【摘要】：目的 :探討不同添加時間、療程及劑量益生菌在根除幽門螺桿菌(helicobacter pylori,Hp)治療中的臨床療效。方法:280例Hp陽性的患者隨機分為5個治療組:A組:蘭索拉唑片30 mg+克拉霉素片500mg+阿莫西林膠囊1 000 mg,每日2次,療程14 d;B組:雙歧桿菌乳桿菌三聯活菌片(2 000 mg,每日3次)服用14 d后,給予A組治療方案治療14 d,總療程28 d;C_1組:A組治療方案基礎上加用雙歧桿菌乳桿菌三聯活菌片(2 000 mg,每日2次),療程14 d;C_2組:A組治療方案基礎上加用雙歧桿菌乳桿菌三聯活菌片(2 000 mg,每日3次),療程14 d;D組:C_2組方案根除治療后,繼續(xù)用雙歧桿菌乳桿菌三聯活菌片(2 000 mg,每日3次)14 d,總療程28 d。療程結束4周后復查~(13)C尿素呼氣試驗評估根除療效。治療期間記錄患者的不良反應發(fā)生情況。結果:252例(90.0%)患者按方案完成治療,A、B、C_1、C_2、D組治療完成率分別為78.6%(44/56)、92.9%(52/56)、87.5%(49/56)、96.4%(54/56)和94.6%(53/56),B、C_2及D組顯著高于A組(P0.05),而C_2略高于B及D組,但差異無統計學意義(P0.05)。A、B、C_1、C_2及D組按意向治療(ITT)根除率分別為62.5%、80.4%、69.6%、85.7%和87.5%,B、C_2及D組顯著高于A組(χ~2=4.375,P=0.036;χ~2=7.864,P=0.005;χ~2=9.333,P=0.002),且C_2組高于C_1組(χ~2=4.171,P=0.041),而D組稍高于B組及C_2組,但差異無統計學意義(P0.05);按方案治療(PP)五組根除率分別為79.5%、86.5%、79.6%、88.9%和92.5%,各組間差異無統計學意義(P0.05)。不良反應包括惡心、腹脹、味覺異常(口苦、口腔異味)、厭食及便秘等。A、B、C_1、C_2及D組不良反應的發(fā)生率分別為67.9%(38/56)、26.8%(15/56)、35.7%(20/56)、21.4%(12/56)及17.9%(10/56),B、C_2及D組明顯少于A組(P0.05),而B、C_2及D組各組間的差異無統計學意義(P0.05)。結論:三聯療法聯合雙歧桿菌乳桿菌三聯活菌能夠顯著降低傳統根除療法的胃腸道不良反應,提高患者依從性,從而提高患者Hp的根除率,且隨著益生菌劑量的增加,Hp的根除率也隨之增加,同時服用益生菌14 d為最佳選擇。
[Abstract]:Objective: to investigate the clinical efficacy of probiotics at different time, course and dose in the eradication of helicobacter pylorium-HP. Methods one hundred and twenty patients with HP positive were randomly divided into 5 groups: group A: lansoprazole 30 mg clarithromycin tablet 500mg amoxicillin capsule 1 000 mg twice a day. Group B was treated with bifidobacterium Lactobacillus triple live bacteria tablet (2 000 mg, 3 times a day) for 14 days. Group A was given the treatment regimen for 14 days, and the total course of treatment was 28 days. Group 1: group A was treated with bifidobacterium Lactobacillus triple live bacteria tablet (2 000 mg, twice a day) on the basis of the treatment plan of group 1: a, and bifidobacterium milk was added to the treatment plan of group C 2: a for 14 days. Three live bacilli tablets (2 000 mg, 3 times a day) for 14 days, group D, group 1: C, group C, group 2, after eradication treatment, Bifidobacterium Lactobacillus triplex live bacteria tablets (2 000 mg, 3 times a day) for 14 days, the total course of treatment was 28 days. The eradication effect was evaluated by ~ (13) C urea breath test after 4 weeks of treatment. Adverse reactions were recorded during treatment. Results among 252 patients (90.0%), the complete rate of treatment in group C was 78.6% (44 / 56) or 92.9% (5256), respectively, 87.5% (54 / 56) and 94.6% (53 / 56) of BC2 and group D were significantly higher than those of group A (P0.05), while the rate of C2C2 was slightly higher than that of group B and D. However, there was no significant difference between the two groups (P0.05). The eradication rates of (ITT) in group D and group C were 62.5 and 89.60.45%, respectively, which were significantly higher than those in group A (蠂 2 4.375P0.036; 蠂 2 7.864 P 0.005; 蠂 2 9.333P 0.002), and in group C2 higher than those in group C1 (蠂 24.171P0. 041), while group D was slightly higher than those in group B and group C2, and in group D they were higher than those in group C (P < 0.05), but in group D were higher than those in group C (P < 0.05), but no significant difference was found between group C and group D (P 0.05). The eradication rate of (ITT) in group C was higher than that in group C 1 (P < 0.05), but that in group D was slightly higher than that in group C and group B (P 0.036; P 0.036; 蠂 2 9.333P 0.002). But the difference was not statistically significant (P0.05); the eradication rate of the five groups of (PP) was 79.5% and 92.5%, respectively. There was no significant difference among the five groups (P0.05). The incidence of adverse reactions including nausea, abdominal distension, abnormal taste (bitter mouth, mouth odour), anorexia and constipation were 67.9% (38 / 56), 26.8% (15 / 56) and 35.7% (20 / 56), respectively. The incidence of adverse reactions in group B and D was significantly lower than that in group A (P0.05). Conclusion: triple therapy combined with living bacteria of Lactobacillus bifidobacterium can significantly reduce gastrointestinal adverse reactions of traditional eradication therapy, improve compliance of patients, and thus improve the eradication rate of HP in patients. The eradication rate of HP increased with the increase of probiotic dose, and the best choice was to take probiotics for 14 days.
【作者單位】： 廣東藥學院附屬第二醫(yī)院(廣州新海醫(yī)院)消化內科;廣東省醫(yī)學科學院 廣東省人民醫(yī)院消化內科;
【基金】：廣東省醫(yī)學科學技術研究基金項目(編號:A2016406)
【分類號】：R57

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