含莫西沙星三联方案根除幽门螺杆菌感染的疗效观察(第5稿,20090828).docVIP

含莫昔沙星三联方案根除幽门螺杆菌的疗效观察 王承党 庄则豪 陆岽 李文清 吴婷 陈玉丽 福建医科大学附属第一医院消化科，福建医科大学消化系病研究室,350005，福州 目的：观察9天疗程的含莫西沙星三联方案对初治和复治幽门螺杆菌(Hp)感染病人的根除效果。 方法：将313例Hp感染初治病人、51例第2次治疗病人、32例第3次治疗病人纳入研究，莫西沙星400mg，1次/日，埃索美啦唑20mg，2次/日，替硝唑400mg，2次/日，疗程9天。疗程结束后4周以后复查呼气试验，阴性者为根除成功，按照意向分析(ITT)和按方案分析(PP)计算Hp根除率及95%可信区间，并观察药物的不良反应和病人的顺应性。 结果：按ITT分析，首次治疗组、第2次治疗组、第3次治疗组的Hp根除率分别是89.80%(95％CI 86.69%-92.99%)、81.25%(75.32%-90.90%)、81.25% (66.14%-92.65%)，差异无统计学意义(X2=4.3393, p0.05)；按PP分析，3组HP根除率分别是93.95%(90.87%-96.43%)、84.78%(79.13%-93.57%)、81.25% (66.14%-92.65%)，差异有显著性意义(X2=9.2936, p0.010 )，第2次治疗组、第3次治疗组的根除率分别低于首次治疗组(X2=4.8850，p0.05；X2=7.0235，p0.01)。在首次治疗组中，不管按照ITT分析还是PP分析，溃疡病和慢性胃炎病人的Hp根除率之差异都没有统计学意义(ITT：X2= 1.6701，p0.10；PP：X2=0.0305，p0.75)。按ITT分析，3组慢性胃炎病人的Hp根除率之差异无统计学意义(X2=2.9505, p0.10)，而按PP分析则差异有显著性意义(X2=8.5507, p0.025)，其中第3次治疗的慢性胃炎病人Hp根除率低于首次治疗(X2=8.0763，p0.005)。比较常见的不良事件是大便次数增多、腹部不适和头晕，多出现在服药的头3天内，一般可以忍受，仅1例(0.27%)因头晕而停药，治疗的依从性为95.99%。 结论：9天疗程的莫昔沙星+埃索美啦唑+替硝唑方案对于初治和复治Hp感染病人都有比较高的根除率，顺应性高，副作用小，可以作为一线甚至二线补救治疗的选择方案。 关键词：幽门螺杆菌;根除率;莫昔沙星;埃索美啦唑;消化性溃疡;慢性胃炎 通讯作者：王承党，wangcdhl@,Efficacy of Moxifloxacin-based Triple Therapy to Eradicate Helicobacter Pylori Infection Wang Cheng-dang, Zhuang Ze-hao, Lu Dong, Li Wen-qing, Wu Ting, Chen Yu-li Dept. of the First Affiliated Hospital of Fujian Medical University, The Digestive Disease Lab of Fujian Medical University, 350005, Fuzhou, Fujian Province Aim: To evaluated the efficacy of 9-day moxifloxacin-based triple therapy as first- or second-line treatment to eradicate helicobacter pylori(Hp). Methods: Three hundred and thirteen Hp-positive patients without previous treatment (Group A), 51 Hp-positive patients with one-failed treatment(Group B), and 32 with two-failed treatment(Group C) were recruited to receive moxifloxacin, esomeprazole, tinidazole(MET) for 9 days. Hp status was re-assessed 4 weeks after the end of therapy by urea breath test. The eradication rate and its 95% confidence interval (59%CI) were calculated in intention-to-treat(ITT) and per-