两种方案根除消化性溃疡和慢性胃炎患者幽门螺杆菌的疗效对比
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摘要
目的对比标准三联与四联方案根除消化性溃疡和慢性胃炎患者幽门螺杆菌(Hp)的疗效。方法 2016年10月～2018年3月在西安市北方医院经胃镜检查确诊为慢性胃炎、胃溃疡或十二指肠溃疡患者320例作为研究对象。采用随机数表法,将320例患者分为克拉霉素+甲硝唑+奥美拉唑组(CMO组),克拉霉素+阿莫西林+奥美拉唑组(CAO组),克拉霉素+甲硝唑+奥美拉唑+果胶铋组(CMOP组),克拉霉素+阿莫西林+奥美拉唑+果胶铋组(CAOP组),每组80例。对比4组Hp根除率、临床症状缓解程度、不良反应。此外分析成本-效果比(C/E)。以CMO组为参照,比较不同治疗方案的成本/效果,计算△C/△E=(C1-C2)/(E1-E2)。结果治疗后第1d、7d和14d时,4组症状缓解程度相当,组间比较差异无统计学意义(P>0.05)。治疗结束后CMOP组和CAOP组Hp根除率均较CMO组和CAO组高(P<0.05)。4组不良反应的发生率比较差异无统计学意义(P>0.05)。以CMO组为对照,CAO组、CMOP组和CAOP组的△C/△E分别为4.51、1.98和2.48。结论含铋剂四联方案的Hp根除率较三联方案高,副作用小且较为经济,可在临床上推广应用。
Objective To compare the efficacy of standard triple and quadruple regimens in eradicating Helicobacter pylori(Hp) in patients with peptic ulcer and chronic gastritis. Methods From October 2016 to March 2018, 320 patients with chronic gastritis, gastric ulcer or duodenal ulcer were diagnosed by gastroscopy in our hospital. 320 patients were divided into clarithromycin + metronidazole + omeprazole(CMO) group, clarithromycin + amoxicillin + omeprazole(CAO) group, clarithromycin + metronidazole + omeprazole + pectin bismuth(CMOP) group, clarithromycin + amoxicillin + omeprazole + pectin bismuth(CAOP) group, 80 cases in each group. Hp eradication rate, clinical symptom relief and adverse reactions were compared between the four groups. In addition, the cost-effectiveness ratio(C/E) was analyzed. The cost/effectiveness of different treatment regimens was compared with that of CMO group, and △C/△E=(C1-C2)/(E1-E2) was calculated. Results On the 1 st, 7 th and 14 th day after treatment, the symptoms of the four groups were relieved to the same extent, and there was no significant difference between the groups(P>0.05). After treatment, the eradication rates of HP in the four groups were 70.00%(56/80), 72.50%(58/80), 91.25%(73/80) and 93.75%(75/80), respectively. The eradication rates of Hp in CMOP and CAO P groups were higher than those in CMO and CAO groups(P<0.05). The incidence of adverse reactions was 3.75%, 2.50%, 2.50% and 3.75% respectively. There was no significant difference between the four groups(P>0.05). C/E in group CMO, group CAO, group CMOP and group CAOP were 8.65, 8.51, 7.10 and 7.02 respectively. In group CMO, the △C/△E of group CAO, group CMOP and group CAOP were 4.51, 1.98 and 2.48 respectively. Conclusion The Hp eradication rate of bismuth containing quadruple regimen is higher than that of the triplet scheme, and the side effect is small and economical.
Objective To compare the efficacy of standard triple and quadruple regimens in eradicating Helicobacter pylori(Hp) in patients with peptic ulcer and chronic gastritis. Methods From October 2016 to March 2018, 320 patients with chronic gastritis, gastric ulcer or duodenal ulcer were diagnosed by gastroscopy in our hospital. 320 patients were divided into clarithromycin + metronidazole + omeprazole(CMO) group, clarithromycin + amoxicillin + omeprazole(CAO) group, clarithromycin + metronidazole + omeprazole + pectin bismuth(CMOP) group, clarithromycin + amoxicillin + omeprazole + pectin bismuth(CAOP) group, 80 cases in each group. Hp eradication rate, clinical symptom relief and adverse reactions were compared between the four groups. In addition, the cost-effectiveness ratio(C/E) was analyzed. The cost/effectiveness of different treatment regimens was compared with that of CMO group, and △C/△E=(C1-C2)/(E1-E2) was calculated. Results On the 1 st, 7 th and 14 th day after treatment, the symptoms of the four groups were relieved to the same extent, and there was no significant difference between the groups(P>0.05). After treatment, the eradication rates of HP in the four groups were 70.00%(56/80), 72.50%(58/80), 91.25%(73/80) and 93.75%(75/80), respectively. The eradication rates of Hp in CMOP and CAO P groups were higher than those in CMO and CAO groups(P<0.05). The incidence of adverse reactions was 3.75%, 2.50%, 2.50% and 3.75% respectively. There was no significant difference between the four groups(P>0.05). C/E in group CMO, group CAO, group CMOP and group CAOP were 8.65, 8.51, 7.10 and 7.02 respectively. In group CMO, the △C/△E of group CAO, group CMOP and group CAOP were 4.51, 1.98 and 2.48 respectively. Conclusion The Hp eradication rate of bismuth containing quadruple regimen is higher than that of the triplet scheme, and the side effect is small and economical.
