內(nèi)鏡下不同分期消化性潰瘍的幽門螺桿菌根除率的比較
發(fā)布時(shí)間：2018-09-11 16:02
【摘要】：研究背景:消化性潰瘍是全球性常見的疾病,為多因素疾病。其中最主要的病因是幽門螺桿菌感染(Helicobacter pylori,H.pylori)和非甾體抗炎藥(non-steroidal anti-inflammatory drug,NSAID)的服用。其他因素還包括吸煙,遺傳,應(yīng)激等。上腹痛是本病的主要癥狀。但也有一部分患者無癥狀或者癥狀比較輕,而以出血,穿孔為首發(fā)癥狀就診。消化性潰瘍是慢性過程,發(fā)作常有季節(jié)性,多發(fā)生在秋冬或冬春交替之時(shí)。腹痛常有節(jié)律性。出血是最常見的并發(fā)癥。還可發(fā)生穿孔,幽門梗阻甚至少部分胃潰瘍可發(fā)生癌變。所以早期發(fā)現(xiàn)潰瘍,對(duì)于潰瘍的病因如H.pylori進(jìn)行根除治療是治愈潰瘍,防止復(fù)發(fā),防治并發(fā)癥是有極大意義的。目前消化性潰瘍根據(jù)病因的不同,治療方案也不一樣。無論是否存在H.pylori的感染,均應(yīng)服用質(zhì)子泵抑制劑,抑制胃酸分泌。對(duì)于H.pylori陽性的患者中,首先是根除H.pylori。但我國目前克拉霉素,甲硝唑,左氧氟沙星的耐藥率在逐年上升,應(yīng)用標(biāo)準(zhǔn)三聯(lián)療法根除H.pylori根除率低于80%。目前我國仍推薦使用含鉍劑的四聯(lián)方案根除H.pylori。在消化性潰瘍的治療中提出無論消化性潰瘍是否為活動(dòng)期,都應(yīng)根除H.pylori。但消化性潰瘍?cè)趦?nèi)鏡下的不同分期中的H.pylori的根除率尚無大量研究,國外有學(xué)者認(rèn)為H.pylori根除可能與胃黏膜不同程度的炎癥相關(guān),還有待進(jìn)一步的研究證明。研究目的:處于內(nèi)鏡下不同分期的消化性潰瘍的患者,給予H.pylori的根除治療,觀察不同分期的根除率是否一致,從中找出規(guī)律,指導(dǎo)進(jìn)一步的H.pylori相關(guān)性的消化性潰瘍的治療。材料與方法:2015年7月至2015年12月就診于吉林大學(xué)第一醫(yī)院,符合納入標(biāo)準(zhǔn)的127例消化性潰瘍(胃潰瘍(gastric ulcer,GU)44例,十二指腸潰瘍(duodenal ulcer,DU)83例)患者。其中男性77例,女性50例,平均年齡為46.26±12.82。內(nèi)鏡下將消化性潰瘍分為活動(dòng)期(A)、愈合期(H)、瘢痕期(S)。分為活動(dòng)階段(A)和非活動(dòng)階段(H+S)。其中A期73例,H期33例,S期21例。14碳尿素呼氣試驗(yàn)均為陽性,統(tǒng)一給予含鉍劑四聯(lián)方案(PPI+麗珠維三聯(lián)(枸櫞酸鉍鉀片110mg,替硝唑片500mg,克拉霉素片250mg,一天2次,14天))根除H.pylori。GU患者治療8周,DU患者治療6周后停藥2-4周復(fù)查14碳尿素呼氣試驗(yàn),觀察內(nèi)鏡下不同分期的消化性潰瘍的H.pylori的根除率。結(jié)果:在GU中不同分期的H.pylori根除率有顯著差異(活動(dòng)期vs愈合期vs瘢痕期;80.0%vs 44.4%vs 40.0%,P=0.01),但DU中不同分期的H.pylori根除率無顯著差異(活動(dòng)期vs愈合期vs瘢痕期;72.9%vs 70.8%vs 36.4%,P=0.215)。在多變量分析中,活動(dòng)潰瘍是成功消滅H.pylori的顯著的獨(dú)立預(yù)測(cè)因素(優(yōu)勢(shì)比;2.660,95%CI;1.223-5.784,P=0.014)。結(jié)論:內(nèi)鏡下不同分期的GU的H.pylori根除率有顯著差異。活動(dòng)潰瘍是根除H.pylori的獨(dú)立預(yù)測(cè)因素。
[Abstract]:Background: peptic ulcer is a common disease in the world. It is a multivariate disease. The leading causes are Helicobacter pylori infection (Helicobacter pylori,H.pylori) and non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drug,NSAID). Other factors include smoking, heredity, stress and so on. Epigastric pain is the main symptom of the disease. But there are also some patients asymptomatic or mild symptoms, and bleeding, perforation as the first symptoms. Peptic ulcer is a chronic process, attacks often seasonal, more in autumn and winter or spring alternate time. Abdominal pain is often rhythmic. Bleeding is the most common complication. Perforation can also occur, pyloric obstruction or even a few gastric ulcers can cause cancer. Therefore, early detection of ulcers, for the causes of ulcers such as H.pylori eradication therapy is to cure ulcers, prevent recurrence, prevention and treatment of complications is of great significance. Current peptic ulcer is different according to the etiology, the treatment plan is also different. Proton pump inhibitors should be taken to inhibit gastric acid secretion regardless of H.pylori infection. For H.pylori positive patients, the first step is to eradicate H. pylori. However, the drug resistance rate of clarithromycin, metronidazole and levofloxacin is increasing year by year in China. The eradication rate of H.pylori by standard triple therapy is lower than 80%. At present, China still recommends the use of bismuth-containing tetralogy to eradicate H. pylorius. H. pylorius should be eradicated in the treatment of peptic ulcer, regardless of whether the peptic ulcer is active or not. However, the eradication rate of H.pylori in different stages of peptic ulcer under endoscope has not been studied. Some foreign scholars believe that H.pylori eradication may be related to different degrees of inflammation of gastric mucosa, which needs further study. Objective: patients with peptic ulcer at different stages under endoscope were given H.pylori eradication therapy to find out the regularity of eradication rate in different stages and to guide the further treatment of peptic ulcer associated with H.pylori. Materials and methods: from July 2015 to December 2015, a total of 127 patients with peptic ulcer (44 gastric ulcer (gastric ulcer,GU) and 83 duodenal ulcer (duodenal ulcer,DU) were admitted to the first Hospital of Jilin University. There were 77 males and 50 females with an average age of 46.26 鹵12.82. Endoscopic classification of peptic ulcer into active (A), healing (H), scar (S). Divided into active (A) and inactive (H S). Of the 73 cases in stage A, 33 cases were in stage S, 21 cases were positive for carbamide breath test. PPI Lizhuwei triple regimen (bismuth potassium citrate tablet 110 mg, tinidazole tablet 500 mg, clarithromycin tablet 250 mg, twice a day for 14 days) was given to eradicate H.pylori.GU patients for 8 weeks after 6 weeks treatment and 2 to 4 weeks for 14 carbon urea breath test. To observe the eradication rate of H.pylori in different stages of peptic ulcer under endoscope. Results: there was significant difference in H.pylori eradication rate among different stages in GU (active vs healing stage, vs scar stage vs 44.4%vs 40.0, P0.01), but there was no significant difference in H.pylori eradication rate in different stages of DU (active vs healing vs scar stage 72.9 vs 70.8%vs 36.4% P0.215). In multivariate analysis, active ulcer was a significant independent predictor of successful elimination of H.pylori (odds ratio was 2.66095 CI 1.223-5.784P0. 