西安地區(qū)不同藥物治療方案對幽門螺桿菌根除療效的分析
發(fā)布時(shí)間：2019-01-23 21:05
【摘要】：目的:1分析不同藥物治療方案對幽門螺桿菌(Helicobacter pylori,Hp)根除療效的影響。2分析不同性別、年齡、上消化道疾病類型對幽門螺桿菌根除療效的影響。方法:1研究對象:收集2014年6月1日-2016年6月1日于陜西省人民醫(yī)院門診就診的經(jīng)胃鏡下快速尿素酶試驗(yàn)或13C-呼氣試驗(yàn)確診Hp陽性且檢查前28天內(nèi)未使用抗生素、抑酸藥及鉍劑的患者共316例。227例治療結(jié)束28天后復(fù)查評估療效(設(shè)為研究組);89例失訪(設(shè)為失訪組),即未能按醫(yī)囑說明復(fù)查評估療效。收集316例患者的性別、年齡、疾病的臨床診斷及胃鏡下診斷、Hp根除方案及療效。2研究方法:在研究組的227例患者中,依治療分案分為6個(gè)不同的治療組,分別為RAN+AMO+CLA 14d組(雷尼替丁+阿莫西林+克拉霉素14天療法)、PAN+AMO+CLA 14d組(泮托拉唑+阿莫西林+克拉霉素14天療法)、PAN+AMO+CLA+BIS 14d組(泮托拉唑+阿莫西林+克拉霉素+膠體酒石酸鉍14天療法)、PAN+AMO+CLA+BIS 10d組(泮托拉唑+阿莫西林+克拉霉素+膠體酒石酸鉍10天療法)、OME+AMO+MET+BIS 14d組(奧美拉唑+阿莫西林+甲硝唑+膠體酒石酸鉍14天療法)、PAN+AMO+LEV+BIS 10d組(泮托拉唑+阿莫西林+左氧氟沙星+膠體酒石酸鉍10天療法),對比不同治療方案下的Hp根除療效。分別對比男女之間、各年齡段、不同上消化道疾病類型在PAN+AMO+CLA+BIS 10d或14d組的Hp根除療效。在研究組的227例患者中,多因素的Logistic回歸分析不同治療方案、性別、年齡、上消化道疾病類型對Hp根除療效的影響。3統(tǒng)計(jì)學(xué)分析:采用SPSS19.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)的整理與分析,多因素分析采用二分類的logistic回歸分析方法,單因素分析用卡方檢驗(yàn)或Fisher′s檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1在失訪組的89例患者中,30~39歲的比例最高,為30.3%。2研究組中不同治療方案下的Hp根除療效比較2.1 PAN+AMO+CLA+BIS 14d組的Hp根除率較PAN+AMO+CLA 14d組和RAN+AMO+CLA 14d組高,差異有統(tǒng)計(jì)學(xué)意義。2.2 OME+AMO+MET+BIS14d組的Hp根除率較RAN+AMO+CLA 14d組高,差異有統(tǒng)計(jì)學(xué)意義。2.3在鉍劑四聯(lián)方案中,OME+AMO+MET+BIS14d組的Hp根除率最高,為94.12%,PAN+AMO+LEV+BIS 10d組的Hp根除率最低,為64.71%,但差異無統(tǒng)計(jì)學(xué)意義。2.4 PAN+AMO+CLA+BIS 10d組與PAN+AMO+CLA+BIS 14d組的Hp根除率比較差異無統(tǒng)計(jì)學(xué)意義。3 PAN+AMO+CLA+BIS 10d和14d組的中,男女性別之間的Hp根除率比較無顯著性差異;但40以下人群Hp根除率在各年齡段中最低,為75.7%,60歲以上為93.3%,但差異無統(tǒng)計(jì)學(xué)意義;慢性萎縮性胃炎、慢性非萎縮性胃炎與消化性潰瘍患者之間Hp根除率比較,差異均無統(tǒng)計(jì)學(xué)意義。4 Logistic逐步回歸分析顯示性別、年齡及上消化道疾病不是Hp根除療效的影響因素,而治療方案是Hp根治療效的影響因素。結(jié)論:1不同治療方案可影響Hp根除療效,而性別、年齡、上消化道疾病類型對Hp根除療效影響不大。2本研究發(fā)現(xiàn)泮托拉唑+阿莫西林+克拉霉素14天的標(biāo)準(zhǔn)三聯(lián)療法和雷尼替丁+阿莫西林+克拉霉素14天療法的根除療效差,聯(lián)合鉍劑后將會有效提高Hp根除率;包含甲硝唑的鉍劑四聯(lián)方案療效較好,其原因可能為隨著給藥劑量和給藥次數(shù)的增加,甲硝唑的耐藥可被完全或部分抵消。包含左氧氟沙星的鉍劑四聯(lián)方案Hp根除療效較差,其原因可能與本地區(qū)左氧氟沙星高耐藥有關(guān)。3在成年幽門螺桿菌感染者中,40歲以下在治療失訪人群中所占比例最高,且Hp根除率較其他年齡段低。
[Abstract]:Objective: To study the effect of different drug treatment on the eradication of Helicobacter pylori (Hp). Method: 1 Study object: collected from June 1, 2014 to June 1, 2016 in the outpatient department of the People's Hospital of Shaanxi Province, the rapid urease test or the 13C-exhale test was confirmed to be positive for Hp and no antibiotics were used in the first 28 days. A total of 316 patients were treated with acid-inhibiting and anti-inflammatory agents. The efficacy of the assessment (set as the study group) was reviewed after 28 days after the end of the treatment, and 89 cases of lost-to-follow-up (set to the lost-to-follow-up group), that is, the evaluation efficacy could not be reviewed according to the doctor's order. A total of 316 patients with sex, age, and disease were collected for clinical diagnosis and under gastroscopy, and the eradication of Hp and its effect were collected. Methods: In the 227 patients of the study group, 6 different treatment groups were divided into six different treatment groups according to the treatment. For RAN + AMO + CLA 14d group (ranitidine + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA 14d group (tortotolizumab + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA + BIS 14d group (Tortolizumab + amoxicillin + clarithromycin + colloidal tartaric acid and 14-day therapy), PAN + AMO + CLA + BIS 10d (Tortolizumab + Amoxicillin + Clarithromycin + Colloidal Tartrate for 10 days), OME + AMO + MET + BIS 14d (Omeirah + Amoxicillin + Nitrocin + Colloidal Tartrate 14-Day Therapy), PAN + AMO + LEV + BIS 10d (Amoxicillin + amoxicillin + levofloxacin + colloidal tartaric acid for 10 days), and compared with the curative effect of Hp eradication under different treatment protocols. The efficacy of Hp eradication in the group of PAN + AMO + CLA + BIS 10d or 14d was compared between men and women, all ages and different