引文
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[12] Cheha KM,Dib SOA,Alhalabi MM.Pilot study:Comparing efficacy of 14-day triple therapy clarithromycin versus levofloxacin on eradication of helicobacter pylori infection in syrian population single-center experience[J].Avicenna J Med,2018,8(1):14-17.
[13] 陈良,魏政熙,阮君山,等.CYP2C19基因多态性对PPI不良反应发生率的影响[J].临床消化病杂志,2015,27(6):329-332.
[14] 朱新影,吴婧,孟霞,等幽门螺杆菌耐药性与铋剂四联方案临床根除疗效的相关性分析[J].中华消化杂志,2016,36(1):26.
[15] 于芳,魏英飞.含铋剂的四联疗法与标准三联疗法对幽门螺杆菌相关性消化性溃疡的疗效对比[J].中国实用医药,2016,11(21):144-145.
[16] 司小北,蓝宇,乔蕾.含铋剂四联方案联合微生态制剂根除幽门螺杆菌疗效的Meta分析[J].中华内科杂志,2017,56(10):752-759.
[17] 第四次全国幽门螺杆菌感染处理共识报告[J].中华内科杂志,2012,51(10):832-837.疗效的Meta分析[J].中华内科杂志,2017,56(10):752-759.
[18] 孔聪聪,刘改芳,吴婧,等.不同铋剂四联方案根除幽门螺杆菌240例的疗效分析[J].中华消化杂志,2014,34(8):513-515.
[19] 黄颖妍,周志全,杨贤杰,等.含铋剂四联疗法、序贯疗法与标准三联疗法根治幽门螺杆菌的疗效对比研究[J].吉林医学,2017,38(5):874-876.
[2] 屈姝均,白雪松,陈利华,等.健康体检人群幽门螺旋杆菌感染的调查[J].中华老年医学杂志,2017,36(2):214-218.
[3] Fuccio L,Minardi ME,Zagari RM,et al.Meta-analysis:duration of first-line proton-pump inhibitor based triple therapy for helicobacter pylori eradication[J].Ann Intern Med,2007,147(8):553-562.
[4] Lahbabi M,Alaoui S,EL Rhazi K,et al.Sequential therapy versus standard triple-drug therapy for helicobacter pylori eradication:result of the HPFEZ randomised study[J].Clin Res Hepatol Gastroenterol,2013,37(4):416-421.
[5] 吕秋菊,蒲强红.白介素1β基因多态性对质子泵抑制剂三联方案根除幽门螺杆菌疗效影响的Meta分析[J].中国现代应用药学,2018,35(5):730-734.
[6] Gisbert JP,Pajares R,Pajares JM.Evolution of helicobacter pylori therapy from a meta-analytical perspective[J].Helicobacter,2007,12(2):50-58.
[7] Malfertheiner P,Megraud F,O'morain CA,et al.Management of helicobacter pylori infection-the maastricht v/florence consensus report[J].2017,66(1):6-30.
[8] 蒋永爱,欧希龙,王建宁.地衣芽孢杆菌联合PPI三联疗法根除幽门螺杆菌的临床疗效[J].世界华人消化杂志,2013,56(9):840-844.
[9] 王波玲,高峰.标准三联与四联方案根除幽门螺杆菌感染成本-效果分析[J].中国全科医学,2016,19(11):1237-1241.
[10] O'morain NR,Dore MP,O'connor AJP,et al.Treatment of helicobacter pylori infection in 2018[J].Helicobacter,2018,23(1):e12519.
[11] Ennkaa A,Shaath N,Salam A,et al.Comparison of 10 and 14 days of triple therapy versus 10 days of sequential therapy for helicobacter pylori eradication:a prospective randomized study[J].Turk J Gastroenterol,2018,29(5):549-554.
[12] Cheha KM,Dib SOA,Alhalabi MM.Pilot study:Comparing efficacy of 14-day triple therapy clarithromycin versus levofloxacin on eradication of helicobacter pylori infection in syrian population single-center experience[J].Avicenna J Med,2018,8(1):14-17.
[13] 陈良,魏政熙,阮君山,等.CYP2C19基因多态性对PPI不良反应发生率的影响[J].临床消化病杂志,2015,27(6):329-332.
[14] 朱新影,吴婧,孟霞,等幽门螺杆菌耐药性与铋剂四联方案临床根除疗效的相关性分析[J].中华消化杂志,2016,36(1):26.
[15] 于芳,魏英飞.含铋剂的四联疗法与标准三联疗法对幽门螺杆菌相关性消化性溃疡的疗效对比[J].中国实用医药,2016,11(21):144-145.
[16] 司小北,蓝宇,乔蕾.含铋剂四联方案联合微生态制剂根除幽门螺杆菌疗效的Meta分析[J].中华内科杂志,2017,56(10):752-759.
[17] 第四次全国幽门螺杆菌感染处理共识报告[J].中华内科杂志,2012,51(10):832-837.疗效的Meta分析[J].中华内科杂志,2017,56(10):752-759.
[18] 孔聪聪,刘改芳,吴婧,等.不同铋剂四联方案根除幽门螺杆菌240例的疗效分析[J].中华消化杂志,2014,34(8):513-515.
[19] 黄颖妍,周志全,杨贤杰,等.含铋剂四联疗法、序贯疗法与标准三联疗法根治幽门螺杆菌的疗效对比研究[J].吉林医学,2017,38(5):874-876.