十天序贯疗法与标准三联疗法治疗幽门螺杆菌感染的疗效及对患者昼夜胃内p H的影响
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摘要
目的探讨在幽门螺杆菌(Hp)感染治疗中10 d序贯疗法与标准三联疗法的疗效及其对患者昼夜胃内p H的影响。方法选择2016年5月至2018年2月中南大学湘雅医学院附属海口医院收治的128例Hp相关性胃溃疡患者为研究对象,根据治疗方法的不同分为观察组与对照组各64例。对照组给予标准三联疗法(埃索美拉唑+阿莫西林克拉维酸钾+克拉霉素)连续治疗10 d;观察组给予10 d序贯疗法(前5天埃索美拉唑+阿莫西林克拉维酸钾,后5天埃索美拉唑+克拉霉素+替硝唑)治疗。疗程结束4周后复查胃镜评定,对比疗效和Hp清除率;进行两组昼夜胃内p H值变化情况监测。结果治疗4周后评价,总有效率观察组为98. 4%,对照组为87. 5%,观察组高于对照组(P <0. 05)。治疗4周后检测,Hp根除率观察组达100. 0%,对照组仅90. 6%,观察组优于对照组(P <0. 05)。在24 h、进餐时、餐后2 h与夜间的胃内p H值两组治疗后都显著低于同时点治疗前(P均<0. 05),观察组各时点均低于对照组(P均<0. 05)。治疗期间,恶心、腹泻、头晕、纳差等不良反应的总发生率观察组为7. 8%,对照组为10. 9%,二者相当(P> 0. 05)。结论相对于标准三联疗法,10 d序贯疗法治疗Hp感染,能促进昼夜胃内p H值的降低,提高Hp根治率与治疗效果,且安全性好。
Objective To investigate the effects of 10-day sequential therapy and standard triple therapy on treatment of Helicobacter pylori( Hp) infection and its influence on circadian intragastric p H in patients. Methods A total of 128 patients with Hp-related gastric ulcer treated in affiliated Haikou Hospital of Xiangya School of Medicine from May 2016 to February 2018 were selected and divided into the observation group and the control group( n = 64,each) according to the different treatment methods. The standard triple therapy was given for ten days in control group,and the 10-day sequential therapy was given in observation group. Four weeks after the end of treatment,gastroscopy was reexamined to evaluate the efficacy and clearance rate of Hp. The changes of circadian intragastric p H were observed and recorded between two groups.Results After four weeks of treatment,the total effective rate( 98. 4% vs 87. 5%) and the eradication rate of Hp( 100. 0% vs 90. 6%) in observation group were significantly higher than those in control group( all P < 0. 05). The gastric p H values at 24 hours,at mealtime,postprandial 2 hours and at night were significantly lower than those before treatment in both groups( all P < 0. 05),and they were also statistically lower in observation group than those in control group at each point( all P < 0. 05). During the treatment period,the total incidence of adverse reactions such as nausea,diarrhea,dizziness and poor appetite was 7. 8% in observation group and 10. 9% in control group,but there was no significant difference between two groups( P > 0. 05). Conclusion Compared with standard triple therapy,10-day sequential therapy can reduce the circadian intragastric p H values,increase the eradication rate and curative effect with a good safety for the patients with Hp infection.
Objective To investigate the effects of 10-day sequential therapy and standard triple therapy on treatment of Helicobacter pylori( Hp) infection and its influence on circadian intragastric p H in patients. Methods A total of 128 patients with Hp-related gastric ulcer treated in affiliated Haikou Hospital of Xiangya School of Medicine from May 2016 to February 2018 were selected and divided into the observation group and the control group( n = 64,each) according to the different treatment methods. The standard triple therapy was given for ten days in control group,and the 10-day sequential therapy was given in observation group. Four weeks after the end of treatment,gastroscopy was reexamined to evaluate the efficacy and clearance rate of Hp. The changes of circadian intragastric p H were observed and recorded between two groups.Results After four weeks of treatment,the total effective rate( 98. 4% vs 87. 5%) and the eradication rate of Hp( 100. 0% vs 90. 6%) in observation group were significantly higher than those in control group( all P < 0. 05). The gastric p H values at 24 hours,at mealtime,postprandial 2 hours and at night were significantly lower than those before treatment in both groups( all P < 0. 05),and they were also statistically lower in observation group than those in control group at each point( all P < 0. 05). During the treatment period,the total incidence of adverse reactions such as nausea,diarrhea,dizziness and poor appetite was 7. 8% in observation group and 10. 9% in control group,but there was no significant difference between two groups( P > 0. 05). Conclusion Compared with standard triple therapy,10-day sequential therapy can reduce the circadian intragastric p H values,increase the eradication rate and curative effect with a good safety for the patients with Hp infection.
引文
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[20] Sebbagh S,Roux J,Dreyer C,et al. Efficacy of a sequential treatment strategy with GEMOX-based followed by FOLFIRI-based chemotherapy in advanced biliary tract cancers[J]. Acta Oncol,2016,55(9/10):1168-1174.
[21] Li A,Li W,Hao F,et al. Early stage blood purification for paraquat poisoning:a multicenter retrospective study[J]. Blood Purif,2016,42(2):93-99.
[22] Voron T,Eveno C,Jouvin I,et al. Cytoreductive surgery with a hyperthermic intraperitoneal chemotherapy program:safe after 40 cases,but only controlled after 140 cases[J]. Eur J Surg Oncol,2015,41(12):1671-1677.
