CAJ | 학술논문

目的：比较不同三联疗法治疗幽门螺杆菌(H.pylori)的疗效,筛选效价比较高的根除方案。方法：将117例有消化不良症状经胃镜诊断为胃溃疡或十二指肠球溃疡或活动性慢性胃炎且伴有H.pylori感染的患者随机分为四组进行根除治疗,EAC组：埃索美拉唑、阿莫西林、克拉霉素14d,EAT组：埃索美拉唑、阿莫西林、替硝唑14d,ECT组：埃索美拉唑、克拉霉素、替硝唑14d,BECT组：枸橼酸铋钾、埃索美拉唑、克拉霉素、替硝唑14d。所有患者停药至少4周后复查13C尿素酶呼气试验,判断H.pylori根除情况。结果：(1)EAC组H.pylori根除率为90.00%(27/30), EAT组86.21%(25/29),ECT组56.67%(17/30), BECT组75.00%(21/28),EAC组与EAT组的H.pylori根除率无统计学差异,EAC组和EAT组H.pylori根除率较ECT组明显增高(P分别为0.004和0.012),BECT组H.pylori根除率较EAC组低,较ECT组高,但无统计学差异。(2)EAC、EAT、ECT、BECT组不良反应发生率分别为7/30(23.33%)、5/29(17.24%),9/30(30.00%),9/28(32.14%),各组间比较无统计学差异；(3)EAC组费用为628.87元,EAT组为404.45元,ECT组为585.22元,BECT组为623.01元,EAT组费用最低。结论：14d的含有阿莫西林的三联组合即埃索美拉唑、阿莫西林、替硝唑及埃索美拉唑、阿莫西林、克拉霉素H. pylori根除率较高,不良反应轻微,均可作为根除H. pylori的一线方案,前者效价比更高。14d的埃索美拉唑、克拉霉素、替硝唑三联组合根除率低,联合铋剂组成四联方案根除率有增高趋势。
목적：비교불동삼련요법치료유문라간균(H.pylori)적료효,사선효개비교고적근제방안。방법：장117례유소화불량증상경위경진단위위궤양혹십이지장구궤양혹활동성만성위염차반유H.pylori감염적환자수궤분위사조진행근제치료,EAC조：애색미랍서、아막서림、극랍매소14d,EAT조：애색미랍서、아막서림、체초서14d,ECT조：애색미랍서、극랍매소、체초서14d,BECT조：구연산필갑、애색미랍서、극랍매소、체초서14d。소유환자정약지소4주후복사13C뇨소매호기시험,판단H.pylori근제정황。결과：(1)EAC조H.pylori근제솔위90.00%(27/30), EAT조86.21%(25/29),ECT조56.67%(17/30), BECT조75.00%(21/28),EAC조여EAT조적H.pylori근제솔무통계학차이,EAC조화EAT조H.pylori근제솔교ECT조명현증고(P분별위0.004화0.012),BECT조H.pylori근제솔교EAC조저,교ECT조고,단무통계학차이。(2)EAC、EAT、ECT、BECT조불량반응발생솔분별위7/30(23.33%)、5/29(17.24%),9/30(30.00%),9/28(32.14%),각조간비교무통계학차이；(3)EAC조비용위628.87원,EAT조위404.45원,ECT조위585.22원,BECT조위623.01원,EAT조비용최저。결론：14d적함유아막서림적삼련조합즉애색미랍서、아막서림、체초서급애색미랍서、아막서림、극랍매소H. pylori근제솔교고,불량반응경미,균가작위근제H. pylori적일선방안,전자효개비경고。14d적애색미랍서、극랍매소、체초서삼련조합근제솔저,연합필제조성사련방안근제솔유증고추세。
Objective: To compare the efficacy of three different triple therapies for Helicobacter pylori(H. pylori) infection and to screen an eradication treatment with high cost-effectiveness performance. Methods:117 H. pylori-infected patients with active chronic gastritis or peptic ulcer diagnosed by gastroscope were randomized to four groups. Patients in Group EAC received esomeprazole, amoxicillin and clarithromycin for 14 days. Patients in Group EAT received esomeprazole, amoxicillin and tinidazole for 14 days. Patients in Group ECT received esomeprazole, clarithromycin and tinidazole for 14 days. And patients in Group BECT received bismuth potassium citrate, esomeprazole, clarithromycin and tinidazole for 14 days. Eradication of H. pylori was determined by 13C-urea breath test at least 4 weeks after completion of treatment. Results:(1)The eradication rates were as follows:Group EAC 90.00%(27/30), Group EAT 86.21%(25/29), Group ECT 56.67%(17/30), and Group BECT 75.00%(21/28). NO significant differences in Group EAT and Group EAC. Both the eradication rates in Group EAT and Group EAC were significantly higher than that in Group ECT (P=0.04 and 0.012, respectively). The eradication rate in BECT was lower than that in Group EAC, and higher than that in Group ECT, however, no significant differences were found among these groups. (2)Incidences of adverse effect were:7/30(23.33%) in Group EAC, 5/29(17.24%) in Group EAT,9/30(30.00%) in Group ECT and 9/28(32.14%) in Group BECT. No significant differences were found among these groups. (3)Medical costs were 628.87 RMB yuan in Group EAC, 404.45 RMB yuan in Group EAT, 585.22 RMB yuan in Group ECT and 623.01 RMB yuan in Group BECT, respectively. Group EAT was of the lowest cost. Conclusions:Both the 14-day EAT triple therapy(esomeprazole, amoxicillin and tinidazole-containing) and EAC triple therapy (esomeprazole, amoxicillin and clarithromycin-containing) achieve a high eradication rate and a low adverse effect rate and could be used as fist-line therapy. Especially the former has higher cost-effectiveness performance. The 14-day ECT triple therapy (esomeprazole, clarithromycin and tinidazole-containing) has a lower eradication rate. However, the quadruple regimen of ECT combined with bismuth achieves a higher eradication rate than ECT triple therapy.