克拉霉素四联方案对一线方案根除失败幽门螺杆菌再根除效果评估.docVIP

克拉霉素四联方案对一线方案根除失败幽门螺杆菌再根除效果评估 　　摘 要：目的 评价含克拉霉素四联方案治疗的一线方案失败后Hp根除效果。方法 择取2016年3月～2017年3月收集的32例接受Hp根除OABM方案和31例接受OAMF方案失败的患者进入本研究，均给予奥美拉唑20 mg，阿莫西林1 g、次枸橼酸铋钾240 mg和克拉霉素500 mg，bid，疗程14 d。治疗8 周后14C-尿素呼气试验评估Hp根除情况。结果 共61例患者完成研究，二线方案根除率OABM组和OAMF组分别为84.37%和77.41%；PP根除率分别为87.09%和82.75%；同时累积根除率为80.95%和85.00%。11.11%患者有副作用。结论 根除率80%和很低的不良反应发生率含克拉霉素四联方案可作为一线方案失败后的二线方案。 　　关键词：幽门螺杆菌；根除；克拉霉素；二线方案 　　中图分类号：R573 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.02.044 　　文章编号：1006-1959（2018）02-0121-03 　　Abstract：Objective To evaluate the first-line treatment of clarithromycin containing quadruple therapy after failure of Hp eradication effect. Methods From March 2016 to March 2017，32 patients who received HP eradication OABM regimen and 31 patients who failed OAMF regimen were selected to enter the study.All patients were given omeprazole 20 mg，1 g of amoxicillin，240 mg of bismuth potassium citrate and 500 mg of clarithromycin， bid for 14 d.The HP eradication was evaluated by 14C-urea breath test after 8 weeks of treatment.Results 61 patients completed the study.The eradication rates of the second line regimen in OABM group and OAMF group were 84.37% and 77.41 respectively.The eradication rates of PP were 87.09% and 82.75，respectively.At the same time，the cumulative eradication rate was 80.95% and 85.00%.11.11% patients had side effects.Conclusion The tetralogy of clarithromycin combined with eradication rate80% and very low adverse reaction rate can be used as a second line regimen after the failure of the first-line regimen. 　　Key words：Helicobacter pylori；Eradication；Clarithromycin；Second line scheme 　　幽门螺杆菌（Helicobacter pylori，H.pylori）感染?c消化性溃疡、胃癌和胃淋巴瘤的关系密切。赵进报道人群Hp感染率为47.86%，男性高于女性[1]。研究显示一线方案根除失败率为20%，需要采用二线方案[2]。Maastricht IV 共识推荐在低克拉霉素耐药地区以克拉霉素三联方案或含铋剂的四联方案作为一线治疗方案，如治疗失败推荐含铋剂方案或含左氧氟沙星的三联方案；而高耐药地区推荐含铋剂的四联方案或不含铋剂的四联方案作为一线方案，如根除失败推荐含左氧氟沙星的三联方案[3]。我国属于Hp高感染率国家，PPI加两种抗生素的三联疗法是多数指南推荐一线治疗方法。临床常用抗生素包括甲硝唑、克拉霉素和阿莫西林，但Hp耐药率正逐年上升， 而PPI三联疗法根除失败的主要原因是Hp的耐药性。国内克拉霉素耐药率为 13.5%～29.17%[4]。本研究在