本文關(guān)鍵詞：蘭索拉唑、阿莫西林和依卡倍特鈉三聯(lián)根除幽門螺桿菌的臨床觀察，由筆耕文化傳播整理發(fā)布。

        目的：探討蘭索拉唑、阿莫西林、依卡倍特鈉三聯(lián)根除幽門螺桿菌(Hp)的有效性，旨在減少抗生素副作用、降低耐藥性和抗生素不良反應(yīng)發(fā)生率、提高患者依從性，并探討其對(duì)細(xì)胞毒素相關(guān)蛋白(CagA)+Hp患者和CagA-Hp患者幽門螺桿菌根除療效的影響，觀察幽門螺桿菌根除治療前后患者血清胃蛋白酶原含量的變化。方法：選取2010年9月至2012年1月期間在長(zhǎng)沙市第一醫(yī)院消化科門診及住院部就診行14碳呼氣試驗(yàn)（14C—UBT）及胃鏡確診的194例Hp感染的糜爛性胃炎患者作為觀察對(duì)象。采用ELISA法測(cè)定患者血清CagA蛋白抗體后分成2組，即CagA+Hp患者組98例，CagA-Hp患者組96例，將CagA+Hp患者分成3組：A組（32例）：蘭索拉唑片（30mg Bid）+阿莫西林膠囊（1.0g Bid）+克拉霉素緩釋片（0.5g Bid），療程7天；B組（30例）：蘭索拉唑片（30mg Bid）+阿莫西林膠囊（1.0g Bid）+克拉霉素緩釋片（0.5g Bid）+依卡倍特鈉顆粒（1.0gBid），療程7天；C組（36例）：蘭索拉唑片（30mg Bid）+阿莫西林膠囊（1.0gBid）+依卡倍特鈉顆粒（1.0g Bid），療程7天；將CagA-Hp患者分成3組：D組（31例）：蘭索拉唑片（30mg Bid）+阿莫西林膠囊（1.0g Bid）+克拉霉素緩釋片（0.5g Bid），療程7天；E組（33例）：蘭索拉唑片（30mg Bid）+阿莫西林膠囊（1.0g Bid）+克拉霉素緩釋片（0.5g Bid）+依卡倍特鈉顆粒（1.0g Bid），療程7天；F組（32例）：蘭索拉唑片（30mg Bid）+阿莫西林膠囊（1.0g Bid）+依卡倍特鈉顆粒（1.0g Bid），療程7天。予停藥后1個(gè)月復(fù)查14C—UBT以了解Hp根除情況。分別予用藥前、停藥后1個(gè)月抽血測(cè)定血清中胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）含量并計(jì)算PGⅠ/PGⅡ比值，比較治療前后PGⅠ、PGⅡ含量的變化，同時(shí)完善治療前后血常規(guī)、肝腎功能檢查，記錄治療期間及之后患者的不良反應(yīng)。結(jié)果：各組Hp根除療效：通過(guò)治療后A組的Hp根除率為71.9%，B組的Hp根除率為86.7%，C組的Hp根除率為69.4%，D組的Hp根除率為77.4%，，E組的Hp根除率為90.9%，F(xiàn)組的Hp根除率為75.0%。C組與A組相比較無(wú)統(tǒng)計(jì)學(xué)意義，C組與B組相比較有統(tǒng)計(jì)學(xué)意義，F(xiàn)組與D組相比較無(wú)統(tǒng)計(jì)學(xué)意義，F(xiàn)組與E組相比較有統(tǒng)計(jì)學(xué)意義。