CAJ | 학술논문

目的：对比分析标准四联疗法和序贯疗法治疗胃溃疡H．pylori阳性患者的临床疗效。方法收集重庆三峡中心医院消化内科2012年1月－2013年12月120例胃溃疡H．pylori阳性患者，并随机分为实验组和对照组。其中实验组予以序贯疗法（前5 d予以雷贝拉唑肠溶片20 mg＋阿莫西林1000 mg，2次／d，后5 d予以雷贝拉唑肠溶片20 mg＋左氧氟沙星200 mg＋克拉霉素500 mg，2次／d）。对照组予以标准四联疗法（雷贝拉唑肠溶片20 mg＋阿莫西林1000 mg＋胶体果胶铋220 mg＋克拉霉素500 mg，2次／d）。对比两组患者治疗前及治疗结束4周后的Glasgow评分；对比两组患者治疗结束4周后的H．pylori根除情况（14 C呼气试验）及内镜下溃疡治疗有效率。同时对比两组患者治疗期间药物不良反应发生率。结果治疗结束4周后，两组患者的临床症状评分均显著低于治疗前（P＜0．01），且实验组显著低于对照组（P＜0．01）；两组患者腹痛、腹胀和反酸嗳气症状评分均显著低于治疗前，且实验组显著低于对照组（P＜0．01）；实验组的H．pylori根除率显著高于对照组（P＜0．05）；实验组胃镜下的溃疡愈合总有效率显著高于对照组（P＜0．05）。两组患者治疗期间不良反应发生率相比，差异无统计学意义（P＞0．05）。结论序贯疗法在治疗胃溃疡中根除H．pylori，改善患者症状和促进溃疡愈合的疗效优于标准四联疗法，同时不增加不良反应发生率，可以作为胃溃疡H．pylori阳性患者的初治首选方案。
목적：대비분석표준사련요법화서관요법치료위궤양H．pylori양성환자적림상료효。방법수집중경삼협중심의원소화내과2012년1월－2013년12월120례위궤양H．pylori양성환자，병수궤분위실험조화대조조。기중실험조여이서관요법（전5 d여이뢰패랍서장용편20 mg＋아막서림1000 mg，2차／d，후5 d여이뢰패랍서장용편20 mg＋좌양불사성200 mg＋극랍매소500 mg，2차／d）。대조조여이표준사련요법（뢰패랍서장용편20 mg＋아막서림1000 mg＋효체과효필220 mg＋극랍매소500 mg，2차／d）。대비량조환자치료전급치료결속4주후적Glasgow평분；대비량조환자치료결속4주후적H．pylori근제정황（14 C호기시험）급내경하궤양치료유효솔。동시대비량조환자치료기간약물불량반응발생솔。결과치료결속4주후，량조환자적림상증상평분균현저저우치료전（P＜0．01），차실험조현저저우대조조（P＜0．01）；량조환자복통、복창화반산애기증상평분균현저저우치료전，차실험조현저저우대조조（P＜0．01）；실험조적H．pylori근제솔현저고우대조조（P＜0．05）；실험조위경하적궤양유합총유효솔현저고우대조조（P＜0．05）。량조환자치료기간불량반응발생솔상비，차이무통계학의의（P＞0．05）。결론서관요법재치료위궤양중근제H．pylori，개선환자증상화촉진궤양유합적료효우우표준사련요법，동시불증가불량반응발생솔，가이작위위궤양H．pylori양성환자적초치수선방안。
Objective To analyze the efficacy of standard quadruple and sequential therapy for gastric ulcer with H.pylori positive patients .Methods One hundred and twenty gastric ulcer with H.pylori positive patients from Jan . 2012 to Dec.2013 in the Central Hospital of Chengqing Three Gorges were selected and divided into the experimental group and control group .The experimental group received sequential therapy ( first five days:rabeprazole enteric coated tablets 20 mg +amoxicillin 1 000 mg bid, next five days:rabeprazole enteric coated tablets 20 mg +levofloxacin 200 mg+clarithromycin 500 mg bid ) .The control group received standard quadruple therapy ( rabeprazole enteric coated tablets 20 mg +amoxicillin 1 000 mg +colloidal bismuth pectin 220 mg +clarithromycin 500 mg bid).The Glasgow score of two groups before treatment and at 4 th week after the treatment was compared .The abdominal pain , abdominal distention and sour regurgitation scores of two groups before treatment and at 4 th week after the treatment were com-pared.The H.pylori eradication conditions (14C breath test) and endoscopic ulcer treatment efficiency of two groups at 4 th week after the treatment were compared .The incidence of adverse reactions of two groups during treatment was also compared .Results At 4 th week after treatment , the Glasgow score of two groups was significantly lower than that be-fore the treatment , while that in the experimental group was significantly lower than that in the control group ( P <0 .01 );the abdominal pain , abdominal distention and sour regurgitation scores of two groups were significantly lower than those before the treatment , while the abdominal pain , abdominal distention and sour regurgitation scores of the ex-perimental group were significantly lower than those of the control group (P<0.01).The H.pylori eradication condi-tions ( 14 C breath test ) and endoscopic ulcer treatment efficiency of the experimental group were significantly higher than those of the control group ( P<0 .05 ) .The incidence of adverse reactions during treatment had no significant difference between two groups (P>0.05).Conclusion The sequential therapy for gastric ulcers with H.pylori positive patients can improve symptoms and promote ulcer healing more effectively than standard quadruple therapy , while it is without increasing the incidence of adverse reactions .The sequential therapy can be used as the initial treatment of choice for gastric ulcer with H.pylori positive patients .