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41卷第4期
传统三联疗法与新四联疗法在老年幽门螺旋杆菌的疗效评价
Efficacy of traditional triple therapy and new quadruple therapy in senile Helicobacter pylori
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DOI:
作者:
张紫欢,张聪,崔月,沈晔
作者单位:
长宁区仙霞街道社区卫生服务中心
关键词:
幽门螺杆菌;老年人;三联疗法;四联疗法;
Helicobacter pylori; Elderly; triple therapy; quadruple therapy;
摘要:
[摘要] 目的:探究三联疗法和四联疗法在老年幽门螺杆菌感染(Helicobacter pylori, H.pylori)中的有效根除率。方法:收集 2014 年11月1日至2016年12月31日期间在长宁区某社区卫生服务中心门诊就诊的经胃镜下活检确诊的 356例H.pylor感染的老年患者,随机分为两组,对照组(n=176)给予泮托拉唑40mg+克拉霉素500mg+阿莫西林1000mg,每日2次的三联疗法,疗程14天;组2:实验组(n=180)给予泮托拉唑40mg+克拉霉素500mg+阿莫西林1000mg+枸橼酸铋钾220mg,每日2次的四联疗法,疗程14天;治疗结束并停药4~8周后,用13-C快速尿素酶呼气试验检测H.pylor,比较两组老年患者的H.pylor根除率。结果:按意向性治疗分析(intention-to-treat, ITT)分析三联疗法与四联疗法的H.pylor根除率分别为73.9%,82.8% ;按方案(pre-protocol, PP)分析两组H.pylor根除率为75.0%,85.0% ;四联疗法的老年患者组的根除率优于三联疗法的老年患者组(P<0.05)。多因素Logistic回归结果显示,治疗方案的不同对H.pylor根除率的影响较大,而年龄,性别,基础疾病对H.pylor根除率无明显影响。结论:四联疗法在老年H.pylor感染患者中H.pylor根除率优于三联疗法,这可能是临床根除H.pylor的更适用的方案。
[Abstract] Objective: To investigate the effective eradication rates of triple therapy and quadruple therapy in elderly Helicobacter pylori (H.pylor). Methods: A total of 356 elderly patients with H.pylor infection diagnosed by gastroscopic biopsy at outpatient or medical examination center of Changning District Community Health Center from November 1, 2014 to December 31, 2016 were collected and randomly divided into two groups , Group 1: triple therapy group named as control group1 (n = 176)with pantoprazole 40mg + clarithromycin 500mg + amoxicillin 1000mg twice daily for 14 days; group 2(n= 180) named quadruple therapy group to pantoprazole 40mg + clarithromycin 500mg + amoxicillin 1000mg + bismuth potassium citrate 220mg, 2 times a day for 14 days; after the end of treatment and withdrawal 4 to 8 weeks , H.pylor was detected by 13-C rapid urease breath test, and H.pylor eradication rate was compared between the two groups. Results: The H.pylor eradication rates of triple therapy and quadruple therapy were 73.9% and 82.8% respectively by intention-to-treat (ITT) analysis. According to the pre-protocol (PP) H.pylor eradication rates were 75.0% and 85.0%, respectively. The eradication rates of the elderly patients treated with quadruple therapy were superior to those of the elderly patients treated with triple therapy (P <0.05). Multivariate logistic regression analysis showed that different treatment regimens had a significant effect on H.pylor eradication rate, while age, sex, and underlying diseases had no significant effect on H.pylor eradication rate. Conclusions: Tetralogy of cure is superior to triple therapy in the treatment of H.pylor infection in elderly patients with H.pylor, which may be a more suitable protocol for the clinical eradication of H.pylor.