埃索美拉唑三联疗法治疗胃溃疡合并Hp感染的疗效观察(1)
[摘要] 目的 观察埃索美拉唑、阿莫西林、克拉霉素三联疗法治疗幽门螺杆菌(Hp)感染阳性的胃溃疡的效果。方法 将60例Hp阳性的胃溃疡患者随机分为三组：1、2、3组，予以埃索美拉唑、阿莫西林、克拉霉素三联疗法治疗。 结果 60例患者都完成治疗疗程，没有失访。三组的Hp根除率为85.0%～95.0%，无显著差异(P>0.05)。胃溃疡愈合率为85.0%～90.0%，无显著差异(P>0.05)，溃疡治疗有效率为90.0%～95.0%，无显著差异(P>0.05)。三组症状好转积分量比较无显著差异(P>0.05)。副反应发生率为40.0%～80.0%，有显著差异(P<0.05)。 结论 三组方案都能比较有效地根除Hp和促进胃溃疡的愈合，缓解临床症状，但短程疗法疗程短、副作用少、费用低、经济适用，更值得临床推广。
[关键词] 幽门螺杆菌；三联疗法；埃索美拉唑；胃溃疡
[中图分类号] R573.1 [文献标识码] B [文章编号] 1673-9701(2015)04-0023-03
, 百拇医药
[Abstract] Objective To investigate the clinical effects of esomeprazole based triple therapy(esomeprazole+amoxicillin+clarithromycin) for stomach ulcer with H.pylori infection. Methods Sixty stomach ulcer patients with Helicobacter pylori infection were randomly divided into three groups and were treated with esomeprazole based triple therapy for different times. Results All of the sixty patients completed the course of treatment. Hp eradication rates of three groups was 85.0%～95.0%，and no significant difference was found (P>0.05). Stomach ulcer healing rates was 85.0%～90.0%，no significant difference was found (P>0.05). Stomach ulcer efficiency rates was 90.0%～95.0%，and no significant difference was found (P>0.05). Score of symptom improvement of three groups has no significant difference (P>0.05). The incidence of side effects rates was between 40.0%～80.0%，and the difference among the three groups was significant(P<0.05). Conclusion The three different types of esomeprazole based triple therapy could effectively eradicate H.pylori infection，promote ulcer healing rate and improve clinical symptom， however， the short-term therapy may be better because of its fewer side effects and lower costs.
, 百拇医药
[Key words] Helicobacter pylori；Triple therapy；Esomeprazole；Stomach ulcer
目前认为感染幽门螺杆菌(Hp)是消化性溃疡最为主要的发病因素[1]。近年研究认为，根除Hp可以使胃溃疡、十二指肠球部溃疡的复发率下降到5%以下[2]。根除Hp的一线方案之一就是：埃索美拉唑加克拉霉素和阿莫西林三联疗法。克拉霉素又称6氧甲基红霉素，为十四元环大环内酯类抗生素。阿莫西林为常用的半合成青霉素类广谱抗菌素。而两者均为pH值依赖性的抗菌素，当胃液的pH值大于4时能发挥最大的抗菌效果。埃索美拉唑为奥美拉唑的S型异构体，为一种高效新型的PPI制剂，抑酸效果好，生物利用度高。本研究设计了三组不同疗程的服药方案，观察埃索美拉唑、阿莫西林、克拉霉素三联疗法治疗Hp感染阳性的胃溃疡的治疗疗效。
1 资料与方法
1.1 一般资料
, 百拇医药
60例病例都选自本院2013年10月～2014年5月门诊经内镜确诊病例，男32例，女28例，年龄18～45岁，平均38岁；本研究经过我院伦理委员会审批通过，所有受试对象均签署知情同意书。所有观察对象用药前1个星期内，经胃镜和14C呼吸实验证实为Hp感染阳性的A1期胃溃疡患者，溃疡数目小于或等于两个，溃疡直径小于1.5 cm；无出血、穿孔、梗阻、恶变等并发症，两个星期内没有服用过H2受体阻断剂、质子泵抑制类制剂、解痉药、铋剂、抗胆碱药等影响胃酸分泌、Hp繁殖和胃肠道功能的药物；及心、肝、肾无明显的功能障碍。排除复合溃疡、溃疡数大于或等于3个、胃或十二指肠曾做过手术、妊娠或哺乳期妇女、某些特殊原因引起的溃疡，如胃泌素瘤等、恶性溃疡或疑似肿瘤、有严重并发症或全身性原发疾病、对本方案中的药品过敏者、食管糜烂或溃疡、幽门梗阻或幽门管溃疡。将患者随机分为三组，1组20例，男11例，女9例，年龄19～45岁，平均(37.4±4.8)岁；2组20例，男10例，女10例，年龄18～45岁，平均(38.8±5.2)岁；3组20例，男11，女9例，年龄20～44岁，平均(36.8±6.4)岁。三组年龄、性别等人口学特征及临床特点无明显差异(P>0.05)，具有可比性。, 百拇医药(贺慧鹏 陈维顺)
