CAJ | 학술논문

目的评价不同铋剂四联方案根除H.pylori的有效性和安全性.方法收集2012年12月至2013年10月H.pylori阳性患者240例,均分为克拉霉素组、左氧氟沙星组、呋喃唑酮组、甲硝唑组,每日2次,每次口服枸橼酸铋钾220mg、埃索美拉唑20 mg、阿莫西林1 000 mg,同时各组分别每日2次,每次口服克拉霉素500mg、左氧氟沙星200 mg、呋喃唑酮100 mg、甲硝唑400mg,各组疗程均为10 d.治疗结束停药至少4周后空腹行13C-尿素呼气试验或14C-尿素呼气试验,结果为阴性者判为H.pylori根除成功.观察并记录治疗过程中的不良反应.对H.pylori根除率进行按意向治疗(ITT)分析和按方案治疗(PP)分析.以卡方检验比较各组的根除率.结果克拉霉素组、左氧氟沙星组、呋喃唑酮组、甲硝唑组ITT分析的H.pylori根除率分别为81.67％(49/60)、88.33％(53/60)、93.33％(56/60)、73.33％(44/60),PP分析的根除率分别为85.96％(49/57)、89.83％(53/59)、94.92％(56/59)、75.86％(44/58),4组间比较差异均有统计学意义(x2=10.13和9.89,P均＜0.05),呋喃唑酮组与甲硝唑组比较差异均有统计学意义(x2＝8.64和8.55,P均＜0.01),各组不良反应发生率差异无统计学意义(x2 =0.47,P＞0.05).结论含呋喃唑酮的铋剂四联方案具有较高的H.pylori根除率且安全性良好,或可作为根除H.pylori的一线治疗方案.
목적 평개불동필제사련방안근제H.pylori적유효성화안전성.방법 수집2012년12월지2013년10월H.pylori양성환자240례,균분위극랍매소조、좌양불사성조、부남서동조、갑초서조,매일2차,매차구복구연산필갑220mg、애색미랍서20 mg、아막서림1 000 mg,동시각조분별매일2차,매차구복극랍매소500mg、좌양불사성200 mg、부남서동100 mg、갑초서400mg,각조료정균위10 d.치료결속정약지소4주후공복행13C-뇨소호기시험혹14C-뇨소호기시험,결과위음성자판위H.pylori근제성공.관찰병기록치료과정중적불량반응.대H.pylori근제솔진행안의향치료(ITT)분석화안방안치료(PP)분석.이잡방검험비교각조적근제솔.결과 극랍매소조、좌양불사성조、부남서동조、갑초서조ITT분석적H.pylori근제솔분별위81.67％(49/60)、88.33％(53/60)、93.33％(56/60)、73.33％(44/60),PP분석적근제솔분별위85.96％(49/57)、89.83％(53/59)、94.92％(56/59)、75.86％(44/58),4조간비교차이균유통계학의의(x2=10.13화9.89,P균＜0.05),부남서동조여갑초서조비교차이균유통계학의의(x2＝8.64화8.55,P균＜0.01),각조불량반응발생솔차이무통계학의의(x2 =0.47,P＞0.05).결론 함부남서동적필제사련방안구유교고적H.pylori근제솔차안전성량호,혹가작위근제H.pylori적일선치료방안.
Objective To evaluate the efficacy and safety of different bismuth-based quadruple therapies for Helicobacter pylori (H.pylori) eradication.Methods From December 2012 to October 2013,240 patients with H.pylori infection were collected and evenly divided into clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group.Each group received bismuth potassium citrate 220 mg,esomeprazole 20 mg and amoxicillin 1 000 mg twice daily.In addition,each group received clarithromycin 500 mg,levofloxacin 200 mg,furanzolidone 100 mg,and metronidazole 400 mg,respectively.The course of treatment was 10 days.At least four weeks after the end of therapy and withdrawal the medicine,patients underwent fasting 13C-urea breath test or 14C-urea breath test.The negative result indicated as successful H.pylori eradication.The adverse effects were observed and recorded during treatment.The rate of H.pylori eradication was analyzed by the intention to treat (ITT) analysis and per protocol (PP) analysis.Chi-square test was performed for eradication rate comparison among groups.Results According to ITT analysis,the eradication rate of clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group was 81.67％ (49/60),88.33％ (53/60),93.33％ (56/60) and 73.33％ (44/60),respectively,and according to PP analysis which was 85.96％ (49/57),89.83％ (53/59),94.92％ (56/59) and 75.86％ (44/58),respectively.The differences among four groups were statistically significant (x2 ＝10.13 and 9.89,both P＜0.05).The differences between furanzolidone group and metronidazole group were statistically significant (x2 =8.64 and 8.55,both P＜0.01).There were no statisticaly significant differences in adverse effects among the four groups (x2 =0.47,P＞0.05).Conclusion The H.pylori eradication rate is high in furanzolidone contained bismuth based quadruple therapy and with good safety,which could be the first line treatment for H.pylori eradication.