本文選題：瑞巴派特 + 鉍劑��； 參考：《第二軍醫(yī)大學》2017年碩士論文

【摘要】：目的:對比不使用黏膜保護劑、使用鉍劑和使用瑞巴派特的三組胃潰瘍患者在治療后潰瘍愈合情況、胃黏膜組織學變化、臨床癥狀變化、幽門螺旋桿菌(Hp)根除情況和藥物不良反應,綜合評價瑞巴派特在治療胃潰瘍中的安全性、有效性,以及在根除Hp中的作用,從而為優(yōu)化胃黏膜保護劑的選擇,尋找可替代鉍劑進行根除Hp的胃黏膜保護劑做出探索。方法:選取海軍總醫(yī)院消化內科胃潰瘍患者共180名,其中納入Hp(+)、Hp(-)者各90名。Hp(+)胃潰瘍患者隨機分為三聯(lián)組(30人)、B四聯(lián)組(30人)、R四聯(lián)組(30人)。三組用藥方案分別是泮托拉唑鈉腸溶片40mg 2/日+阿莫西林克拉維酸鉀片1500mg 2/日+克拉霉素片500mg 2/日;泮托拉唑鈉腸溶片40mg 2/日+阿莫西林克拉維酸鉀片1500mg 2/日+克拉霉素片500mg 2/日+枸櫞酸鉍鉀膠囊0.3g 3/日;泮托拉唑鈉腸溶片40mg 2/日+阿莫西林克拉維酸鉀片1500mg 2/日+克拉霉素片500mg 2/日+瑞巴派特片100mg 3/日。第0天開始服藥,第14天停用抗生素,第28天復查胃鏡。記錄第0天、第28天的癥狀、潰瘍形態(tài)、胃黏膜組織形態(tài);記錄第28天藥物不良反應癥狀;復查13C呼氣實驗并記錄Hp根除情況,對比三組之間上述指標的差異。Hp(-)胃潰瘍患者隨機分為PPI組(31人)、PPI+B組(26人)、PPI+R組(33人)。三組用藥方案分別是泮托拉唑鈉腸溶片40mg 2/日;泮托拉唑鈉腸溶片40mg 2/日+枸櫞酸鉍鉀膠囊0.3g 3/日;泮托拉唑鈉腸溶片40mg2/日+瑞巴派特片100mg 3/日。第0天開始服藥,第28天復查胃鏡。記錄第0天、第28天的癥狀、潰瘍形態(tài)、胃黏膜組織形態(tài);記錄第28天藥物不良反應癥狀,對比三組之間上述指標的差異。結果:1、Hp(+)胃潰瘍患者治療28天后,在殘留潰瘍數(shù)量、崎田三輪(AHS)分類、S期潰瘍患者例數(shù)、潰瘍愈合情況等指標上,三組之間差異顯著(P0.05)。在潰瘍直徑、Forrest分級、總有效率等指標上無顯著差異(P0.05)。兩兩組間對比:在殘留潰瘍數(shù)量上,R四聯(lián)組(0.30±0.53)、B四聯(lián)組(0.40±0.72)分別少于三聯(lián)組(0.83±0.87),差異顯著(P0.05,P0.05);在AHS分期上,R四聯(lián)組和三聯(lián)組差異顯著(P0.05),前者潰瘍脫離急性期的情況優(yōu)于后者;在S期潰瘍患者例數(shù)占比上,R四聯(lián)組(73.73%)高于三聯(lián)組(40%),差異顯著(P0.017);在潰瘍愈合情況上,R四聯(lián)組和三聯(lián)組差異顯著(P0.05),前者愈合情況優(yōu)于后者。2、Hp(+)胃潰瘍患者在Hp根除率上,三組之間差異顯著(P0.05)。兩兩組間對比:B四聯(lián)組(96.67%)高于三聯(lián)組(73.33%),差異顯著(P0.017)。R四聯(lián)組(86.67%)分別和三聯(lián)組(73.33%)、B四聯(lián)組(96.67%)相比,均無顯著差異(P0.017,P0.017)。3、Hp(+)胃潰瘍患者治療28天后,三組之間在黏膜損傷積分上差異顯著(P0.05)。兩兩組間對比:R四聯(lián)組(1.13±0.35)、B四聯(lián)組(1.40±0.56)分別低于三聯(lián)組(1.87±0.78),差異顯著(P0.05,P0.05)。4、Hp(+)胃潰瘍患者治療28天后,三組之間在腹痛、燒心、總積分上差異顯著(P0.05),在噯氣、腹脹、少食積分上無顯著差異(P0.05)。兩兩組間對比:在腹痛積分上,R四聯(lián)組(0.17±0.38)、B四聯(lián)組(0.20±0.41)分別低于三聯(lián)組(0.57±0.68),差異顯著(P0.05,P0.05);在燒心積分上,R四聯(lián)組(0.10±0.31)低于三聯(lián)組(0.60±0.67)和B四聯(lián)組(0.40±0.56),差異顯著(P0.05,P0.05);在總積分上,R四聯(lián)組(0.93±0.98)低于三聯(lián)組(1.93±1.87),差異顯著(P0.05)。5、Hp(+)胃潰瘍患者治療28天后,三聯(lián)組3名腹瀉,1名惡心;B四聯(lián)組1名腹瀉,2名惡心,2名口苦;R四聯(lián)組1名惡心。三組間不良反應積分無顯著差異(P0.05)。6、Hp(-)胃潰瘍患者治療28天后,在殘留潰瘍數(shù)量、AHS分期、S期潰瘍患者例數(shù)、潰瘍愈合情況等指標上,三組之間差異顯著(P0.05)。在潰瘍直徑、Forrest分級、總有效率等指標上,三組間無顯著差異(P0.05)。兩兩組間對比:在殘留潰瘍數(shù)量上,PPI+R組(0.39±0.70)、PPI+B組(0.35±0.63)分別少于PPI組(0.74±0.63),差異顯著(P0.05,P0.05);在AHS分期上,PPI+R組和PPI組差異顯著(P0.05),PPI+R組潰瘍脫離急性期的情況優(yōu)于PPI組;在S期潰瘍患者例數(shù)占比上,PPI+R組(69.70%)、PPI+B組(73.08%)分別高于PPI組(35.48%),差異顯著(P0.017,P0.017);在潰瘍愈合情況上,PPI+R組和PPI組差異顯著(P0.05),PPI+R組的愈合情況優(yōu)于PPI組。7、Hp(-)胃潰瘍患者治療28天后,三組之間在黏膜損傷積分上差異顯著(P0.05)。兩兩組間對比:PPI+R組(1.18±0.39)、PPI+B組(1.23±0.51)分別低于PPI組(1.71±0.78),差異顯著(P0.05,P0.05)。8、Hp(-)胃潰瘍患者治療28天后,三組間在腹痛、燒心積分、總積分上顯著差異(P0.05),而在噯氣、腹脹、少食積分上無顯著差異(P0.05)。兩兩組間對比:在腹痛積分上,PPI+R組(0.21±0.48)、PPI+B組(0.23±0.43)分別低于PPI組(0.61±0.72),差異顯著(P0.05,P0.05);在燒心積分上,PPI+R組(0.15±0.36)、PPI+B組(0.15±0.37)分別低于PPI組(0.52±0.68),差異顯著(P0.05,P0.05);在總積分上,PPI+R組(0.94±1.54)低于PPI組(2.00±1.81),差異顯著(P0.05)。9、Hp(-)胃潰瘍患者治療28天后,PPI組1名腹瀉,PPI+B組1名口苦。各組患者間不良反應積分無顯著差異(P0.05)。結論:Hp(+)和Hp(-)的胃潰瘍患者,按照治療效果是否顯著排序,在胃鏡表現(xiàn)、臨床癥狀方面均為瑞巴派特鉍劑無黏膜保護劑,在黏膜組織形態(tài)方面為瑞巴派特≈鉍劑無黏膜保護劑。Hp根除率上,B四聯(lián)組R四聯(lián)組三聯(lián)組,但僅有B四聯(lián)組與三聯(lián)組之間有統(tǒng)計學差異,其他兩兩相比無顯著差異,提示瑞巴派特可能有根除Hp作用,但缺乏顯著性。所有患者不良反應均較輕微,且組間無明顯差別。
