CAJ | 학술논문

目的：探讨抗幽门螺杆菌（ Hp）治疗失败患者的再治疗方案。方法将2012年1月至2014年1月在青岛市市立医院经胃镜、组织学检查确诊的86例既往反复抗Hp治疗失败的患者按数字表法随机分为对照组与观察组（各43例），分别采用常规四联疗法（雷贝拉唑＋胶体果胶铋＋阿莫西林＋克拉霉素，连续服药14 d）与改良四联疗法（雷贝拉唑＋胶体果胶铋＋阿莫西林＋克拉霉素治疗7 d，序贯给予兰索拉唑＋胶体果胶铋＋左氧氟沙星＋甲硝唑治疗7 d）治疗。采用χ2检验比较两组患者按方案治疗（ PP）根除率和按意向治疗（ ITT）根除率以及Hp复发率。结果观察组43例患者中42例完成疗程，42例全部根除成功，PP根除率为100．00％，ITT根除率为97．67％；对照组43例患者全部完成治疗，其中24例根除治疗成功，PP和ITT根除率均为55．81％；两组患者PP和ITT根除率比较差异均具有统计学意义（χ2＝23．90和21．11，P＜0．05）。观察组治疗后3个月的复发率为14．29％，6个月的复发率为20．00％，均低于对照组（分别为20．83％和34．78％），但差异无统计学意义（χ2＝0．12和1．68，P＞0．05）。结论改良四联疗法治疗抗Hp失败病例可获得满意的疗效。
목적：탐토항유문라간균（ Hp）치료실패환자적재치료방안。방법장2012년1월지2014년1월재청도시시립의원경위경、조직학검사학진적86례기왕반복항Hp치료실패적환자안수자표법수궤분위대조조여관찰조（각43례），분별채용상규사련요법（뢰패랍서＋효체과효필＋아막서림＋극랍매소，련속복약14 d）여개량사련요법（뢰패랍서＋효체과효필＋아막서림＋극랍매소치료7 d，서관급여란색랍서＋효체과효필＋좌양불사성＋갑초서치료7 d）치료。채용χ2검험비교량조환자안방안치료（ PP）근제솔화안의향치료（ ITT）근제솔이급Hp복발솔。결과관찰조43례환자중42례완성료정，42례전부근제성공，PP근제솔위100．00％，ITT근제솔위97．67％；대조조43례환자전부완성치료，기중24례근제치료성공，PP화ITT근제솔균위55．81％；량조환자PP화ITT근제솔비교차이균구유통계학의의（χ2＝23．90화21．11，P＜0．05）。관찰조치료후3개월적복발솔위14．29％，6개월적복발솔위20．00％，균저우대조조（분별위20．83％화34．78％），단차이무통계학의의（χ2＝0．12화1．68，P＞0．05）。결론개량사련요법치료항Hp실패병례가획득만의적료효。
Objective To evaluate the efficacy of modified quadruple therapy for patients who were failed in previous Helicobacter pylori ( Hp) eradication treatment .Methods A total of 86 patients with confirmed Hp infection and failed in previous Hp eradication treatment were collected from Qingdao Municipal Hospital during January 2012 and January 2014.Patients were randomly assigned into two group:43 patients in control group were given conventional quadruple therapy ( rabeprazole +colloidal bismuth pectin +amoxicillin +clarithromycin for 14 d ) , and 43 patients in test group were given modified quadruple therapy ( rabeprazole +colloidal bismuth pectin +amoxicillin +clarithromycin for 7 d, and lansoprazole +colloidal bismuth pectin +levofloxacin +metronidazole for 7 d).Chi square test was performed to analyze per-protocol (PP) eradication rates, intent-to-treat (ITT) eradication rates, and Hp recurrence rates between two groups .Results Among 43 patients in test group , 42 completed treatments with PP eradication rate of 100.00% and ITT eradication rate of 97.67%.All patients in control group completed treatments , and Hp eradication was observed in 24 patients , and both PP and ITT eradication rates were 55.81%.The differences in PP and ITT eradication rates between two groups were of statistical significance (χ2 =23.90 and 21.11, P<0.05).The 3-month and 6-month Hp recurrence rates in test group (14.29%and 20.00%) tended to be lower than those in control group (20.83%and 34.78%), but the differences were not of statistical significance (χ2 =0.12 and 1.68, P>0.05).Conclusion The efficacy of modified quadruple therapy for patients who were failed in the previous Hp eradication treatment is satisfactory.