我国幽门螺杆菌感染患者原发耐药情况以及不同根除方案对其疗效的前瞻性多中心课稿.ppt

Introduction 2014年4月Am J Gastroenterol发表了北京大学第三医院消化科周丽雅教授牵头的一项国内5家中心共同完成的临床试验“序贯方案和标准三联方案在我国幽门螺杆菌感染初治患者中的多中心、随机对照研究”(Zhou L，Zhang J，Chen M，et a1．A comparative study of sequential therapy and standard triple therapy for Helicobacter pylori infection：a randomized multicenter trial．Am J Gastroenterol，2014，109：535-541)，系统严格地比较了序贯方案和标准三联方案根除幽门螺杆菌(Hp)感染的疗效、安全性、依从性等问题，并深人探讨了抗菌药物耐药对序贯方案疗效的影响。 Background Helicobacter pylori ( H. pylori ) infection is an important causal factor in a wide range of upper gastrointestinal diseases, including chronic gastritis, peptic ulcer disease, and gastric cancer. As such, it is a major contributor that affects public health on a worldwide basis, especially in developing countries. Background Traditionally, standard triple therapy (STT) comprising a proton pump inhibitor (PPI) combined with two antibiotics (clarithromycin and amoxicillin or metronidazole) is the firstline option for empiric H. pylori eradication. However, the effectiveness of STT has declined to unacceptable levels in many regions of the world, mainly owing to antibiotic resistance. Consequently, it is no longer a suitable first-line treatment approach, and there is a clear need for new regimens with good efficacy and safety in order to effectively manage this widespread form of infection. Objectives Studies conducted in large populations of patients and providing full information on Helicobacter pylori ( H. pylori ) antibiotic resistance are needed to determine the efficacy of sequential therapy (SQT) against this pathogen. This study compared eradication rates with SQT and standard triple therapy (STT), and evaluated the impact of antibiotic resistance on outcomes. Methods The study population included adults with positive H. pylori culture presenting at four centers in China between March 2008 and December 2010. Patients were randomly assigned to 10 days of treatment with esomeprazole, amoxicillin, and clarithromycin (STT; n = 140) or to 5 days of treatment with esomep