10天、14天序貫療法與鉍劑四聯(lián)在幽門螺桿菌補(bǔ)救治療中的效果觀察
發(fā)布時(shí)間：2019-03-28 12:27
【摘要】：目的：觀察10天、14天序貫療法及10天鉍劑四聯(lián)療法三種方案作為幽門螺桿菌（H.Pylori)）根除失敗后二線補(bǔ)救治療方案的根除效果、患者的癥狀改善情況、藥物的安全性及副反應(yīng)，并對(duì)三組治療方案進(jìn)行成本-效果分析，進(jìn)而為臨床上尋找一種對(duì)Hp安全、有效的、價(jià)格相對(duì)低廉且患者容易接受的補(bǔ)救治療方法。 方法：通過門診胃鏡檢查診斷為慢性胃炎或消化性潰瘍的患者，且所有患者既往經(jīng)過正規(guī)抗Hp治療，本次復(fù)診時(shí)14C尿素呼氣試驗(yàn)Hp仍為陽性的患者91例。隨機(jī)分為三組。A組（n＝30例，男18，女12）鉍劑四聯(lián)療法：雷貝拉唑10mg bid+膠體果較鉍0.15g tid+阿莫西林克拉維酸鉀(0.457g bid)+左氧氟沙星0.2g bid，療程10天；B組（n＝30例，男17，女13）10d序貫療法：前5d雷貝拉唑10mgbid+阿莫西林克拉維酸鉀(0.457g bid)，后5d雷貝拉唑10mg+替硝唑0.5g+左氧氟沙星0.2g，bid；C組（n＝31例，男19，女12）14d序貫療法：前7天雷貝拉唑10mgbid+阿莫西林克拉維酸鉀(0.457g bid)，后7天雷貝拉唑10mg+替硝唑（0.5g bid）+左氧氟沙星（0.2g bid）。隨訪患者服藥期間的不良反應(yīng)和癥狀緩解情況，復(fù)診時(shí)間為抗生素停用最少1月， PPI至少14天后行14C-尿素呼氣試驗(yàn)（Urea BreanthTest，UBT）檢測(cè)Hp的根除情況。 結(jié)果：本實(shí)驗(yàn)共有91例患者，三組各失訪1例，，治療期間患者無因嚴(yán)重的不良反應(yīng)（ADR）而退出實(shí)驗(yàn)。10天鉍劑四聯(lián)組、10天序貫療法組和14天序貫方案組分別為30例、30例和31例。三組方案的Hp根除率按意向治療分析（ITT）根除率分別為73.3%、76.7%和80.6%；完成治療分析（PP）根除率分別為75.9%、79.3%和83.3%；三組方案的Hp根除率差異用統(tǒng)計(jì)學(xué)解釋無顯著性意義(P0.05)。三種不同治療方法的癥狀緩解率和不良反應(yīng)發(fā)生率也無顯著性差異（P0.05）；成本-效果分析顯示，每增加1%的根除率，10天序貫療法比10天鉍劑四聯(lián)療法的成本低33.5元，10天序貫療法比14天序貫療法的成本低14.13元。 結(jié)論：10日序貫療法、14日序貫療法、10天鉍劑四聯(lián)療法對(duì)Hp的補(bǔ)救治療中，序貫14天方案的根除率相對(duì)較高，但三種方案間的差異還不能用統(tǒng)計(jì)學(xué)解釋（P＞0.05）。可能是因?yàn)楸狙芯繕颖竞啃。约熬窒拊趤砦以壕驮\的患者、及本地區(qū)對(duì)抗生素的耐藥情況等因素，還需要大樣本、多中心、隨機(jī)的實(shí)驗(yàn)來證明。三組補(bǔ)救治療方案的臨床癥狀緩解率及不良反應(yīng)的發(fā)生率并沒有顯著差異。三組方案的不良反應(yīng)發(fā)生率無統(tǒng)計(jì)學(xué)差異（P＞0.05），提示三種方案有較好的安全性。10日序貫療法作為Hp的二線補(bǔ)救治療方案根除率高、更經(jīng)濟(jì)，易于被廣大患者接受，值得在臨床上推廣。
[Abstract]:Objective: to observe the efficacy of 10-day, 14-day sequential therapy and 10-day bismuth tetra-therapy as second-line remedial therapy after the failure of Helicobacter pylori (H.Pylori) eradication, and improve the symptoms of the patients. The safety and side effects of the drug were analyzed, and the cost-effectiveness analysis was carried out to find a safe, effective, low-cost and easy-to-accept remedy for Hp. Methods: 91 patients with chronic gastritis or peptic ulcer diagnosed by out-patient gastroscopy were treated with regular anti-Hp therapy. The 14C urea breath test (Hp) was still positive in 91 patients at the time of re-diagnosis. Group A (n = 30, M 18, F 12) were randomly divided into three groups: group A (n = 30, M 18, F 12): Rabeprazole 10mg bid colloid fruit was treated with 0.2 g bid, of levofloxacin compared with bismuth 0.15g tid amoxicillin clavulanate potassium (0.457g bid,); Group B (n = 30, male 17, F 13) received 10-day sequential therapy: Rabeprazole 10mgbid, amoxicillin-clavulanate potassium (0.457g bid),) 5 days later, 10mg tinidazole 0.5g levofloxacin 0.2g, bid; Group C (n = 31, M 19, F 12) 14 days sequential therapy: Rabeprazole 10mgbid amoxicillin clavulanate potassium (0.457g bid),) 7 days after lameprazole 10mg tinidazole (0.5g bid) levofloxacin (0.2g bid).) The adverse reactions and symptom relief during the treatment were followed up. The duration of re-diagnosis was at least 1 month after antibiotic discontinuation. The eradication of Hp was detected by 14C-urea breath test (Urea BreanthTest,UBT) after at least 14 days of PPI. Results: there were 91 patients in this experiment, one in each of the three groups, and there were no serious side effects such as (ADR) during the treatment, 30 patients in the 10-day bismuth quadruple group, 10-day sequential therapy group and 14-day sequential therapy group were 30 cases, respectively, and there were 30 cases in the 10-day sequential therapy group and in the 14-day sequential therapy group, respectively. 30 cases and 31 cases. The Hp eradication rate of the three groups was 73.3%, 76.7% and 80.6% respectively according to the intention-to-treat analysis, and the (PP) eradication rate of the complete treatment analysis was 75.9%, 79.3% and 83.3%, respectively. There was no significant difference in Hp eradication rate among the three groups (P0.05). There was no significant difference in symptom remission rate and adverse reaction rate among the three different treatment methods (P0.05). Cost-effectiveness analysis showed that for every 1% increase in eradication rate, the cost of 10-day sequential therapy was 33.5 yuan lower than that of 10-day bismuth quadruple therapy, and 10-day sequential therapy was 14.13 yuan lower than that of 14-day sequential therapy. Conclusion: among the 10-day sequential therapy, 14-day sequential therapy and 10-day bismuth quadruple therapy, the eradication rate of sequential 14-day regimen for Hp was relatively high, but the differences among the three regimens could not be explained statistically (P > 0.05). This study may be due to the small sample size, limited to our hospital patients, as well as the region's antibiotic resistance and other factors, but also need large samples, multicenter, randomized trials to prove. There was no significant difference in the remission rate of clinical symptoms and the incidence of adverse reactions among the three groups. There was no statistical difference in the incidence of adverse reactions among the three groups (P > 0.05), suggesting that the three regimens had better safety. 10-day sequential therapy as a second-line remedial therapy for Hp had high eradication rate, more economical, and easy to be accepted by the majority of patients. It is worth popularizing in clinic.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R573
