【摘要】 目的 探討含鉍劑的四聯(lián)療法作為一線方案對幽門螺桿菌感染的有效性和安全性。 方法 選擇2008年9月-2010年9月間137例確診幽門螺桿菌感染的初治患者，隨機分為RAC組（雷貝拉唑、阿莫西林和克拉霉素）和RBAC組（雷貝拉唑、阿莫西林、克拉霉素和枸櫞酸鉍鉀）。經治療7 d后比較兩組根除率和不良反應發(fā)生率。 結果 RAC組和RBAC組的按方案分析根除率分別為77.6%和90.3%，意向性治療分析根除率分別為72.6%和86.7%。RBAC組的按方案分析和意向性治療分析根除率均高于RAC組（P lt;0.05）。不良反應發(fā)生率分別為1.6%和1.3%（P gt;0.05）。 結論 以雷貝拉唑、阿莫西林、克拉霉素和枸櫞酸鉍鉀為組合的四聯(lián)療法能顯著提高幽門螺桿菌感染的初治成功率，不良反應少，安全有效。
【Abstract】 Objective To investigate the effectiveness and safety of the quadruple therapy containing a bismuth compound for first-line Helicobacter pylori eradication treatment. Methods A total of 137 patients diagnosed to be Helicobacter pylori-positive between September 2008 and September 2010 were randomized into two groups to receive the combination of rabeprazole, amoxicillin and clarithromycin (RAC group) and the combination of rabeprazole, amoxicillin, clarithromycin and bismuth potassinm citrate (RBAC group) respectively. The efficacy and tolerance were observed after the treatment for 7 days. Results The per protocol (PP) eradication rates of Helicobacter pylori were 86.7% for RAC group and 90.3% for RBAC group (P lt;0.05), respectively. The intention-to-treat protocol (ITT) eradication rates of Helicobacter pylori were 72.6% for RAC group and 86.7% for RBAC group (P lt;0.05), respectively. The was no significant difference in the incidence of side effects between the two groups (1.6% vs. 1.3%, P gt;0.05). Conclusion The quadruple therapy containing rabeprazole, amoxicillin, clarithromycin and bismuth potassinm citrate provides a good eradication rate of Helicobacter pylori with a good compliance when compared with the standard triple therapy schemes.
引用本文： 李虎,譚禮讓,何濱岑,吳龍飛. 含鉍劑四聯(lián)療法作為一線方案根治幽門螺桿菌感染的臨床研究. 華西醫(yī)學, 2011, 26(10): 1488-1490. doi: 復制
| 1. | 肖文君, 王一平. 幽門螺桿菌與胃癌[J]. 華西醫(yī)學, 1999, 14(3): 373-374. |
| 2. | Malfertheiner P, Mégraud F, O′Morain C, et al. Current concepts in the management of Helicobacter pylori infection-the Maastricht 2-2000 Consensus Report[J]. Aliment Pharmacol Ther, 2002, 16(2): 167-180. |
| 3. | Malfertheiner P, Megraud F, O′Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht Ⅲ Consensus Report[J]. Gut, 2007, 56(6): 772-781. |
| 4. | 中華醫(yī)學會消化病學分會幽門螺桿菌學組/全國幽門螺桿菌科研協(xié)作組. 中國幽門螺桿菌耐藥狀況以及耐藥對治療的影響——全國多中心臨床研究[J]. 胃腸病學, 2007, 12(9):525-530. |
| 5. | Megraud F. Update on therapeutic options for Helicobacter pylori-related diseases[J]. Curr Infect Dis Rep, 2005, 7(2): 115-120. |
| 6. | 斯錁, 廖文. 兩種常用根除幽門螺桿菌三聯(lián)方案的療效觀察[J]. 華西醫(yī)學, 2009, 24(4): 896-898. |
| 7. | 成虹, 李江, 胡伏蓮. 枸櫞酸鉍鉀對幽門螺桿菌耐藥菌株體外抗菌活性研究[J]. 胃腸病學和肝膽病學雜志, 2008, 17(7): 543-546. |
| 8. | Stoltenberg M, Martiny M, Srensen K, et al. Histochemical tracing of bismuth in Helicobacter pylori after in vitro exposure to bismuth citrate[J]. Scand J Gastroenterol, 2001, 36(2): 144-148. |
