三種方案初始治療幽門螺桿菌感染的療效觀察
發(fā)布時間：2019-04-17 10:30
【摘要】：1.研究背景和目的:我國屬于發(fā)展中國家,H.pylori感染率高,H.pylori感染與上胃腸道疾病關(guān)系密切,同時還與某些胃腸道外疾病具有相關(guān)性,世界衛(wèi)生組織已經(jīng)把H.pylori列為胃癌的I類致癌因子,所以H.pylori感染治療是H.pylori研究領(lǐng)域中的重點課題。在幽門螺桿菌的治療中仍然存在著許多問題,要徹底根除H.pylori依舊很困難,主要是因為幽門螺桿菌對抗生素的耐藥性問題,導(dǎo)致H.pylori根除率越來越低。近年來為了提高幽門螺桿菌的根除率國際上推薦了一些根除方案,序貫療法(sequential therapy)、伴同療法(concomitant therapy)、包括左氧氟沙星的三聯(lián)療法等,我國多中心隨機對照研究顯示序貫療法與標準三聯(lián)療法相比并未顯示優(yōu)勢。本研究目的通過比較含鉍劑四聯(lián)方案、含克拉霉素三聯(lián)方案、含呋喃唑酮三聯(lián)方案對H.pylori的根除率,篩選出本地區(qū)有效、安全、簡便、經(jīng)濟的治療方案。2.方法:將2013年11月至2014年10月在天津港口醫(yī)院消化內(nèi)科門診經(jīng)14C尿素呼氣試驗檢測方法診斷為H.pylori感染的212名初治患者隨機分為三組,A組(72例):埃索美拉唑(20mg 2/日)+枸櫞酸鉍鉀220mg+克拉霉素500mg+阿莫西林1.0g,10天;B組(71例):埃索美拉唑20mg+阿莫西林1.0g+克拉霉素500mg,10天;C組(69例):埃索美拉唑20mg+阿莫西林1.0g+呋喃唑酮100mg,10天,停藥4周后應(yīng)用14C-UBT檢測幽門螺桿菌,比較各組的幽門螺桿菌根除率。3.結(jié)果不同方案根除率的比較:212名患者中完成治療和隨訪的202例,未完成的10例。按意向治療(ITT)分析A、B、C三組根除率分別為83.3%、67.6%、82.6%,三組患者根除率相比差異有統(tǒng)計學(xué)意義,其中A組與B組、B組與C組根除率相比差異有統(tǒng)計學(xué)意義(P㩳0.05),A組和C組根除率相比差異無統(tǒng)計學(xué)意義(P㧐0.05)。按符合方案集(PP)分析A、B、C三組根除率分別為87.0%、69.6%、89.1%,三組患者的根除率相比差異有統(tǒng)計學(xué)意義(P㩳0.05),其中A組與B組、B組與C組相比根除率差異有統(tǒng)計學(xué)意義(P㩳0.05),A組和C組根除率相比差異無統(tǒng)計學(xué)意義(P㧐0.05)。不良反應(yīng)發(fā)生情況:三組的不良反應(yīng)發(fā)生率分別為14.5%,11.6%和10.9%,三組間比較差異無統(tǒng)計學(xué)意義(P0.05)。三組治療方案所需費用的比較:A組403.7元,B組370.9元,C組289.1 元,成本-效果分析顯示C組取得的單位效果成本最低。4結(jié)論:含鉍劑四聯(lián)方案和含呋喃唑酮三聯(lián)方案均比含克拉霉素三聯(lián)方案能更有效的根除H.Pylori,但含呋喃唑酮組單位效果成本最低,所以在本地區(qū)臨床工作中,10天含呋喃唑酮三聯(lián)方案可作為經(jīng)驗性治療H.Pylori感染的首選方案。
[Abstract]:1. Background and objective: China is a developing country with a high rate of H.pylori infection. H.pylori infection is closely related to upper gastrointestinal diseases, and it is also associated with some extragastrointestinal diseases. The World Health Organization (WHO) has listed H.pylori as a class I carcinogen of gastric cancer, so the treatment of H.pylori infection is a key topic in the field of H.pylori research. There are still many problems in the treatment of Helicobacter pylori. It is still difficult to eradicate H.pylori completely. It is mainly because of the antibiotic resistance of Helicobacter pylori that the eradication rate of H.pylori becomes lower and lower. In recent years, in order to improve the eradication rate of Helicobacter pylori, some eradication programs have been recommended internationally, such as sequential therapy of (sequential therapy), combined with (concomitant therapy), including triad therapy of levofloxacin, etc. Our multicenter randomized controlled study shows that sequential therapy has no advantage over standard triple therapy. The purpose of this study was to find out the effective, safe, simple and economical therapeutic regimen in this area by comparing the eradication rate of H.pylori with four regimen containing bismuth agent, three regimens containing clarithromycin and three regimens containing furazolidone. Methods: from November 2013 to October 2014, a total of 212 newly diagnosed patients with H.pylori infection were randomly divided into three groups, who were diagnosed as H.pylori infection by 14C urea breath test in the Department of Gastroenterology of Tianjin Port Hospital from November 2013 to October 2014. Group A (72 cases): Esomeprazole (20mg 2 / day) bismuth potassium citrate 220mg clarithromycin 500mg amoxicillin 1.0 g for 10 days; Group B (71 cases): Esomeprazole 20mg Amoxicillin 1.0 g clarithromycin 500 mg, 10 days; Group C (69 cases): Esomeprazole 20mg 1.0g furazolidone 100mg, 10 days. After 4 weeks of withdrawal, Helicobacter pylori was detected by 14C-UBT, and the eradication rate of Helicobacter pylori in each group was compared. 3. Results among 212 patients, 202 patients completed treatment and follow-up, and 10 patients did not. The eradication rates of group A, B and C were 83.3%, 67.6% and 82.6%, respectively, according to the intention-to-treat (ITT) analysis. There was a significant difference in the eradication rates among the three groups, among which group A and group B were significantly higher than those in group B. There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference between group B and C (P < 0.05). The eradication rates of group A, group B and group C were 87.0%, 69.6% and 89.1% respectively according to the concordance set (PP) analysis. There was significant difference in eradication rate among the three groups (P < 0.05), among which group A was significantly higher than group B (P < 0.05), and group B was significantly higher than that of group B (P < 0.05). There was a significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C. there was no significant difference in eradication rate between group B and group C (P < 0.05). The incidence of adverse reactions in the three groups was 14.5%, 11.6% and 10.9%, respectively. There was no significant difference among the three groups (P0.05). Comparison of the cost of treatment regimen among three groups: $403.7 in group A, $370.9 in group B, and $289.1 in group C. The cost-effectiveness analysis showed that group C achieved the lowest unit cost. 4 conclusion: both bismuth-containing quadruple regimen and furazolidone-containing triple regimen are more effective than clarithromycin-containing triad regimen in the eradication of H. Pylori. However, the unit cost of the group containing furazolidone was the lowest. Therefore, the triplex regimen containing furazolidone for 10 days could be used as the first choice for empirical treatment of H.Pylori infection in the clinical work of this area.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R573.1