[Abstract]:Objective: To compare the ulcer healing, the histological changes of the gastric mucosa, the changes of the clinical symptoms, the eradication of Helicobacter pylori (Hp) and the adverse drug reactions, and to evaluate the safety and effectiveness of rebacon in the treatment of gastric ulcers without mucous membrane protectants and three groups of gastric ulcers using bismuth and rebacat. And in the eradication of Hp, in order to optimize the selection of gastric mucosal protective agents, search for the replacement of bismuth agent for the eradication of Hp gastric mucosal protective agent to explore. Methods: selected Navy General Hospital gastropeptic ulcer patients 180, including Hp (+), Hp (-) 90.Hp (+) gastric ulcer patients were randomly divided into triad group (30), B quadruple group ( 30 people), R quadruple group (30 people). The three groups are Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day + Amoxicillin and Clavulanate Potassium Tablets 1500mg 2/ day + Clarithromycin Tablets 500mg 2/ day, Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day + Amoxicillin and Clavulanate Potassium Tablets 1500mg 2/ day + Clarithromycin Tablets 500mg 500mg + Bismuth potassium Citrate Capsules + Bismuth potassium Citrate Capsules birthday day; 40mg 2/ days + Amoxicillin and Clavulanate Potassium Tablets 1500mg 2/ days + 1500mg 2/ day + Clarithromycin Tablets 500mg 2/ day + Rebamipide Tablets 100mg 3/ days. Start taking medicine, disuse antibiotics and review gastroscopy for twenty-eighth days. Record zeroth days, twenty-eighth days' symptoms, ulcer morphology, gastric mucous membrane morphology, and record twenty-eighth days of adverse drug reaction symptoms The 13C exhalation test and Hp eradication were reviewed, and the differences between the three groups were divided into PPI group (31 people), PPI+B group (26 people) and group PPI+R (33 people). The three groups were Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day, Pantoprazole Sodium Enteric-coated Tablets 40mg 2/ day + Bismuth potassium Citrate Capsules 0.3g 3/ day; pepo. Natriol sodium enteric coated tablets 40mg2/ days + Rebamipide Tablets 100mg 3/ days. Zeroth days to start taking medicine, twenty-eighth days reexamination of gastroscope. Record zeroth days, twenty-eighth days of symptoms, ulcer morphology, gastric mucosa tissue morphology, record twenty-eighth days of adverse drug reaction symptoms, compared the three groups between the indicators of the difference. Results: 1, Hp (+) gastric ulcer patients 28 days after treatment, in residual ulcer, in residual ulceration after 28 days. The number of ulcers, the three rounds of Yazaki (AHS), the number of S ulcers and the healing of ulcers were significant (P0.05). There were