014). Conclusion: there is significant difference in H.pylori eradication rate among different stages of GU under endoscopy. Active ulcer is an independent predictor of H.pylori eradication.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R573.1
本文編號(hào)：2237161
[Abstract]:Background: peptic ulcer is a common disease in the world. It is a multivariate disease. The leading causes are Helicobacter pylori infection (Helicobacter pylori,H.pylori) and non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drug,NSAID). Other factors include smoking, heredity, stress and so on. Epigastric pain is the main symptom of the disease. But there are also some patients asymptomatic or mild symptoms, and bleeding, perforation as the first symptoms. Peptic ulcer is a chronic process, attacks often seasonal, more in autumn and winter or spring alternate time. Abdominal pain is often rhythmic. Bleeding is the most common complication. Perforation can also occur, pyloric obstruction or even a few gastric ulcers can cause cancer. Therefore, early detection of ulcers, for the causes of ulcers such as H.pylori eradication therapy is to cure ulcers, prevent recurrence, prevention and treatment of complications is of great significance. Current peptic ulcer is different according to the etiology, the treatment plan is also different. Proton pump inhibitors should be taken to inhibit gastric acid secretion regardless of H.pylori infection. For H.pylori positive patients, the first step is to eradicate H. pylori. However, the drug resistance rate of clarithromycin, metronidazole and levofloxacin is increasing year by year in China. The eradication rate of H.pylori by standard triple therapy is lower than 80%. At present, China still recommends the use of bismuth-containing tetralogy to eradicate H. pylorius. H. pylorius should be eradicated in the treatment of peptic ulcer, regardless of whether the peptic ulcer is active or not. However, the eradication rate of H.pylori in different stages of peptic ulcer under endoscope has not been studied. Some foreign scholars believe that H.pylori eradication may be related to different degrees of inflammation of gastric mucosa, which needs further study. Objective: patients with peptic ulcer at different stages under endoscope were given H.pylori eradication therapy to find out the regularity of eradication rate in different stages and to guide the further treatment of peptic ulcer associated with H.pylori. Materials and methods: from July 2015 to December 2015, a total of 127 patients with peptic ulcer (44 gastric ulcer (gastric ulcer,GU) and 83 duodenal ulcer (duodenal ulcer,DU) were admitted to the first Hospital of Jilin University. There were 77 males and 50 females with an average age of 46.26 鹵12.82. Endoscopic classification of peptic ulcer into active (A), healing (H), scar (S). Divided into active (A) and inactive (H S). Of the 73 cases in stage A, 33 cases were in stage S, 21 cases were positive for carbamide breath test. PPI Lizhuwei triple regimen (bismuth potassium citrate tablet 110 mg, tinidazole tablet 500 mg, clarithromycin tablet 250 mg, twice a day for 14 days) was given to eradicate H.pylori.GU patients for 8 weeks after 6 weeks treatment and 2 to 4 weeks for 14 carbon urea breath test. To observe the eradication rate of H.pylori in different stages of peptic ulcer under endoscope. Results: there was significant difference in H.pylori eradication rate among different stages in GU (active vs healing stage, vs scar stage vs 44.4%vs 40.0, P0.01), but there was no significant difference in H.pylori eradication rate in different stages of DU (active vs healing vs scar stage 72.9 vs 70.8%vs 36.4% P0.215). In multivariate analysis, active ulcer was a significant independent predictor of successful elimination of H.pylori (odds ratio was 2.66095 CI 1.223-5.784P0. 014). Conclusion: there is significant difference in H.pylori eradication rate among different stages of GU under endoscopy. Active ulcer is an independent predictor of H.pylori eradication.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R573.1
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