說(shuō)明蘭索拉唑、阿莫西林、依卡倍特鈉三聯(lián)療法組在Hp感染根除治療中能有效的根除Hp，其療效相當(dāng)于傳統(tǒng)三聯(lián)療法組，但低于蘭索拉唑、阿莫西林、克拉霉素、依卡倍特鈉四聯(lián)療法組。C組與F組相比較有統(tǒng)計(jì)學(xué)意義，B組與E組相比較有統(tǒng)計(jì)學(xué)意義，A組與D組相比較無(wú)統(tǒng)計(jì)學(xué)意義。說(shuō)明蘭索拉唑、阿莫西林、依卡倍特鈉三聯(lián)療法組與蘭索拉唑、阿莫西林、克拉霉素、依卡倍特鈉四聯(lián)療法組對(duì)CagA-Hp患者的根除療效優(yōu)于CagA+Hp患者。不良反應(yīng)情況：194例患者在根除Hp過(guò)程中出現(xiàn)不同程度惡心、嘔吐、腹痛、血常規(guī)異常、腹瀉、頭暈、皮疹、金屬味覺、肝腎功能異常等不良反應(yīng)。A組的不良反應(yīng)率為43.8%，B組的不良反應(yīng)率為36.7%，C組的不良反應(yīng)率為13.9%，D組的不良反應(yīng)率為41.9%，E組的不良反應(yīng)率為36.4%，F(xiàn)組的不良反應(yīng)率為18.9%。C組與A組比較有統(tǒng)計(jì)學(xué)意義，C組與B組比較有統(tǒng)計(jì)學(xué)意義，F(xiàn)組與D組比較有統(tǒng)計(jì)學(xué)意義，F(xiàn)組與E組比較有統(tǒng)計(jì)學(xué)意義。說(shuō)明蘭索拉唑、阿莫西林、依卡倍特鈉三聯(lián)療法組的不良反應(yīng)發(fā)生率低于傳統(tǒng)三聯(lián)療法組與蘭索拉唑、阿莫西林、克拉霉素、依卡倍特鈉四聯(lián)療法組。各組治療前后血清PGⅠ／PGⅡ比值升高程度：A組治療前后血清PGⅠ／PGⅡ比值升高程度有統(tǒng)計(jì)學(xué)意義（P=0.034）；B組的有統(tǒng)計(jì)學(xué)意義（P=0.030）；C組的有統(tǒng)計(jì)學(xué)意義（P=0.016）；D組的有統(tǒng)計(jì)學(xué)意義（P=0.040）；E組的有統(tǒng)計(jì)學(xué)意義（P=0.035）；F組的有統(tǒng)計(jì)學(xué)意義（P=0.029）。說(shuō)明各組藥物根除Hp前后血清胃蛋白酶原均有不同程度的特異性改變，表現(xiàn)為PGⅠ下降、PGⅡ明顯下降、PGⅠ／PGⅡ升高。結(jié)論：（1）蘭索拉唑、阿莫西林、依卡倍特鈉三聯(lián)療法組在Hp根除治療中能有效根除Hp，可減少抗生素耐藥性和不良反應(yīng)發(fā)生率，同時(shí)提高患者依從性；（2）蘭索拉唑、阿莫西林、依卡倍特鈉三聯(lián)療法組對(duì)CagA-Hp患者的Hp根除療效優(yōu)于CagA+Hp患者；（3）抗Hp藥物根除Hp前后血清胃蛋白酶原均有不同程度的特異性改變，表現(xiàn)為PGⅠ下降、PGⅡ明顯下降、PGⅠ／PGⅡ升高。