no significant differences in the diameter of the ulcer, the Forrest classification and the total efficiency (P0.05). The 22 groups were compared in the number of residual ulcers (0.30 + 0.53), and the B quadruple group (0.40 + 0.72) were less than those in the number of residual ulcers. In the triad group (0.83 + 0.87), the difference was significant (P0.05, P0.05), and in the AHS staging, the difference between the R quadruple group and the triple group was significant (P0.05). The former was superior to the latter in the acute phase of the ulcer, and in the number of cases of S ulcer patients, the R quadruple group (73.73%) was higher than the triple group (40%), and the difference was significant (P0.017); in the ulcer healing, the R quadruple group and the triple group were in the case of ulcer healing. The difference was significant (P0.05), the former was better than the latter.2, and the difference between the three groups in the Hp eradication rate was significant (P0.05). The 22 groups were compared: the B quadruple group (96.67%) was higher than the triad group (73.33%), and the difference was significant (P0.017) in the quadruple group (86.67%) and the triple group (73.33%) and the B quadruple group (96.67%), no significant difference (P0.01). 7, P0.017).3, Hp (+) gastric ulcer patients after 28 days of treatment, the difference between the three groups was significantly different (P0.05). The 22 groups were compared: R quadruple group (1.13 + 0.35), B quadruple group (1.40 + 0.56) were lower than the triad group (1.87 + 0.78), the difference was significant (P0.05, P0.05).4, Hp (+) gastric ulcer patients after 28 days of treatment, between three groups in abdominal pain, heartburn, total product between three groups. There was no significant difference (P0.05) in the scores of belching, abdominal distention and less food (P0.05). The 22 groups were compared: in the abdominal pain score, the R quadruple group (0.17 + 0.38), the B quadruple group (0.20 + 0.41) were lower than the triad group (0.57 + 0.68), the difference was significant (P0.05, P0.05); in the heartburn integral, the R quadruple group (0.10 + 0.31) was lower than the triad group (0.60 + 0.67) and B four In the group (0.40 + 0.56), the difference was significant (P0.05, P0.05); in the total score, the R quadruple group (0.93 + 0.98) was lower than the triad group (1.93 + 1.87), the difference was significant (P0.05).5, the patients with Hp (+) gastric ulcer were treated for 28 days, 3 diarrhea in the triad group and 1 nausea, 1 diarrhea in the B group, 2 nausea and 2. The R quadruple group was nauseous. The scores of adverse reactions between the four groups were not significant. Difference (P0.05).6, Hp (-) gastric ulcer patients 28 days after treatment, the number of residual ulcers, AHS staging, the number of patients with S ulcers, ulcer healing and other indexes, the difference between the three groups was