⅣtrial[J].Helicobacter,2012,17(6):458-465.
[25]李江,成虹,高文,等.不同中药提取物对幽门螺杆菌耐药菌株体外抗菌活性研究[J].现代中医临床,2015,21(2):21-23,28.
[26]于靖,叶晖,李江,等.复方清热化湿制剂对幽门螺杆菌的体外抗菌作用研究[J].中国中西医结合消化杂志,2016,24(4):245-248.
[27]陈炼,廖旺娣,李国华,等.江西蜂胶对幽门螺杆菌的体外抑菌作用研究[J].江西医学院学报,2009,49(12):27-28,32.
[28]汪红兵,张声生,李乾构.健脾清化法联合西药治疗幽门螺杆菌相关性胃炎34例[J].中国中西医结合消化杂志,2006,14(6):390-391.
[29]全国多中心临床研究科研协作组.温胃舒或养胃舒治疗幽门螺杆菌相关性慢性胃炎和消化性溃疡的全国多中心临床研究[J].中华医学杂志,2010,90(2):75-78.
[30]胡伏莲,成虹,张学智,等.多中心临床观察荆花胃康联合三联疗法治疗幽门螺杆菌相关性十二指肠溃疡和胃炎疗效及耐药分析[J].中华医学杂志,2012,92(10):679-684.
[31]黄星涛,张学智,李宁,等.荆花胃康胶丸对幽门螺杆菌耐药菌株体外抑菌作用的研究[J].中国中西医结合消化杂志,2010,18(5):290-293.