upper gastrointestinal diseases. In the 227 patients of the study group, the effects of different treatment schemes, sex, age and upper gastrointestinal disease type on the curative effect of Hp eradication were analyzed by logistic regression of multiple factors. The multi-factor analysis is a two-class logistic regression analysis method. The single-factor analysis is used for either the card-side test or the Fisher's test, and the difference is significant. Results: 1 In the 89 patients of the lost-to-follow-up group, the proportion of the 30 to 39-year-old group was the highest, which was 30.3%. The Hp eradication rate of the group was higher than that of the PAN + AMO + CLA 14-d group and the RAN + AMO + CLA 14-d group, and the difference was statistically significant. The results showed that the eradication rate of Hp in the group of OME + AMO + MET + BIS14d was the highest, the lowest of the eradication rate of Hp was 94.2%, the lowest in the group of PAN + AMO + LEV + BIS 10d was 64. 71%, but the difference was not statistically significant. The difference of Hp eradication rate in the group of PAN + AMO + CLA + BIS 10d and PAN + AMO + CLA + BIS 14d was not statistically significant. The eradication rate of Hp between male and female was no significant difference, but the eradication rate of Hp in the following groups was the lowest in all age groups, 75.7% and 93.3%, but the difference was not significant; chronic atrophic gastritis, There was no significant difference in the eradication rate of Hp between chronic non-atrophic gastritis and the patients with digestive ulceration. Logistic regression analysis showed that the effect of sex, age and upper gastrointestinal disease was not the effect of Hp eradication. Conclusion: 1 Different treatment options can affect the curative effect of Hp eradication, while sex and age, The effect of the type of upper gastrointestinal disease on the eradication of Hp was not great. The results of this study found that the standard triple therapy of the 14-day treatment of the amoxicillin + amoxicillin + clarithromycin and the 14-day treatment of the ranitidine + amoxicillin + clarithromycin were poor, and the eradication rate of Hp was effectively improved after the combination of the therapeutic agent. The results of the tetralogy of the tetralogy of tetralogy of nitroprusis better, and the cause may be to be completely or partially offset with the increase in the dose of administration and the number of doses administered. The results of Hp eradication in the four-tetralogy of tetratetralogy of levofloxacin may be related to the high resistance of levofloxacin in the region. In the case of adult H. pylori, the proportion of patients under the age of 40 is the highest among those who have been lost to follow-up, and the eradication rate of Hp is lower than that of other age groups.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R57
本文編號：2414190
[Abstract]:Objective: To study the effect of different drug treatment on the eradication of Helicobacter pylori (Hp). Method: 1 Study object: collected from June 1, 2014 to June 1, 2016 in the outpatient department of the People's Hospital of Shaanxi Province, the rapid urease test or the 13C-exhale test was confirmed to be positive for Hp and no antibiotics were used in the first 28 days. A total of 316 patients were treated with acid-inhibiting and anti-inflammatory agents. The efficacy of the assessment (set as the study group) was reviewed after 28 days after the end of the treatment, and 89 cases of lost-to-follow-up (set to the lost-to-follow-up group), that is, the evaluation efficacy could not be reviewed according to the doctor's order. A total of 316 patients with sex, age, and disease were collected for clinical diagnosis and under gastroscopy, and the eradication of Hp and its effect were collected. Methods: In the 227 patients of the study group, 6 