significant (P0.05). There was no significant difference between the three groups (P0.05) in the diameter of ulcers, Forrest classification, and the total efficiency (P0.05). In the 22 groups, the number of residual ulcers was in the number of residual ulcers. In group PPI+R (0.39 + 0.70) and group PPI+B (0.35 + 0.63) less than group PPI (0.74 + 0.63), the difference was significant (P0.05, P0.05). In AHS stage, there was a significant difference between group PPI+R and PPI group (P0.05), and the ulcer in PPI+R group was better than that in the PPI group; the number of cases in the S stage ulcer was higher than that in the S group (69.70%), and the group (73.08%) was higher than that of the group (35.48%), respectively. The difference was significant (P0.017, P0.017). In the ulcer healing, the difference between the group PPI+R and the PPI group was significant (P0.05), the healing of the group PPI+R was better than that of the PPI group.7. The difference of the mucosal damage score between the three groups was significantly different (P0.05) after 28 days of treatment. The 22 groups were compared: the PPI+R group (1.18 + 0.39) and the PPI+B group (1.23 + 0.51) were lower than those in the group (1). .71 + 0.78), the difference was significant (P0.05, P0.05).8, Hp (-) gastric ulcer patient 28 days after treatment, three groups of abdominal pain, heart score, total integral difference (P0.05), but in belching, abdominal distention, and less integral difference (P0.05). 22 groups of comparison: in the abdominal pain score, PPI+R group (0.21 + 0.48), PPI+B group (0.23 + 0.43) is lower than PPI group (0.61 The difference was significant (P0.05, P0.05), and in the heart score, group PPI+R (0.15 + 0.36), group PPI+B (0.15 + 0.37) were lower than group PPI (0.52 + 0.68), the difference was significant (P0.05, P0.05), PPI+R group (0.94 + 1.54) was lower than PPI group (2 + 1.81), and the difference was significant (P0.05).9. There was no significant difference in the score of adverse reactions between the patients in each group (P0.05). Conclusion: the patients with Hp (+) and Hp (-) gastric ulcer were classified according to the effect of the treatment, in the gastroscopy and the clinical symptoms, the regabpat bismuth non mucosa protectant was used in the clinical symptoms and the rate of the eradication rate of the regabpat bismuth free mucosal protective agent.Hp in the morphology of the mucosa. In the B quadruple group, the R quadruple group was in the triad group, but only the B quadruple group and the triad group had statistical difference. The other 22 had no significant difference, suggesting that ruiba pate might have the effect of eradicating Hp, but it was not significant. All the patients had less adverse reactions, and there was no significant difference between the groups.

【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R573.1

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