序貫療法與三聯(lián)療法根除幽門螺桿菌療效分析
發(fā)布時間：2018-11-19 15:36
【摘要】：目的： 慢性胃炎是臨床的常見病和多發(fā)病，在各種胃病中居于首位，約占接受胃鏡檢查患者的90%以上。幽門螺桿菌（Helicobacter pylori, Hp）感染是慢性胃炎的主要致病因素，長期感染后，部分患者可發(fā)生胃黏膜萎縮，可進(jìn)一步發(fā)展為腸化、異型增生，發(fā)生癌變的可能性增高。根除Hp可使胃黏膜炎癥消退，慢性炎癥程度減輕，成為治療慢性胃炎的關(guān)鍵環(huán)節(jié)之一。 本研究采用序貫療法和三聯(lián)療法治療Hp相關(guān)性慢性胃炎，觀察序貫療法與三聯(lián)療法根除Hp的初治療效，隨訪根除Hp后患者的胃腸道癥狀緩解狀況，分析其不良反應(yīng)發(fā)生率，為臨床選擇高效、安全的根除方案提供依據(jù)。 方法： 將經(jīng)胃鏡檢查確診為慢性胃炎且Hp感染的患者隨機(jī)分為序貫療法組（簡稱序貫組）、三聯(lián)療法組（簡稱三聯(lián)組）。序貫組150例，前5天給予埃索美拉唑20mg，阿莫西林1g，后5天給予埃索美拉唑20mg，克拉霉素0.5g，替硝唑0.2g，均每日2次口服；三聯(lián)組150例，每天給予奧美拉唑20mg，克拉霉素0.5g，阿莫西林1g，每日2次口服，療程10天。 治療結(jié)束后停藥4周后，復(fù)查Hp，觀察Hp根除效果，并分別對患者入組時、治療結(jié)束停藥4周后隨訪時的胃腸道癥狀評分，比較兩組患者在根除過程中的癥狀改善情況、藥物不良反應(yīng)發(fā)生情況。 結(jié)果： 1.序貫療法、三聯(lián)療法的Hp根除率分別為82.7%、69.3%，序貫療法高于三聯(lián)療法（P＜0.05）。 2.序貫組的治療前與治療結(jié)束停藥4周后胃腸道癥狀總積分，分別為19.17分、12.56分，治療后的胃腸道癥狀總積分小于治療前（P＜0.001）；三聯(lián)組的治療前與治療結(jié)束停藥4周后胃腸道癥狀總積分，分別為19.23分、12.69分，治療后的胃腸道癥狀總積分小于治療前（P＜0.001）。 3.治療前，序貫組與三聯(lián)組的胃腸道癥狀總積分差異不顯著（P＞0.05）；治療結(jié)束停藥4周后，序貫組與三聯(lián)組的胃腸道癥狀總積分差異不顯著（P＞0.05）；治療前與治療結(jié)束停藥4周后的胃腸道癥狀總積分差，序貫組為6.61分，三聯(lián)組為6.54分，差異無統(tǒng)計學(xué)意義（P＞0.05）；序貫組與三聯(lián)組的療效指數(shù)分別為0.34和0.34，無統(tǒng)計學(xué)差異（P＞0.05）。 4.藥物不良反應(yīng)發(fā)生率，序貫組與三聯(lián)組分別為11.3%、10.0%，差異不明顯（P＞0.05）。 結(jié)論： 1.序貫療法的Hp根除率＞80%，高于三聯(lián)療法。 2.序貫療法與三聯(lián)療法均能明顯緩解Hp相關(guān)性慢性胃炎患者的胃腸道癥狀。 3.序貫療法與三聯(lián)療法的不良反應(yīng)發(fā)生率基本接近。 4.對有鉍劑禁忌而不能采用鉍劑四聯(lián)方案者，可考慮應(yīng)用10d序貫療法進(jìn)行Hp相關(guān)性胃炎的治療。有必要進(jìn)行多中心、大樣本、隨機(jī)雙盲的臨床研究，進(jìn)一步研究序貫療法有效性。
[Abstract]:Objective: chronic gastritis is one of the most common and frequent diseases in clinical practice, which accounts for more than 90% of the patients undergoing gastroscopy. Helicobacter pylori (Helicobacter pylori, Hp) infection is the main pathogenic factor of chronic gastritis. After long-term infection, gastric mucosal atrophy can occur in some patients, which can be further developed into intestinal metaplasia, dysplasia, and the possibility of carcinogenesis is increased. Eradication of Hp can attenuate the inflammation of gastric mucosa and reduce the degree of chronic inflammation, which becomes one of the key links in the treatment of chronic gastritis. In this study, sequential therapy and triple therapy were used to treat chronic gastritis associated with Hp. The initial therapeutic effects of sequential therapy and triple therapy on Hp eradication were observed. The symptoms of gastrointestinal tract after Hp eradication were followed up and the incidence of adverse reactions was analyzed. To provide evidence for clinical selection of effective and safe eradication programs. Methods: patients with chronic gastritis and Hp infection diagnosed by gastroscopy were randomly divided into sequential therapy group (Sequential group) and triple therapy group (triplex group). 150 patients in the sequential group were given esomeprazole 20mg in the first 5 days, amoxicillin 1g, esomeprazole 20mg, clarithromycin 0.5g, tinidazole 0.2g after 5 days. 150 patients in the triple group were given omeprazole 20 mg, clarithromycin 0.5 g and amoxicillin 1 g daily for 10 days. Four weeks after the end of treatment, Hp, was re-examined to observe the eradication effect of Hp, and the gastrointestinal symptoms of the patients at the time of entering the group and 4 weeks after the end of the treatment were evaluated, and the improvement of the symptoms in the eradication process was compared between the two groups. Adverse drug reactions occurred. Results: 1. The Hp eradication rates of sequential therapy and triple therapy were 82.7% and 69.3%, respectively, which were higher than that of triple therapy (P < 0. 05). 2. The total scores of gastrointestinal symptoms before treatment and 4 weeks after treatment were 19.17 and 12.56, respectively. The total scores of gastrointestinal symptoms after treatment were lower than those before treatment (P < 0.001). The total scores of gastrointestinal symptoms before treatment and 4 weeks after treatment were 19.23 and 12.69, respectively. The total scores of gastrointestinal symptoms after treatment were lower than those before treatment (P < 0.001). 3. Before treatment, there was no significant difference in the total scores of gastrointestinal symptoms between the sequential group and the triple group (P > 0.05), but there was no significant difference in the total score of the gastrointestinal symptoms between the sequential group and the triple group after 4 weeks (P > 0.05). The total scores of gastrointestinal symptoms before treatment and 4 weeks after withdrawal were 6.61 in sequential group and 6.54 in triple group (P > 0.05). The curative effect index of sequential group and triple group were 0.34 and 0.34 respectively, there was no statistical difference (P > 0.05). 4. The incidence of adverse drug reactions in sequential group and triple group were 11.3and 10.0, respectively, with no significant difference (P > 0.05). Conclusion: 1. The Hp eradication rate of sequential therapy was more than 80, higher than that of triple therapy. 2. Sequential therapy and triple therapy can significantly alleviate the gastrointestinal symptoms in patients with chronic gastritis associated with Hp. 3. The incidence of adverse reactions in sequential therapy and triple therapy was similar. 4. For those who have contraindications of bismuth and can not use the quadruple regimen of bismuth, we can consider the treatment of Hp associated gastritis with sequential therapy for 10 days. There is a need for multicenter, large-sample, randomized double-blind clinical studies to further study the efficacy of sequential therapy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R573.1