本文編號(hào)：2448865
[Abstract]:Objective: to observe the efficacy of 10-day, 14-day sequential therapy and 10-day bismuth tetra-therapy as second-line remedial therapy after the failure of Helicobacter pylori (H.Pylori) eradication, and improve the symptoms of the patients. The safety and side effects of the drug were analyzed, and the cost-effectiveness analysis was carried out to find a safe, effective, low-cost and easy-to-accept remedy for Hp. Methods: 91 patients with chronic gastritis or peptic ulcer diagnosed by out-patient gastroscopy were treated with regular anti-Hp therapy. The 14C urea breath test (Hp) was still positive in 91 patients at the time of re-diagnosis. Group A (n = 30, M 18, F 12) were randomly divided into three groups: group A (n = 30, M 18, F 12): Rabeprazole 10mg bid colloid fruit was treated with 0.2 g bid, of levofloxacin compared with bismuth 0.15g tid amoxicillin clavulanate potassium (0.457g bid,); Group B (n = 30, male 17, F 13) received 10-day sequential therapy: Rabeprazole 10mgbid, amoxicillin-clavulanate potassium (0.457g bid),) 5 days later, 10mg tinidazole 0.5g levofloxacin 0.2g, bid; Group C (n = 31, M 19, F 12) 14 days sequential therapy: Rabeprazole 10mgbid amoxicillin clavulanate potassium (0.457g bid),) 7 days after lameprazole 10mg tinidazole (0.5g bid) levofloxacin (0.2g bid).) The adverse reactions and symptom relief during the treatment were followed up. The duration of re-diagnosis was at least 1 month after antibiotic discontinuation. The eradication of Hp was detected by 14C-urea breath test (Urea BreanthTest,UBT) after at least 14 days of PPI. Results: there were 91 patients in this experiment, one in each of the three groups, and there were no serious side effects such as (ADR) during the treatment, 30 patients in the 10-day bismuth quadruple group, 10-day sequential therapy group and 14-day sequential therapy group were 30 cases, respectively, and there were 30 cases in the 10-day sequential therapy group and in the 14-day sequential therapy group, respectively. 30 cases and 31 cases. The Hp eradication rate of the three groups was 73.3%, 76.7% and 80.6% respectively according to the intention-to-treat analysis, and the (PP) eradication rate of the complete treatment analysis was 75.9%, 79.3% and 83.3%, respectively. There was no significant difference in Hp eradication rate among the three groups (P0.05). There was no significant difference in symptom remission rate and adverse reaction rate among the three different treatment methods (P0.05). Cost-effectiveness analysis showed that for every 1% increase in eradication rate, the cost of 10-day sequential therapy was 33.5 yuan lower than that of 10-day bismuth quadruple therapy, and 10-day sequential therapy was 14.13 yuan lower than that of 14-day sequential therapy. Conclusion: among the 10-day sequential therapy, 14-day sequential therapy and 10-day bismuth quadruple therapy, the eradication rate of sequential 14-day regimen for Hp was relatively high, but the differences among the three regimens could not be explained statistically (P > 0.05). This study may be due to the small sample size, limited to our hospital patients, as well as the region's antibiotic resistance and other factors, but also need large samples, multicenter, randomized trials to prove. There was no significant difference in the remission rate of clinical symptoms and the incidence of adverse reactions among the three groups. There was no statistical difference in the incidence of adverse reactions among the three groups (P > 0.05), suggesting that the three regimens had better safety. 10-day sequential therapy as a second-line remedial therapy for Hp had high eradication rate, more economical, and easy to be accepted by the majority of patients. It is worth popularizing in clinic.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R573
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 洪衛(wèi)康;;左氧氟沙星序貫與鉍劑四聯(lián)抗幽門螺桿菌的隨機(jī)對(duì)照研究[J];中外醫(yī)療;2013年36期
本文編號(hào)：2448865
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