    ObjectiveThe aim of the research is to explore a new treatment of helicobacter pylorieradication with lansoprazole amoxicillin and ecabet sodium, so as to reduce the resis-tance and clarithromycin antibiotics adverse reaction rate,to improve patients’com-pliance. And to further explore the influence of the treatment of Helicobacter pylori ofthe CagA+Hp patients and CagA-Hp patients, to observe the change of PG before and aftereradicate helicobacter pylori for patients.MethodsSubjects were these patients with erosive gastritis who infected by Hp.Those194cases were selected randomly from outpatient and inpatient in Gastroenterology deptin Changsha First Hospital during September2010to January2012(227cases wereselected,but33of them were removed).Do14C—UBT,Hp histological examination af-ter gastric mucous membrane live organization did HE staining before the treatment.The person who meets them were proved to be Hp positive.Do14C—UBT to confirmewhether Hp was eradicated after1month treatment.Each patient was used ELISA method to determine the patients’ serum CagAprotein antibody. Firstly, divided194patients into2groups (98CagA+Hp patientsand96CagA-Hp patients). And then divided98CagA+Hp patients randomly into3groups: Patients in the A group(32cases) were received treatment of lansoprazoletablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid)for7days.Patients in the B group(30cases) were received treatment of lansoprazoletablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid)+ecabet sodium (1.0g Bid)for7days.Patients in the C group(36cases) were received treatment of lansoprazole tablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+ecabetsodium (1.0g Bid)for7days.Divided96CagA-Hp patients randomly into3groups:Patients in the D group(31cases) were received treatment of lansoprazole tablets (30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid) for7days.Patients in the E group(33cases) were received treatment of lansoprazole tablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+clarithromycin tablets(0.5g Bid)+ecabet so-dium(1.0g Bid)for7days.Patients in the F group(32cases)were received treatment oflansoprazole tablets(30mg Bid)+amoxicillin capsule(1.0g Bid)+ecabet sodium (1.0gBid) for7days.Measured the content of PGⅠand PGⅡin blood serum before treatment and af-ter1month treatment separately,and calculated PGⅠ/PGⅡratio,compared the changeof PGⅠand PGⅡ’s content before and after the treatment,checked routine blood testsand liver and kidney function tests before and after the treatment,recorded patients’ ad-verse reactions during and after the treatment.ResultsThe Hp eradication curative effects:the group C’s Hp eradicate rate was69.4%,the group A’s Hp eradicate rate was71.9%, group C compared with group A was notstatistically significant; the group C’s Hp eradicate rate was69.4%, the group B’s Hperadicate rate was86.7%, group C compared with group B was statistically significant;the group F’s Hp eradicate rate was75.0%,the group D’s Hp eradicate rate was77.4%,group F compared with group D was not statistically significant;the group F’s Hp era-dicate rate was75.0%, the group E’s Hp eradicate rate was90.9%, group F comparedwith group E was statistically significant.It shown that triple therapy with lansoprazo-le,amoxicillin and ecabet sodium could play a certain role in eradicate Hp, its curativeeffect were similar to traditional triple therapy group and lower than the group of lan-soprazole, amoxicillin, clarithromycin and ecabet sodium.The group C(Hp eradicate rate was69.4%) compared with group F (Hp eradicaterate was75.0%) was statistically significant;the group B (Hp eradicate rate was86.7%)compared with group E (Hp eradicate rate was90.9%) was statistically significant; the group A (Hp eradicate rate was71.9%) compared with group D(Hp eradicate rate was77.4%) was not statistically significant. It shown that CagA-Hp patients’ therapeuticeradication was better than CagA+Hp patients in lansoprazole,amoxicillin,ecabet sod-ium triple therapy group and the group of lansoprazole,amoxicillin,clarithromycin andecabet sodium.Reverse reaction:194patients in the the process of Hp eradication appeared naus-ea,vomiting, abdominal pain, diarrhea, abnormal blood routine, dizziness, skin rashes,metal taste,kidney and liver dysfunction adverse reactions in different degrees.The gr-oup C (adverse reaction rate was13.9%) compared with group A(adverse reaction ratewas43.8%) was statistically significant; the group C (adverse reaction rate was13.9%)compared with group B(adverse reaction rate was36.7%) was statistically significant;the group F (adverse reaction rate was18.9%) compared with group D(adverse reacti-on rate was41.9%) was statistically significant; the group F (adverse reaction rate was18.9%) compared with group E(adverse reaction rate was36.4%) was statistically sig-nificant.It shown that the incidence of adverse effects of lansoprazole,amoxicillin,eca-bet sodium triple therapy group was lower than traditional triple therapy group and thegroup of lansoprazole, amoxicillin, clarithromycin and ecabet sodium.The degree of the increase of PGⅠ/PGⅡ ratio before and after eradicate Hp in ea-ch group: the results of the PGⅠ/PGⅡ ratio in the groups from A to F before and afterthe treatment were that P<0.05respectively.It shown that PGⅠ decreased and PGⅡ dr-amatic declined,PGⅠ/PGⅡ increased before and after each group eradicate Hp.It sho-wn that its the degree of the increase of PGⅠ/PGⅡ ratio before and after each grouperadicate Hp was similar to traditional triple therapy group and lower than the groupof lansoprazole, amoxicillin, clarithromycin and ecabet sodium.Conclution(1)Triple therapy with lansoprazole,amoxicillin and ecabet sodium could eradic-ate Hp effectively, its curative effect were similar to traditional triple therapy groupand lower than the group of lansoprazole,amoxicillin,clarithromycin and ecabet sod-ium,could reduce antibiotic application,reduce the resistance and reduce clarithromy- cin antibiotics adverse reaction of incidence,improve patient compliance, improve Hperadication rates relatively.(2) Ecabet sodium could strengthen the CagA-Hp patients’curative effect.(3) The serum pepsinogen were specificity change in different degreebefore and after each group eradicate Hp:PGⅠ decreased and PGⅡ dramatic declined,PGⅠ/PGⅡ increased,PG content in serum could as one of Hp eradicate judgment inde-xes.

        蘭索拉唑、阿莫西林和依卡倍特鈉三聯(lián)根除幽門螺桿菌的臨床觀察

主要英文縮略詞4-5中文摘要5-7Abstract7-10前言11-14材料與方法14-21結(jié)果21-29討論29-33結(jié)論33-34參考文獻(xiàn)34-37綜述37-44    參考文獻(xiàn)（References）41-44攻讀碩士學(xué)位期間發(fā)表的論文44-45致謝辭45

  本文關(guān)鍵詞：蘭索拉唑、阿莫西林和依卡倍特鈉三聯(lián)根除幽門螺桿菌的臨床觀察，由筆耕文化傳播整理發(fā)布。