| 9. | Worku ML, Sidebotham RL, Karim QN. Effects of ranitidine bismuth citrate on Helicobacter pylori motility, morphology and survival[J]. Aliment Pharmacol Ther, 1999, 13(6): 753-760. |
| 10. | 牟方宏, 胡伏蓮, 楊桂彬, 等. 質子泵抑制劑四聯(lián)療法作為幽門螺桿菌根除治療一線方案的臨床研究[J]. 胃腸病學, 2007, 12(9): 531-534. |
| 11. | 徐美華, 張桂英, 李常娟. 含鉍劑四聯(lián)一線治療方案根除幽門螺桿菌療效觀察[J]. 浙江大學學報(醫(yī)學版), 2011, 40(3): 327-331. |
| 12. | Fischbach LA, van Zanten SV, Dickason J. Meta-analysis: the efficacy, adverse events, and adherence related to first-line anti-Helicobacter pylori quadruple therapies[J]. Aliment Pharmacol Ther, 2004, 20(10): 1071-1082. |
| 13. | Graham DY, Lu H, Yamaoka Y. A report card to grade Helicobacter pylori therapy[J]. Helicobacter, 2007, 12(4): 275-278. |
| 14. | 楊憲武, 趙逵, 張曉博. 根除幽門螺桿菌失敗33例相關因素分析[J]. 華西醫(yī)學, 2010, 25(5): 837-839. |
- 1. 肖文君, 王一平. 幽門螺桿菌與胃癌[J]. 華西醫(yī)學, 1999, 14(3): 373-374.
- 2. Malfertheiner P, Mégraud F, O′Morain C, et al. Current concepts in the management of Helicobacter pylori infection-the Maastricht 2-2000 Consensus Report[J]. Aliment Pharmacol Ther, 2002, 16(2): 167-180.
- 3. Malfertheiner P, Megraud F, O′Morain C, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht Ⅲ Consensus Report[J]. Gut, 2007, 56(6): 772-781.
- 4. 中華醫(yī)學會消化病學分會幽門螺桿菌學組/全國幽門螺桿菌科研協(xié)作組. 中國幽門螺桿菌耐藥狀況以及耐藥對治療的影響——全國多中心臨床研究[J]. 胃腸病學, 2007, 12(9):525-530.
- 5. Megraud F. Update on therapeutic options for Helicobacter pylori-related diseases[J]. Curr Infect Dis Rep, 2005, 7(2): 115-120.
- 6. 斯錁, 廖文. 兩種常用根除幽門螺桿菌三聯(lián)方案的療效觀察[J]. 華西醫(yī)學, 2009, 24(4): 896-898.
- 7. 成虹, 李江, 胡伏蓮. 枸櫞酸鉍鉀對幽門螺桿菌耐藥菌株體外抗菌活性研究[J]. 胃腸病學和肝膽病學雜志, 2008, 17(7): 543-546.
- 8. Stoltenberg M, Martiny M, Srensen K, et al. Histochemical tracing of bismuth in Helicobacter pylori after in vitro exposure to bismuth citrate[J]. Scand J Gastroenterol, 2001, 36(2): 144-148.
- 9. Worku ML, Sidebotham RL, Karim QN. Effects of ranitidine bismuth citrate on Helicobacter pylori motility, morphology and survival[J]. Aliment Pharmacol Ther, 1999, 13(6): 753-760.
- 10. 牟方宏, 胡伏蓮, 楊桂彬, 等. 質子泵抑制劑四聯(lián)療法作為幽門螺桿菌根除治療一線方案的臨床研究[J]. 胃腸病學, 2007, 12(9): 531-534.
- 11. 徐美華, 張桂英, 李常娟. 含鉍劑四聯(lián)一線治療方案根除幽門螺桿菌療效觀察[J]. 浙江大學學報(醫(yī)學版), 2011, 40(3): 327-331.
- 12. Fischbach LA, van Zanten SV, Dickason J. Meta-analysis: the efficacy, adverse events, and adherence related to first-line anti-Helicobacter pylori quadruple therapies[J]. Aliment Pharmacol Ther, 2004, 20(10): 1071-1082.
- 13. Graham DY, Lu H, Yamaoka Y. A report card to grade Helicobacter pylori therapy[J]. Helicobacter, 2007, 12(4): 275-278.
- 14. 楊憲武, 趙逵, 張曉博. 根除幽門螺桿菌失敗33例相關因素分析[J]. 華西醫(yī)學, 2010, 25(5): 837-839.