CAJ | 학술논문

目的比较含左氧氟沙星的三联疗法、铋剂四联疗法及序贯疗法根治幽门螺杆菌(Hp)的疗效.方法 115例Hp阳性患者按时间先后顺序随机分为3组:三联组38例,给予口服兰索拉唑胶囊30 mg、阿莫西林克拉维酸钾片685.5 mg、左氧氟沙星胶囊200 mg,2次/d,治疗7d；四联组38例,予以口服兰索拉唑胶囊30 mg、阿莫西林克拉维酸钾片685.5 mg、左氧氟沙星胶囊200 mg、胶体果胶铋胶囊200 mg,2次/d,7d；序贯组39例,前5d口服兰索拉唑胶囊30 mg、阿莫西林克拉维酸钾片685.5 mg,后5d口服兰索拉唑胶囊30 mg、克拉霉素片500 mg、左氧氟沙星胶囊200 mg,均2次/d.疗程结束后4周复查14C呼气试验检查,评估治疗结果及不良反应.结果三联组完成35例,失访2例,未能按要求服药1例；铋剂四联组完成36例,失访2例；序贯组完成37例,未能按要求服药2例.三联组成功根除29例,按符合方案(PP)分析根除率为82.9％(29/35),意向性治疗(ITT)分析根除率为76.3％(29/38)；铋剂四联组成功根除32例,PP根除率为88.9％(32/36),ITT根除率为84.2％(32/38)；序贯组成功根除34例,PP根除率为91.9％(34/37),ITT根除率为87.2％(34/39).3组间Hp根除率差异无统计学意义(P＞0.05).结论含左氧氟沙星的铋剂四联与序贯治疗均有较高的Hp根除率,但从安全性与疗效方面考虑,含左氧氟沙星的铋剂四联疗法可作为Hp初治的首选方案.
목적 비교함좌양불사성적삼련요법、필제사련요법급서관요법근치유문라간균(Hp)적료효.방법 115례Hp양성환자안시간선후순서수궤분위3조:삼련조38례,급여구복란색랍서효낭30 mg、아막서림극랍유산갑편685.5 mg、좌양불사성효낭200 mg,2차/d,치료7d；사련조38례,여이구복란색랍서효낭30 mg、아막서림극랍유산갑편685.5 mg、좌양불사성효낭200 mg、효체과효필효낭200 mg,2차/d,7d；서관조39례,전5d구복란색랍서효낭30 mg、아막서림극랍유산갑편685.5 mg,후5d구복란색랍서효낭30 mg、극랍매소편500 mg、좌양불사성효낭200 mg,균2차/d.료정결속후4주복사14C호기시험검사,평고치료결과급불량반응.결과 삼련조완성35례,실방2례,미능안요구복약1례；필제사련조완성36례,실방2례；서관조완성37례,미능안요구복약2례.삼련조성공근제29례,안부합방안(PP)분석근제솔위82.9％(29/35),의향성치료(ITT)분석근제솔위76.3％(29/38)；필제사련조성공근제32례,PP근제솔위88.9％(32/36),ITT근제솔위84.2％(32/38)；서관조성공근제34례,PP근제솔위91.9％(34/37),ITT근제솔위87.2％(34/39).3조간Hp근제솔차이무통계학의의(P＞0.05).결론 함좌양불사성적필제사련여서관치료균유교고적Hp근제솔,단종안전성여료효방면고필,함좌양불사성적필제사련요법가작위Hp초치적수선방안.
Objective To compare the effect of triple,colloidal bismuth pectin quadruple and sequential therapies with levofloxacin on Helicobacter pylori(Hp) infection.Methods All 115 Hp positive patients were randomly allocated to three groups.The patients in triple therapy group received a 7-day triple therapy (lansoprazole capsules 30 mg bid,amoxicillin and clavulanate potassium tablets 685.5 mg bid,levofloxacin capsule 200 mg bid).Quadruple therapy group received a 7-day colloidal bismuth pectin quadruple therapy (lansoprazole capsules 30 mg bid,colloidal bismuth pectin 200 mg bid,amoxicillin and clavulanate potassium tablets 685.5 mg bid,levofloxacin capsule 200 mg bid).Sequential therapy group received a 10-day sequential therapy (lansoprazole capsules 30 mg bid,amoxicillin and clavulanate potassium tablets 685.5 mg bid for the first 5 days; lansoprazole capsules 30 mg bid,clarithromycin 500 mg bid and colloidal bismuth pectin 200 mg bid for the remaining 5 days).We assessed the effect of the eradication of Hp by 14C-urea breath test after finishing of Hp therapy at least four weeks later,and adverse reactions were analysed.Results According to intention-to-treat(ITT),the eradication rates in triple therapy group,quadruple group,sequential therapy group were 76.3％ (29/38),84.2％ (32/38) and 87.2％ (34/39) ;according to per-protocol(PP),the eradication rates in triple therapy group,quadruple group,sequential therapy group were 82.9％ (29/35),88.9％ (32/36),91.9％ (34/37).There were no significant differences among three groups (P ＞ 0.05).Conclusion Quadruple group and sequential therapy group of levofloxacin both have higher Hp eradication rates,but taking the security and the curative effect into consideration,colloidal bismuth pectin quadruple therapy with levofloxacin can be used as the first choice of the eradication of Hp for the first treatment.