[23]王瑞勤,徐双成,焦连华,等.十二指肠溃疡胃内pH昼夜变化[J].中华实用诊断与治疗杂志,2002,16(4):249-250.
[24] Lebdai S,Basset V,Branchereau J,et al. What do we know about treatment sequencing of abiraterone,enzalutamide,and chemotherapy in metastatic castration-resistant prostate cancer?[J]. World J Urol,2016,34(5):617-624.
[2] Moradniani M,Mirbeik-Sabzevari Z,Jaferian S,et al. Levofloxacin based vs clarithromycin based sequential therapy in helicobacter pylori eradication; a randomized clinical trial[J]. Gastroenterol Hepatol Bed Bench,2018,11(1):19-26.
[3]李国辉.三种疗法根除儿童幽门螺杆菌的疗效比较[J].天津药学,2017,29(2):45-46.
[4] Seyyed Majidi M,Sanjari Pirayvatlou P,Rajabikashani M,et al.Comparison of Helicobacter pylori eradication regimens in patients with end stage renal disease[J]. Gastroenterol Hepatol Bed Bench,2018,11(1):15-19.
[5] Celik M,Yigit M. The efficiency of levofloxacin containing sequential therapy with or without bismuth,in helicobacter pylori eradication,in non-ulcer dyspepsia[J]. Acta Gastroenterol Belg,2017,80(1):39-42.
[6]彭廷勇,何熙国,周琮凯,等.序贯疗法治疗幽门螺杆菌阳性消化性溃疡的疗效观察及安全性分析[J].实用医院临床杂志,2017,14(2):88-90.
[7] Fujii T,Ganeko R,Kataoka Y,et al. Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock:a systematic review with meta-analysis and trial sequential analysis[J]. Intensive Care Med,2018,44(2):167-178.
[8]杨秀红,樊晓明,谈朋生,等.序贯疗法与四联疗法对幽门螺杆菌的根除效果比较[J].实用临床医药杂志,2017,21(1):170-171,185.
[9] Grabar S,Groh M,Bahuaud M,et al. Pneumococcal vaccination in patients with systemic lupus erythematosus:a multicenter placebocontrolled randomized double-blind study[J]. Vaccine,2017,35(37):4877-4885.
[10]张富东,杨思芸,苏强,等.南充市城区消化性溃疡患者抗幽门螺杆菌规范治疗情况分析[J].广东医学,2017,38(5):775.
[11] Huang CC,Tsai KW,Tsai TJ,et al. Update on the first-line treatment for Helicobacter pylori infection-a continuing challenge from an old enemy[J]. Biomark Res,2017(5):23.
[12]曹翠丽.序贯三联疗法治疗Hp阳性慢性胃炎的疗效观察及安全性分析[J].现代诊断与治疗,2017,28(18):3478-3479.
[13] Hirai E,Sarukawa S,Yamamoto K,et al. Breast cancer in a pectoralis major myocutaneous flap used for the reconstruction of tongue cancer:a case report[J]. J Oral Maxillofac Surg,2017,75(7):1569.
[14]任玲,陆红,李海燕,等.以高剂量和普通剂量雷贝拉唑为基础的改良二联疗法根除幽门螺杆菌疗效初探[J].中华消化内镜杂志,2018,35(1):60-62.
[15] Lahat A,Kopylov U,Neuman S,et al. Helicobacter pylori prevalence and clinical significance in patients with quiescent Crohn's disease[J]. BMC Gastroenterol,2017,17(1):27.
[16] Zeidan AM,Salem MR,Bamadhaj M,et al. The cricoid force necessary to occlude the esophageal entrance:is there a gender difference[J]. Anesth Analg,2017,124(4):1168-1173.
[17] Theodoridis C,Grigoriadis A,Menexes G,et al. Outcomes of implant therapy in patients with a history of aggressive periodontitis. A systematic review and meta-analysis[J]. Clin Oral Investig,2017,21(2):485-503.
[18]郭建强,杨崇美,刘斌,等.雷贝拉唑不同剂量和用法对健康人胃内昼夜pH变化的影响[J].中国新药杂志,2004,13(5):462-465.
[19] Samson C,Tamalet A,Thien HV,et al. Long-term effects of azithromycin in patients with cystic fibrosis[J]. Respir Med,2016,117:1-6.
[20] Sebbagh S,Roux J,Dreyer C,et al. Efficacy of a sequential treatment strategy with GEMOX-based followed by FOLFIRI-based chemotherapy in advanced biliary tract cancers[J]. Acta Oncol,2016,55(9/10):1168-1174.
[21] Li A,Li W,Hao F,et al. Early stage blood purification for paraquat poisoning:a multicenter retrospective study[J]. Blood Purif,2016,42(2):93-99.
[22] Voron T,Eveno C,Jouvin I,et al. Cytoreductive surgery with a hyperthermic intraperitoneal chemotherapy program:safe after 40 cases,but only controlled after 140 cases[J]. Eur J Surg Oncol,2015,41(12):1671-1677.
[23]王瑞勤,徐双成,焦连华,等.十二指肠溃疡胃内pH昼夜变化[J].中华实用诊断与治疗杂志,2002,16(4):249-250.
[24] Lebdai S,Basset V,Branchereau J,et al. What do we know about treatment sequencing of abiraterone,enzalutamide,and chemotherapy in metastatic castration-resistant prostate cancer?[J]. World J Urol,2016,34(5):617-624.