消溃愈疡汤联合三联疗法治疗HP阳性消化性溃疡的疗效观察
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摘要
目的:观察消溃愈疡汤联合三联疗法在治疗幽门螺杆菌(Helicobacter Pylori,HP)阳性消化性溃疡方面的临床疗效。方法:选取2014年8月至2015年3月收住我科的HP阳性消化性溃疡患者90例,随机分成对照组和治疗组,各45例。2组患者均接受传统埃索美拉唑、阿莫西林和克拉霉素抗HP三联疗法,治疗组在上述治疗基础上,联合消溃愈疡汤治疗4个疗程,共治疗4周后观察2组治疗的临床疗效、HP清除情况、症状积分、药物不良反应、血浆MTL及SS水平的变化、溃疡复发等情况。结果:1)治疗后治疗组有效率86.67%,对照组有效率68.89%,2组有效率比较差异有统计学意义(P<0.05);2)2组患者治疗前症状积分比较差异无统计学意义(P>0.05),治疗4周后,症状积分治疗组明显低于对照组(P<0.05);3)不良反应中,对照组出现15例(33.30%),治疗组5例(11.1%),治疗组不良反应明显低于对照组(P<0.05);4)治疗组HP根除率为93.3%,对照组为77.8%,差异有统计学意义(P<0.05),ITT分析比较2组患者差异无统计学意义(P>0.05),PP分析显示治疗组根除率高于对照组,差异有统计学意义(P<0.05);5)治疗4周后,2组患者血浆MTL水平均较治疗前明显下降,血浆SS水平均较治疗前明显上升(P<0.05),且治疗组血浆MTL水平下降或SS上升的幅度较对照组更明显(P<0.05);6)随访1年后,溃疡复发情况比较,治疗组为3例(6.67%),对照组8例(17.8%),治疗组溃疡复发率明显低于对照组(P<0.05)。结论:消溃愈疡汤联合三联疗法治疗HP阳性消化性溃疡方面有显著的临床效果,且不良反应及复发率均明显降低,值得推广。
Objective: To observe the effect of Xiaokui Yuyang Decoction combined with triple therapy to treat helicobacter pylori positive peptic ulcer. Methods: A total of 90 patients with helicobacter pylori positive peptic ulcer who were admitted to our department in August 2014 to March 2015,were randomly divided into control group and observation group with 45 cases in each. Patients in the both groups were treated with traditional triple therapy including Esomeprazole,Amoxicillin and Carat Enzyme,while patients in the observation group received Xiaokui Yuyang Decoction at the same time for four-course treatment. Clinical curative effect,HP clearing situation,symptom integral,adverse drug reactions and the changes of plasma level of MTL and SS,ulcer recurrence,etc. were observed in the two groups during the 4-week treatment. Results: 1) The effective rate of the observation group was 86. 67%,and that of the control group was 68. 89%,showing statistically significant differences( P < 0. 05). 2)Symptoms score between the two groups before the treatment indicated no significant difference( P > 0. 05),but symptom integral score of the observation group was lower than that of the control group after 4-week treatment( P < 0. 05). 3) For adverse reactions,15 cases occurred in the control group( 33. 30%) and5 cases in the observation group( 11. 1%). The incidence of adverse reaction in the observation group was obviously lower than that in the control group( P < 0. 05). 4) HP eradicate rate of the observation group was 93. 3% and that of the control group was 77. 8%. There was statistically significant difference between the two groups( P < 0. 05). ITT analysis between the two groups of patients showed no statistically significant difference( P > 0. 05). PP analysis showed that the eradication rate of the observing group was higher than that of the control group and the difference was statistically significant( P < 0. 05). 5) 4 weeks after the treatment,the plasma MTL level significantly decreased in patients of both the two groups,compared with those before the treatment( P < 0. 05). The declination of plasma MTL level and increase of the level of plasma SS in the observation group were more significantly than those of the control group( P < 0. 05). 6) During the one year follow-up,3 cases in the observation group had ulcer recurrence( 6. 67%) and 8 cases in the control group( 17. 8%). The ulcer recurrence of the observation group was obviously lower than that of the control group( P < 0. 05). Conclusion: Xiaokui Yuyang Decoction combined with triple therapy to treat helicobacter pylori positive peptic ulcer may have significant clinical efficacy,with low HP recurrence rate and no significant adverse reaction,which is worth of promotion.