[关键词] 幽门螺杆菌；三联疗法；埃索美拉唑；胃溃疡
[中图分类号] R573.1 [文献标识码] B [文章编号] 1673-9701(2015)04-0023-03
, 百拇医药
[Abstract] Objective To investigate the clinical effects of esomeprazole based triple therapy(esomeprazole+amoxicillin+clarithromycin) for stomach ulcer with H.pylori infection. Methods Sixty stomach ulcer patients with Helicobacter pylori infection were randomly divided into three groups and were treated with esomeprazole based triple therapy for different times. Results All of the sixty patients completed the course of treatment. Hp eradication rates of three groups was 85.0%～95.0%，and no significant difference was found (P>0.05). Stomach ulcer healing rates was 85.0%～90.0%，no significant difference was found (P>0.05). Stomach ulcer efficiency rates was 90.0%～95.0%，and no significant difference was found (P>0.05). Score of symptom improvement of three groups has no significant difference (P>0.05). The incidence of side effects rates was between 40.0%～80.0%，and the difference among the three groups was significant(P<0.05). Conclusion The three different types of esomeprazole based triple therapy could effectively eradicate H.pylori infection，promote ulcer healing rate and improve clinical symptom， however， the short-term therapy may be better because of its fewer side effects and lower costs.
, 百拇医药
[Key words] Helicobacter pylori；Triple therapy；Esomeprazole；Stomach ulcer
目前认为感染幽门螺杆菌(Hp)是消化性溃疡最为主要的发病因素[1]。近年研究认为，根除Hp可以使胃溃疡、十二指肠球部溃疡的复发率下降到5%以下[2]。根除Hp的一线方案之一就是：埃索美拉唑加克拉霉素和阿莫西林三联疗法。克拉霉素又称6氧甲基红霉素，为十四元环大环内酯类抗生素。阿莫西林为常用的半合成青霉素类广谱抗菌素。而两者均为pH值依赖性的抗菌素，当胃液的pH值大于4时能发挥最大的抗菌效果。埃索美拉唑为奥美拉唑的S型异构体，为一种高效新型的PPI制剂，抑酸效果好，生物利用度高。本研究设计了三组不同疗程的服药方案，观察埃索美拉唑、阿莫西林、克拉霉素三联疗法治疗Hp感染阳性的胃溃疡的治疗疗效。
1 资料与方法
1.1 一般资料
, 百拇医药
60例病例都选自本院2013年10月～2014年5月门诊经内镜确诊病例，男32例，女28例，年龄18～45岁，平均38岁；本研究经过我院伦理委员会审批通过，所有受试对象均签署知情同意书。所有观察对象用药前1个星期内，经胃镜和14C呼吸实验证实为Hp感染阳性的A1期胃溃疡患者，溃疡数目小于或等于两个，溃疡直径小于1.5 cm；无出血、穿孔、梗阻、恶变等并发症，两个星期内没有服用过H2受体阻断剂、质子泵抑制类制剂、解痉药、铋剂、抗胆碱药等影响胃酸分泌、Hp繁殖和胃肠道功能的药物；及心、肝、肾无明显的功能障碍。排除复合溃疡、溃疡数大于或等于3个、胃或十二指肠曾做过手术、妊娠或哺乳期妇女、某些特殊原因引起的溃疡，如胃泌素瘤等、恶性溃疡或疑似肿瘤、有严重并发症或全身性原发疾病、对本方案中的药品过敏者、食管糜烂或溃疡、幽门梗阻或幽门管溃疡。将患者随机分为三组，1组20例，男11例，女9例，年龄19～45岁，平均(37.4±4.8)岁；2组20例，男10例，女10例，年龄18～45岁，平均(38.8±5.2)岁；3组20例，男11，女9例，年龄20～44岁，平均(36.8±6.4)岁。三组年龄、性别等人口学特征及临床特点无明显差异(P>0.05)，具有可比性。, 百拇医药(贺慧鹏 陈维顺)