本文編號：2342779
[Abstract]:Objective: chronic gastritis is one of the most common and frequent diseases in clinical practice, which accounts for more than 90% of the patients undergoing gastroscopy. Helicobacter pylori (Helicobacter pylori, Hp) infection is the main pathogenic factor of chronic gastritis. After long-term infection, gastric mucosal atrophy can occur in some patients, which can be further developed into intestinal metaplasia, dysplasia, and the possibility of carcinogenesis is increased. Eradication of Hp can attenuate the inflammation of gastric mucosa and reduce the degree of chronic inflammation, which becomes one of the key links in the treatment of chronic gastritis. In this study, sequential therapy and triple therapy were used to treat chronic gastritis associated with Hp. The initial therapeutic effects of sequential therapy and triple therapy on Hp eradication were observed. The symptoms of gastrointestinal tract after Hp eradication were followed up and the incidence of adverse reactions was analyzed. To provide evidence for clinical selection of effective and safe eradication programs. Methods: patients with chronic gastritis and Hp infection diagnosed by gastroscopy were randomly divided into sequential therapy group (Sequential group) and triple therapy group (triplex group). 150 patients in the sequential group were given esomeprazole 20mg in the first 5 days, amoxicillin 1g, esomeprazole 20mg, clarithromycin 0.5g, tinidazole 0.2g after 5 days. 150 patients in the triple group were given omeprazole 20 mg, clarithromycin 0.5 g and amoxicillin 1 g daily for 10 days. Four weeks after the end of treatment, Hp, was re-examined to observe the eradication effect of Hp, and the gastrointestinal symptoms of the patients at the time of entering the group and 4 weeks after the end of the treatment were evaluated, and the improvement of the symptoms in the eradication process was compared between the two groups. Adverse drug reactions occurred. Results: 1. The Hp eradication rates of sequential therapy and triple therapy were 82.7% and 69.3%, respectively, which were higher than that of triple therapy (P < 0. 05). 2. The total scores of gastrointestinal symptoms before treatment and 4 weeks after treatment were 19.17 and 12.56, respectively. The total scores of gastrointestinal symptoms after treatment were lower than those before treatment (P < 0.001). The total scores of gastrointestinal symptoms before treatment and 4 weeks after treatment were 19.23 and 12.69, respectively. The total scores of gastrointestinal symptoms after treatment were lower than those before treatment (P < 0.001). 3. Before treatment, there was no significant difference in the total scores of gastrointestinal symptoms between the sequential group and the triple group (P > 0.05), but there was no significant difference in the total score of the gastrointestinal symptoms between the sequential group and the triple group after 4 weeks (P > 0.05). The total scores of gastrointestinal symptoms before treatment and 4 weeks after withdrawal were 6.61 in sequential group and 6.54 in triple group (P > 0.05). The curative effect index of sequential group and triple group were 0.34 and 0.34 respectively, there was no statistical difference (P > 0.05). 4. The incidence of adverse drug reactions in sequential group and triple group were 11.3and 10.0, respectively, with no significant difference (P > 0.05). Conclusion: 1. The Hp eradication rate of sequential therapy was more than 80, higher than that of triple therapy. 2. Sequential therapy and triple therapy can significantly alleviate the gastrointestinal symptoms in patients with chronic gastritis associated with Hp. 3. The incidence of adverse reactions in sequential therapy and triple therapy was similar. 4. For those who have contraindications of bismuth and can not use the quadruple regimen of bismuth, we can consider the treatment of Hp associated gastritis with sequential therapy for 10 days. There is a need for multicenter, large-sample, randomized double-blind clinical studies to further study the efficacy of sequential therapy.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R573.1
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