四联疗法联合中医药对幽门螺杆菌补救治疗.docVIP

四联疗法联合中医药对幽门螺杆菌补救治疗 　 作者：华志民，马忠琴，童蓓丽，李辉，李敏，王瑞芳 【摘要】 目的 对进行过根除幽门螺杆菌（Helicobacter pylori，H.pylori）治疗而失败的患者，应用含铋剂、质子泵抑制剂的四联疗法和中医药联合补救治疗并观察根除疗效。方法 120例H.pylori阳性患者随机分成两组，每组60例；对照组应用奥美拉唑20mg，胶体次枸橼酸铋钾240mg，阿莫西林1000mg，呋喃唑酮100mg，均bid，共7天；而治疗组除应用对照组药物外，同时服用中药14天，观察上腹痛、反酸、饱胀感、嗳气等症状缓解情况，并在补救治疗结束1个月后复查胃黏膜快速尿素酶试验和组织学染色或查14碳-尿素呼气试验，观察其根除率。结果 治疗组有58例完成治疗，其中有53例H.pylori转阴，根除率按意图治疗（ITT）和试验方案（PP）分析分别为88.33%（53/60）和91.38%（53/58），对照组有55例完成治疗，其中有48例转阴，根除率按意图治疗（ITT）和试验方案（PP）分析分别为80.00%（48/60）和87.27%（48/55），两组间比较差异有显著性（Plt;0.05）。治疗后两组症状缓解率分别为94.83%（治疗组）和83.64%（对照组），两组间比较差异有显著性（Plt;0.05）。结论 对H.pylori根除治疗失败的患者，应用四联疗法和中医药联合补救疗法不仅能获得较高的H.pylori根除率，改善临床症状也有良好作用，且副反应较小，值得临床推广。 【关键词】 幽门螺杆菌；四联疗法；中医药；联合疗法；补救治疗 【Abstract】 Objective To compare the efficacy and tolerability of rescue therapy for eradicating Helicobacter pylori （H.pylori） with quadruple regimen and traditional Chinese and western medicine combination therapy after treatment failure of triple regimen. Methods 120 patients with H.pylori infection were randomized to receive colloidal bismuth subcitrate 240mg，omeprazole 20mg，amocillim1000mg，furazolidone100mg bid for7day（western medicine group, n=60）and to receive the same medicine add traditional Chinese medicine for 14day（traditional Chinese and western medicine group, n=60）.Observing the efficacy of the clinical symptoms，at least four weeks after completion of the therapy，the 14C-urea breath test（UBT）was performed to evaluate the success of H.pylori eradication. Results 58 patients in traditional Chinese and western medicine group and 55 patients in western medicine group finished the treatment.By intention-to-treat（TTI）analysis and per-protocol（PP）analysis，the H.pylori eradication rates of traditional Chinese and western medicine group were88.33%（53/60）and91.38%（53/58），and western medicine group were80.00%（48/60）and87.27%（48/55），there was significant difference between the two groups（Plt;0.05）. The effective rate of symptoms were94.83%（48/60）and83.64%（46/55）（Plt;0.05）.Conclusion Quad