Objective: To observe the effect of Xiaokui Yuyang Decoction combined with triple therapy to treat helicobacter pylori positive peptic ulcer. Methods: A total of 90 patients with helicobacter pylori positive peptic ulcer who were admitted to our department in August 2014 to March 2015,were randomly divided into control group and observation group with 45 cases in each. Patients in the both groups were treated with traditional triple therapy including Esomeprazole,Amoxicillin and Carat Enzyme,while patients in the observation group received Xiaokui Yuyang Decoction at the same time for four-course treatment. Clinical curative effect,HP clearing situation,symptom integral,adverse drug reactions and the changes of plasma level of MTL and SS,ulcer recurrence,etc. were observed in the two groups during the 4-week treatment. Results: 1) The effective rate of the observation group was 86. 67%,and that of the control group was 68. 89%,showing statistically significant differences( P < 0. 05). 2)Symptoms score between the two groups before the treatment indicated no significant difference( P > 0. 05),but symptom integral score of the observation group was lower than that of the control group after 4-week treatment( P < 0. 05). 3) For adverse reactions,15 cases occurred in the control group( 33. 30%) and5 cases in the observation group( 11. 1%). The incidence of adverse reaction in the observation group was obviously lower than that in the control group( P < 0. 05). 4) HP eradicate rate of the observation group was 93. 3% and that of the control group was 77. 8%. There was statistically significant difference between the two groups( P < 0. 05). ITT analysis between the two groups of patients showed no statistically significant difference( P > 0. 05). PP analysis showed that the eradication rate of the observing group was higher than that of the control group and the difference was statistically significant( P < 0. 05). 5) 4 weeks after the treatment,the plasma MTL level significantly decreased in patients of both the two groups,compared with those before the treatment( P < 0. 05). The declination of plasma MTL level and increase of the level of plasma SS in the observation group were more significantly than those of the control group( P < 0. 05). 6) During the one year follow-up,3 cases in the observation group had ulcer recurrence( 6. 67%) and 8 cases in the control group( 17. 8%). The ulcer recurrence of the observation group was obviously lower than that of the control group( P < 0. 05). Conclusion: Xiaokui Yuyang Decoction combined with triple therapy to treat helicobacter pylori positive peptic ulcer may have significant clinical efficacy,with low HP recurrence rate and no significant adverse reaction,which is worth of promotion.
引文
[1]邹晓荣,曹琴春.三联疗法联合双歧杆菌治疗消化性溃疡的疗效观察[J].中外医学研究,2013,10(10):3-4.
[2]陈晓燕,梁晟楠.PPI三联疗法联合双歧三联活菌制剂对幽门螺杆菌感染的消化性溃疡的疗效观察[J].新医学,2011,42(7):445-446.
[3]Myllyluoma E,Kajander K,Mikkola H,et al.Probiotic intervention decreases serum gastrin·17 in Helicobacter pyloriinfection[J].Dig Liver Dis,2007,39(6):516-523.
[4]陈灏珠.实用内科学[M].14版.北京:人民卫生出版社,2013:1914-1916.
[5]Harach l A,Hahn E G,Konturek P C.Pseudomembranous colitis after eradication of Helieobacter pylori infection with atriple therapy[J].Med Sci Monit,200l,7(4):751-754.
[6]李益农,陆星华.消化内镜学[M].北京:科学出版社,1998:227.
[7]陈坚强.双歧杆菌三联活菌胶囊联合三联疗法治疗消化性溃疡的疗效及预防复发作用[J].中国基层医药,2012,19(19):2966-2967.
[8]李晓辉,张新晓.乇涛.中两医结合治疗消化性溃疡病的相关性研究[J].中国医药导报,2010,25(4):58.
[9]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:335-336.
[10]咏冬,杨迅,王惠吉.兰索拉唑及胶体果胶铋的四联疗法根除幽门螺杆菌感染[J].中华内科杂志,2001,40(1):101-105.
[11]张德正.溃疡性结肠炎的临床治疗与分析[J].中国现代医生,2007,45(8):37,89.
[12]Patel TA,Abraham P,Ashar VJ,et al.Gastric bacterial overgrowth accompanies profound acid suppression[J].Indian J Gastroenterol,1995,14(4):134-136.
[13]Lewis SJ,Franco S,Young G,et al.Altered bowel runetion the duodenal bacterial overgrowth in patients treated with omeprazole[J].Aliment Pharmacol TIler,1996,10(4):557-561.
[14]Coeonnier M H,Lievin V,Bemet-Camard MF,et al.Antibacterial effect of the adhering human Lactobaeillus acidophihs strain LB[J].Antimicrob Agents Chemother,1997,41(5):1046-1052.
[15]Lionetti E,Miniello VL,Castellaneta SP,et al.Lactobaeillus reuteri therapy to reduce side-effects during anti—Helieobacter pylori treatment in children:a randomized placebo controlled trial[J].Aliment Pharmacol Ther,2006,24(10):1461-1468.
[16]曾忠铭,潘令嘉,周殿元,等.临床微生态学及其理论基础[J].中国微生态学杂志,1999,11(6):321-331.
