CAJ | 학술논문

目的：探讨洛赛克、克拉霉素、替硝唑三联疗法治愈的十二指肠球部溃疡(DU)“再生”粘膜组织成熟度和IL-10、IL-12的水平。方法：将64例幽门螺杆菌(HP)阳性DU患者随机分成2组：A组36例，应用洛赛克20 mg+克拉霉素500 mg+替硝唑500 mg，bid，共1周；B组28例，采取雷尼替丁150 mg bid+阿莫西林500 mg、甲硝唑400 mg，tid，共4周。停药4～6周后复查胃镜，从DU边缘或溃疡疤痕处活检粘膜组织以备组织学检查及IL-10、IL-12的测定。用快速尿素酶试验和美蓝染色来检查HP。结果：Λ组溃疡愈合率90.91％，显著高于B组的69.23%(P<0.05)；A组HP根除率也明显高于B组(93.90％vs69.23%，P<0.05)。从再生粘膜组织成熟度来看，A组73.33%为“良”，而B组为“良”者仅33.33%，P<0.01。A、B组治疗前球部粘膜IL-10水平均高于对照组，IL-12水平也都高于对照组；治疗后A组IL-10的水平显著高于B组和对照组，IL-12水平恢复到正常水平；B组IL-10、IL-12的水平基本上也恢复到正常水平。结论：洛赛克、克拉霉素、替硝唑三联疗法治愈的组织成熟度优于含雷尼替丁方案。其可能抑制IL-12分泌，而促进IL-10的分泌，使IL-10在溃疡愈合后的一段时间内维持在较高水平，为粘膜修复营建有利环境。
목적：탐토락새극、극랍매소、체초서삼련요법치유적십이지장구부궤양(DU)“재생”점막조직성숙도화IL-10、IL-12적수평。방법：장64례유문라간균(HP)양성DU환자수궤분성2조：A조36례，응용락새극20 mg+극랍매소500 mg+체초서500 mg，bid，공1주；B조28례，채취뢰니체정150 mg bid+아막서림500 mg、갑초서400 mg，tid，공4주。정약4～6주후복사위경，종DU변연혹궤양파흔처활검점막조직이비조직학검사급IL-10、IL-12적측정。용쾌속뇨소매시험화미람염색래검사HP。결과：Λ조궤양유합솔90.91％，현저고우B조적69.23%(P<0.05)；A조HP근제솔야명현고우B조(93.90％vs69.23%，P<0.05)。종재생점막조직성숙도래간，A조73.33%위“량”，이B조위“량”자부33.33%，P<0.01。A、B조치료전구부점막IL-10수평균고우대조조，IL-12수평야도고우대조조；치료후A조IL-10적수평현저고우B조화대조조，IL-12수평회복도정상수평；B조IL-10、IL-12적수평기본상야회복도정상수평。결론：락새극、극랍매소、체초서삼련요법치유적조직성숙도우우함뢰니체정방안。기가능억제IL-12분비，이촉진IL-10적분비，사IL-10재궤양유합후적일단시간내유지재교고수평，위점막수복영건유리배경。
Purpose: To investigate the histological maturity of “regenerated” mucosa in duodenal ulcer(DU) and level of IL-10, IL-12 after triple therapy with losec, clarithromycin and tinidazole. Methods: 64patients with helicobacter pylori (HP)-positive DU were randomly divided into 2 groups: A group ( n = 36)with losec 200 mg bid+ clarithromycin 500 mg tid+ tinidazole 500 mg bid for one week (LCT); B group(n = 28) with ranitidine 150 mg bid + amoxicilline 500 mg tid + metronidazole 400 mg tid for 4 weeks(RAM). Endoscopy was repeated 4～6 weeks after the end of treatment, biopsy specimens were got fromthe edge of DU or in the scars of DU for observing the histological maturity and measuring the levels of IL10, IL-12. HP status was determined by rapid urease test and methyl blue stain. Results: 4～6 weeks afterthe end of treatment, healing rate of A group was much higher than that in B group(90.91% vs 69.23%,P <0.05); HP eradication rate in A group was also higher than that of B group(93.90% vs 69.23%, P<0.05). For histological maturity, 73.33% patients in A group were ”good”, but 33.33% patients in Bgroup, P < 0.01. Prior of the treatment, te levels of IL-10 in A、B group were much higher than control,so did IL-12; the levels of IL-10 in ”healed” mucosa of A group were significantly higher than B and controlgroup, the levels of IL-12 returned the normal level; the levels of IL-10、 IL-12 of B group also nearly returned the normal value. Conclusion: After triple therapy with losec, clarithromycin and tinidazole, thehistological maturity of ”regenerated” mucosa with LCT should be preferred to with RAM. LCT may decrease the secretion of IL-12 and increase IL-10, and IL-10 remained a higher level for a peroid of time tobuild the favorable environment for mucosal reconstitution.