different treatment groups were divided into six different treatment groups according to the treatment. For RAN + AMO + CLA 14d group (ranitidine + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA 14d group (tortotolizumab + amoxicillin + clarithromycin 14-day therapy), PAN + AMO + CLA + BIS 14d group (Tortolizumab + amoxicillin + clarithromycin + colloidal tartaric acid and 14-day therapy), PAN + AMO + CLA + BIS 10d (Tortolizumab + Amoxicillin + Clarithromycin + Colloidal Tartrate for 10 days), OME + AMO + MET + BIS 14d (Omeirah + Amoxicillin + Nitrocin + Colloidal Tartrate 14-Day Therapy), PAN + AMO + LEV + BIS 10d (Amoxicillin + amoxicillin + levofloxacin + colloidal tartaric acid for 10 days), and compared with the curative effect of Hp eradication under different treatment protocols. The efficacy of Hp eradication in the group of PAN + AMO + CLA + BIS 10d or 14d was compared between men and women, all ages and different upper gastrointestinal diseases. In the 227 patients of the study group, the effects of different treatment schemes, sex, age and upper gastrointestinal disease type on the curative effect of Hp eradication were analyzed by logistic regression of multiple factors. The multi-factor analysis is a two-class logistic regression analysis method. The single-factor analysis is used for either the card-side test or the Fisher's test, and the difference is significant. Results: 1 In the 89 patients of the lost-to-follow-up group, the proportion of the 30 to 39-year-old group was the highest, which was 30.3%. The Hp eradication rate of the group was higher than that of the PAN + AMO + CLA 14-d group and the RAN + AMO + CLA 14-d group, and the difference was statistically significant. The results showed that the eradication rate of Hp in the group of OME + AMO + MET + BIS14d was the highest, the lowest of the eradication rate of Hp was 94.2%, the lowest in the group of PAN + AMO + LEV + BIS 10d was 64. 71%, but the difference was not statistically significant. The difference of Hp eradication rate in the group of PAN + AMO + CLA + BIS 10d and PAN + AMO + CLA + BIS 14d was not statistically significant. The eradication rate of Hp between male and female was no significant difference, but the eradication rate of Hp in the following groups was the lowest in all age groups, 75.7% and 93.3%, but the difference was not significant; chronic atrophic gastritis, There was no significant difference in the eradication rate of Hp between chronic non-atrophic gastritis and the patients with digestive ulceration. Logistic regression analysis showed that the effect of sex, age and upper gastrointestinal disease was not the effect of Hp eradication. Conclusion: 1 Different treatment options can affect the curative effect of Hp eradication, while sex and age, The effect of the type of upper gastrointestinal disease on the eradication of Hp was not great. The results of this study found that the standard triple therapy of the 14-day treatment of the amoxicillin + amoxicillin + clarithromycin and the 14-day treatment of the ranitidine + amoxicillin + clarithromycin were poor, and the eradication rate of Hp was effectively improved after the combination of the therapeutic agent. The results of the tetralogy of the tetralogy of tetralogy of nitroprusis better, and the cause may be to be completely or partially offset with the increase in the dose of administration and the number of doses administered. The results of Hp eradication in the four-tetralogy of tetratetralogy of levofloxacin may be related to the high resistance of levofloxacin in the region. In the case of adult H. pylori, the proportion of patients under the age of 40 is the highest among those who have been lost to follow-up, and the eradication rate of Hp is lower than that of other age groups.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R57
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