[17]徐平如,黄健,周锋.埃索美拉唑、左氧氟沙星、呋喃唑酮三联疗法根除幽门螺杆菌疗效观察[J].中华医院感染学杂志,2010,20(6):857-859.
[18]陈国平.十天序贯疗法根除42例幽门螺杆菌临床观察[J].临床消化病杂志,2008,21(2):16.
[19]李晓辉,张新晓,乇涛.中两医结合治疗消化性溃疡病的相关性研究[J].中国医药导报,2010,25(4):58.
[20]马建春,赵策,丁留敏.阿莫西林、甲硝唑、奥美拉唑联合治疗消化性溃疡疗效观察[J].中国医药指南,2009,7(7):56-57.
[21]萧树东,刘文忠.幽门螺杆菌感染的治疗现状[J].世界华人消化杂志,1999,7(1):3-4.
[22]魏维师,肖建国.奥美拉唑与雷尼替丁治疗消化性溃疡疗效比较[J].临床和实验医学杂志,2009,8(1):123.
[2]陈晓燕,梁晟楠.PPI三联疗法联合双歧三联活菌制剂对幽门螺杆菌感染的消化性溃疡的疗效观察[J].新医学,2011,42(7):445-446.
[3]Myllyluoma E,Kajander K,Mikkola H,et al.Probiotic intervention decreases serum gastrin·17 in Helicobacter pyloriinfection[J].Dig Liver Dis,2007,39(6):516-523.
[4]陈灏珠.实用内科学[M].14版.北京:人民卫生出版社,2013:1914-1916.
[5]Harach l A,Hahn E G,Konturek P C.Pseudomembranous colitis after eradication of Helieobacter pylori infection with atriple therapy[J].Med Sci Monit,200l,7(4):751-754.
[6]李益农,陆星华.消化内镜学[M].北京:科学出版社,1998:227.
[7]陈坚强.双歧杆菌三联活菌胶囊联合三联疗法治疗消化性溃疡的疗效及预防复发作用[J].中国基层医药,2012,19(19):2966-2967.
[8]李晓辉,张新晓.乇涛.中两医结合治疗消化性溃疡病的相关性研究[J].中国医药导报,2010,25(4):58.
[9]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:335-336.
[10]咏冬,杨迅,王惠吉.兰索拉唑及胶体果胶铋的四联疗法根除幽门螺杆菌感染[J].中华内科杂志,2001,40(1):101-105.
[11]张德正.溃疡性结肠炎的临床治疗与分析[J].中国现代医生,2007,45(8):37,89.
[12]Patel TA,Abraham P,Ashar VJ,et al.Gastric bacterial overgrowth accompanies profound acid suppression[J].Indian J Gastroenterol,1995,14(4):134-136.
[13]Lewis SJ,Franco S,Young G,et al.Altered bowel runetion the duodenal bacterial overgrowth in patients treated with omeprazole[J].Aliment Pharmacol TIler,1996,10(4):557-561.
[14]Coeonnier M H,Lievin V,Bemet-Camard MF,et al.Antibacterial effect of the adhering human Lactobaeillus acidophihs strain LB[J].Antimicrob Agents Chemother,1997,41(5):1046-1052.
[15]Lionetti E,Miniello VL,Castellaneta SP,et al.Lactobaeillus reuteri therapy to reduce side-effects during anti—Helieobacter pylori treatment in children:a randomized placebo controlled trial[J].Aliment Pharmacol Ther,2006,24(10):1461-1468.
[16]曾忠铭,潘令嘉,周殿元,等.临床微生态学及其理论基础[J].中国微生态学杂志,1999,11(6):321-331.
[17]徐平如,黄健,周锋.埃索美拉唑、左氧氟沙星、呋喃唑酮三联疗法根除幽门螺杆菌疗效观察[J].中华医院感染学杂志,2010,20(6):857-859.
[18]陈国平.十天序贯疗法根除42例幽门螺杆菌临床观察[J].临床消化病杂志,2008,21(2):16.
[19]李晓辉,张新晓,乇涛.中两医结合治疗消化性溃疡病的相关性研究[J].中国医药导报,2010,25(4):58.
[20]马建春,赵策,丁留敏.阿莫西林、甲硝唑、奥美拉唑联合治疗消化性溃疡疗效观察[J].中国医药指南,2009,7(7):56-57.
[21]萧树东,刘文忠.幽门螺杆菌感染的治疗现状[J].世界华人消化杂志,1999,7(1):3-4.
[22]魏维师,肖建国.奥美拉唑与雷尼替丁治疗消化性溃疡疗效比较[J].临床和实验医学杂志,2009,8(1):123.