两种序贯疗法与十天三联疗法根除幽门螺杆菌感染疗效比较

【摘要】 目的 评价含呋喃唑酮和含替硝唑的两种序贯疗法和十天三联疗法根除幽门螺杆菌(H.pylori)的疗效。方法 将163例消化性溃疡和慢性胃炎且Hp阳性的患者随机分为3组。序贯疗法A组54例，前5 d予埃索美拉唑20 mg＋阿莫西林1.0 g, 2次/d；后5 d予埃索美拉唑20 mg+克拉霉素500 mg＋呋喃唑酮100 mg，2次/d。序贯疗法B组55例，前5 d予埃索美拉唑20 mg＋阿莫西林1.0 g，2次/d；后5 d予埃索美拉唑20 mg＋克拉霉素500 mg＋替硝唑500 mg，2次/d。三联疗法C组54例，予埃索美拉唑20 mg＋阿莫西林1.0 g＋克拉霉素500 mg，2次/d，疗程10 d。记录治疗期间发生的不良反应。疗程结束停药至少4周以上复查14C-UBT(尿素呼气试验),判断H. pylori根除情况。结果 按试验方案(PP)分析和意向处理(ITT)分析，A组根除率分别为92.0%、85.2%；B组分别为77.6%、69.1%；C组分别为73.5%、66.7%。A组与B、C组分别相比较，差异均有统计学意义(均P＜0.05)；B组与C组比较，差异无统计学意义(P＞ 0.05)。结论 含呋喃唑酮的序贯疗法疗效明显高于含替硝唑序贯疗法及十天三联疗法，可以考虑作为H.pylori感染患者初治的一线治疗方案。

【Abstract】 Objective To evaluate the eradication rate of H.pylori with furazolidone based sequential therapy, tinidazole based sequential therapy and 10-day triple therapy. Methods 163 patients with H.pylori positive peptic ulcer disease or chronic gastritis were randomly divided into group A, B and C.Group A 54 cases received sequential therapy,Eesomeprazole 20 mg plus Amoxicillin 1.0 g for the first 5 days, followed by Esomeprazole 20 mg, Clarithromycin 500 mg and Furazolidone 100 mg for the next 5 days. Group B 55 cases received sequential therapy, Esomeprazole 20 mg and Amoxicillin 1.0 g for the first 5 days, followed by Esomeprazole 20 mg, Clarithromycin 500 mg and Tinidazole 500 mg for the remaining 5 days. Group C 54 cases received triple therapy, Esomeprazole 20 mg, Amoxicillin 1.0 g and Clarithromycin 500 mg for 10 days. All drugs were given twice daily.

The adverse effects were recorded during the course of treatment eradication of H. pylori was determined by 14C-urea breath test 4 weeks after completion of treatment. Results Per-protocol analysis(PP) and intention-to-treat analysis (ITT)eradication rates were 92.0%,85.2% in group A, 77.6%,69.1% in group B, and 73.5%,66.7% in group C respectively. Eradication rates in group A were significantly higher than those in group B and group C(P＜0.05). No significantly difference was found between group B and group C(P＞ 0.05). Conclusion Furazolidone based sequential therapy could achieve higher eradication rate of H.Pylori compared with tinidazole based sequential therapy and 10-day triple therapy, which can be used as first-line therapy at initial treatment.

【Key words】Helicobacter pylori infection; Sequential therapy; Triple therapy; Eradication rate; Furazolidone; Tinidazole