[Abstract]:1. Background and objective: China is a developing country with a high rate of H.pylori infection. H.pylori infection is closely related to upper gastrointestinal diseases, and it is also associated with some extragastrointestinal diseases. The World Health Organization (WHO) has listed H.pylori as a class I carcinogen of gastric cancer, so the treatment of H.pylori infection is a key topic in the field of H.pylori research. There are still many problems in the treatment of Helicobacter pylori. It is still difficult to eradicate H.pylori completely. It is mainly because of the antibiotic resistance of Helicobacter pylori that the eradication rate of H.pylori becomes lower and lower. In recent years, in order to improve the eradication rate of Helicobacter pylori, some eradication programs have been recommended internationally, such as sequential therapy of (sequential therapy), combined with (concomitant therapy), including triad therapy of levofloxacin, etc. Our multicenter randomized controlled study shows that sequential therapy has no advantage over standard triple therapy. The purpose of this study was to find out the effective, safe, simple and economical therapeutic regimen in this area by comparing the eradication rate of H.pylori with four regimen containing bismuth agent, three regimens containing clarithromycin and three regimens containing furazolidone. Methods: from November 2013 to October 2014, a total of 212 newly diagnosed patients with H.pylori infection were randomly divided into three groups, who were diagnosed as H.pylori infection by 14C urea breath test in the Department of Gastroenterology of Tianjin Port Hospital from November 2013 to October 2014. Group A (72 cases): Esomeprazole (20mg 2 / day) bismuth potassium citrate 220mg clarithromycin 500mg amoxicillin 1.0 g for 10 days; Group B (71 cases): Esomeprazole 20mg Amoxicillin 1.0 g clarithromycin 500 mg, 10 days; Group C (69 cases): Esomeprazole 20mg 1.0g furazolidone 100mg, 10 days. After 4 weeks of withdrawal, Helicobacter pylori was detected by 14C-UBT, and the eradication rate of Helicobacter pylori in each group was compared. 3. Results among 212 patients, 202 patients completed treatment and follow-up, and 10 patients did not. The eradication rates of group A, B and C were 83.3%, 67.6% and 82.6%, respectively, according to the intention-to-treat (ITT) analysis. There was a significant difference in the eradication rates among the three groups, among which group A and group B were significantly higher than those in group B. There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference between group B and C (P < 0.05). The eradication rates of group A, group B and group C were 87.0%, 69.6% and 89.1% respectively according to the concordance set (PP) analysis. There was significant difference in eradication rate among the three groups (P < 0.05), among which group A was significantly higher than group B (P < 0.05), and group B was significantly higher than that of group B (P < 0.05). There was a significant difference in eradication rate between group B and group C (P < 0.05). There was no significant difference in eradication rate between group B and group C. there was no significant difference in eradication rate between group B and group C (P < 0.05). The incidence of adverse reactions in the three groups was 14.5%, 11.6% and 10.9%, respectively. There was no significant difference among the three groups (P0.05). Comparison of the cost of treatment regimen among three groups: $403.7 in group A, $370.9 in group B, and $289.1 in group C. The cost-effectiveness analysis showed that group C achieved the lowest unit cost. 4 conclusion: both bismuth-containing quadruple regimen and furazolidone-containing triple regimen are more effective than clarithromycin-containing triad regimen in the eradication of H. Pylori. However, the unit cost of the group containing furazolidone was the lowest. Therefore, the triplex regimen containing furazolidone for 10 days could be used as the first choice for empirical treatment of H.Pylori infection in the clinical work of this area.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R573.1
【參考文獻】
相關(guān)期刊論文 前10條
1 Cong He;Zhen Yang;Nong-Hua Lu;;Helicobacter pylori infection and diabetes:Is it a myth or fact?[J];World Journal of Gastroenterology;2014年16期
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