序贯疗法治疗幽门螺杆菌阳性胃溃疡临床分析.docVIP

序贯疗法治疗幽门螺杆菌阳性胃溃疡临床分析 　　【摘要】目的比较序贯疗法与传统三联疗法治疗幽门螺杆菌(Hp)阳性胃溃疡的疗效与安全性。方法选取84例经胃镜检测证实为Hp阳性胃溃疡病例，随机分为两组：治疗组，前5d予雷贝拉唑、阿莫西林,后5d予雷贝拉唑、替硝唑、克拉霉素治疗；对照组予雷贝拉唑、阿莫西林、克拉霉素治疗10d。随后两组均进行雷贝拉唑巩固治疗4周，疗程结束后均行胃镜复查检测。结果疗程结束时,治疗组溃疡愈合率87.8%,对照组溃疡愈合率86.05%，两组愈合率比较无显著性差异(P＞0.05)；治疗组HP阴转率为92.68%,对照组HP阴转率为83.72%，两组HP阴转率比较具有显著性差异(P 　　【关键词】10d序贯疗法；三联疗法；幽门螺杆菌；胃溃疡 　　 　　Sequential therapies for Helicobacter pylori-positive gastric ulcer clinical analysis 　　【Abstract】Objective To compare sequential therapy with the traditional triple therapies for Helicobacter pylori (Hp)-positive gastric ulcer and security. Methods 84 cases detected by endoscopy confirmed Hp-positive patients with gastric ulcer were randomly divided into two groups: the treatment group，before the therapy of the combination of rabeprazole, amoxicillin and rabeprazole for 5d,tinidazole, clarithromycin mixture therapy of 5d;control group, rabeprazole, Amoxicillin,clarithromycin treatment of 10d. Both groups were followed for consolidation therapy of rabeprazole for 4 weeks after treatment underwent endoscopy review test. Results at the end of treatment, the treatment group 87.8% ulcer healing rate, ulcer healing rate of the control group was 86.05%, the healing rate between the two groups there was no significant difference (P0.05); treatment group HP negative conversion rate was 92.68%, control Group HP negative conversion rate was 83.72%, compared two groups of HP negative rate was significant difference (P 　　3讨论 　　已知Hp是胃溃疡的主要病因，Hp根除是治愈溃疡及预防复发主要手段，但是，目前Hp根除失败的主要原因是Hp对抗生素的耐药问题。在我国，Hp对抗生素的耐药情况日益严重，且地区差异很大，为了克服耐药问题，故合理联合抗生素治疗是提高根治Hp的治疗方向。 　　序贯疗法给Hp根除带来了新的希望，然而具体机制不甚明了，初步研究提示可能机制: (1)前5天诱导期采用的阿莫西林不仅本身能够杀灭幽门螺杆菌,而且还能够减少患者的细菌负荷量,从而增加细菌对克拉霉素的敏感性。这是因为细菌能够形成克拉霉素的流出通道,将药物快速转运出细菌体外,阻止克拉霉索与核糖体的结合。而阿莫西林作用于Hp的细胞壁,第一阶段的阿莫西林治疗能通过破坏细胞壁而阻止克拉霉素流出通道的形成,故可能提高了第二阶段克拉霉素的治疗效果[5]。近年来克拉霉素的耐药率较以前有明显升高,达17 %～44 %[ 6、7] ；(2)序贯疗法适当地延长了疗程,使根除Hp治疗更彻底;3种抗生素短期联合应用,达到了强强联合抑制Hp,又能减少Hp耐药机会。 　　本研究发现序贯疗法较经典三联疗法在胃溃疡的根治Hp感染一线治疗有较好的前景。我们的研究发现，虽在胃溃疡治愈率方面无明