不同四联补救方案根除幽门螺杆菌疗效比较研究_杨雪

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Chinese Journal of Practical Internal Medicine May 2015 Vol. 35 No. 5

论 著

不同四联补救方案根除幽门螺杆菌疗效比较研究

杨 雪，高采平，邱春华

DOI：10.7504/nk2015040303 中图分类号：R573.3 文献标志码：A

摘要：目的 分析3种含铋剂四联方案作为标准方案初治幽门螺杆菌(Helicobacter pylori，Hp)失败的补救治疗的疗效及安全性，并对成本-效果进行分析。方法 以2012年1月至2013年12月四川省人民医院门诊经标准方案初治失败的Hp 阳性慢性胃炎伴消化不良患者180例，将其随机分入A、B、C 3组。A 组：雷贝拉唑10 mg+果胶铋200 mg+四环素750 mg+呋喃唑酮100 mg,每日2次，疗程14 d ；B 组：雷贝拉唑10 mg+果胶铋200 mg+阿莫西林1000 mg，每日2次，联合左氧氟沙星500 mg，每日1次，疗程14 d ；C 组:雷贝拉唑10 mg+果胶铋200 mg+阿莫西林1000 mg+呋喃唑酮100 mg，每日2次，疗程14 d。治疗结束至少停药4周后行14C 尿素呼气试验确定Hp 根除情况。对Hp 根除率进行意向性分析(intention-to-test，ITT)和符合方案分析(per-protocol，PP)。分析3组方案的疗效、安全性及成本-效果。结果 A、B、C 组Hp 根除率分别为：ITT 83.33%(50/60)、PP 89.29%(50/56)，ITT 85.0%(51/60)、PP 87.93%(51/58)，ITT 80.0%(48/60)、PP 87.27%(48/55)；3组的不良反应发生率分别为7.14%(4/56)、5.17%(3/58)、7.27%(4/55)；组间差异均无统计学意义(P ＞0.05)。成本及成本-效果比值显示A 组＜C 组＜B 组。结论 四环素或阿莫西林联合呋喃唑酮以及左氧氟沙星联合阿莫西林的含铋剂四联疗法可以作为标准方案初治Hp 失败的有效安全的补救方案。其中四环素+呋喃唑酮的四联方案更具经济学优势，更为理想。关键词：幽门螺杆菌；铋剂；四环素；呋喃唑酮；左氧氟沙星；阿莫西林

Efficacy comparison between different quadruple rescue therapies in eradication of Helicobacter pylori . YANG Xue, GAO Cai-ping, QIU Chun-hua. Department of Gastroenterology, Sichuan Academy of Medical Sciences & Sichuan Provincial People´s Hospital, Chengdu 610072, China

Corresponding author: YANG Xue, E-mail: lydiayx@

Abstract:Objective To compare the efficacy, safety and cost effectiveness of three different bismuth-containing quadruple rescue regimens in treatment of Helicobacter pylori (HP) infection after failure of the first eradication with standard triple regimen. Methods A total of 180 patients suffered HP-positive chronic gastritis with dyspepsia after failure of the first eradication with standard triple regimen were recruited and randomly assigned into group A, B and C. Group A received treatment of rabeprazole 10 mg+colloidal bismuth pectin 200 mg+tetracycline 750 mg+furazolidone 100 mg twice daily for 14 days. Group B received treatment of rabeprazole 10 mg+colloidal bismuth pectin 200 mg+amoxicillin 1000 mg twice daily, along with levofloxacin 500 mg daily for 14 days. Group C received treatment of rabeprazole 10 mg+colloidal bismuth pectin 200 mg+amoxicillin 1000 mg+furazolidone 100 mg twice daily for 14 days. The 14C-urea breath test was performed at least 4 weeks after completion of therapy to judge whether HP was eradicated. The rates of HP eradication were analyzed according to the intention-to-treat(ITT) and per-protocol(PP) principle. The efficacy, safety and cost effectiveness of the three groups were evaluated. Results The eradication rates of HP in group A, B and C were as follows respectively: ITT 83.33%(50/60), PP 89.29%(50/56), ITT 85.0%(51/60),PP 87.93%(51/58), and ITT 80.0%(48/60), PP 87.27%(48/55). The adverse reaction rates in group A, B and C were 7.14%(4/56), 5.17%(3/58) and 7.27%(4/55), respectively. There were no significant differences between the three groups(P >0.05).The cost and cost-effectiveness ratio were shown as group A

世界上有超过50%的人感染幽门螺杆菌(Hp)。尽管根除Hp 的失败率超过了30%，当前的指南仍推荐标准三联疗法作为治疗Hp 感染的首选方案。

基金项目：国家自然科学基金青年科学基金项目(81001083)作者单位：四川省医学科学院 四川省人民医院消化内科，成都 610072

电子信箱：lydiayx@