在各种治疗策略中,联合治疗对幽门螺杆菌的根除率最高。

PubMed ID
发表日期 2015年Jan月

原始出处 世界胃肠病学杂志
World journal of gastroenterology
作者 Lee  Hyun Jeong  Kim  Jin Il  Lee  Jin Soo  Jun  Eun Jung  Oh  Jung-Hwan  Cheung  Dae Young  Chung  Woo Chul  Kim  Byung-Wook  Kim  Sung Soo 

文献标题 在各种治疗策略中,联合治疗对幽门螺杆菌的根除率最高。
Concomitant therapy achieved the best eradication rate for Helicobacter pylori among various treatment strategies.

文献摘要 AIM

比较克拉霉素三联疗法、甲硝唑三联疗法、序贯疗法和联合疗法对幽门螺杆菌(H.pylori)的根除率。

METHODS

将680例H.pylori感染者分为4组,每组均给予不同的根除治疗。第一组采用克拉霉素三联疗法[雷贝拉唑、阿莫西林、克拉霉素(PAC)组:质子泵抑制剂(PPI)、阿莫西林、克拉霉素],第二组采用甲硝唑三联疗法[雷贝拉唑、阿莫西林、甲硝唑(PAM)组:PPI、阿莫西林、,甲硝唑]。第三组用雷贝拉唑和阿莫西林治疗,然后用雷贝拉唑、克拉霉素和甲硝唑治疗(序贯组)。治疗组同时给予雷贝拉唑、阿莫西林、克拉霉素、甲硝唑治疗。在根除幽门螺杆菌失败的情况下,给予二线四联疗法和三线根除疗法。

RESULTS

分别对PAC、PAM、序贯治疗组和联合治疗组的143、139、141和143例患者进行按方案(PP)分析。我们排除了未接受C(13)-尿素呼气试验的患者(分别为22、20、23和22名患者)和依从性水平低于80%的患者(分别为5、11、6和5名患者)。PAC组根除率为76.2%(109/143),PAM组为84.2%(117/139),序贯组为84.4%(119/141),联合组为94.4%(135/143)(P=0.0002)。14例二线治疗失败的患者均接受三线根除治疗。在14例患者中,有6例通过三线治疗成功地根除了感染。PP和意向治疗分析显示根除率为42.9%(6/14)。PAC组4例中3例治愈(3/4,75%),PAM组2例治愈(2/2,100%),序贯组5例治愈(1/5,20%)。联合组3例均失败(0/3,0%)。

CONCLUSION

联合治疗的根除率明显高于标准三联疗法或序贯疗法(临床试验.gov编号NCT01922765)。


AIM

To compare the Helicobacter pylori (H. pylori) eradication rate of clarithromycin-based triple therapy, metronidazole-based triple therapy, sequential therapy and concomitant therapy.

METHODS

A total of 680 patients infected with H. pylori were divided into 4 groups and each group was treated with a different eradication therapy. Clarithromycin-based triple therapy was applied to the first group [rabeprazole, amoxicillin and clarithromycin (PAC) group: proton pump inhibitor (PPI), amoxicillin, clarithromycin], whereas the second group was treated with metronidazole-based triple therapy [rabeprazole, amoxicillin and metronidazole (PAM) group: PPI, amoxicillin, metronidazole]. The third group was treated with rabeprazole and amoxicillin, followed by rabeprazole, clarithromycin and metronidazole (sequential group). The final group was simultaneously treated with rabeprazole, amoxicillin clarithromycin and metronidazole (concomitant therapy group). In the case of a failure to eradicate H. pylori, second-line quadruple and third-line eradication therapies were administered.

RESULTS

The per protocol (PP) analysis was performed on 143, 139, 141 and 143 patients in the PAC, PAM, sequential and concomitant groups, respectively. We excluded patients who did not receive a C(13)-urea breath test (22, 20, 23 and 22 patients, respectively) and patients with less than an 80% compliance level (5, 11, 6 and 5 patients, respectively). The eradication rates were 76.2% (109/143) in the PAC group, 84.2% (117/139) in the PAM group, 84.4% (119/141) in the sequential group and 94.4% (135/143) in the concomitant group (P = 0.0002). All 14 patients who failed second-line therapy were treated with third-line eradication therapy. Among these 14 patients, 6 infections were successfully eradicated with the third-line therapy. Both PP and intention-to-treat analysis showed an eradication rate of 42.9% (6/14). In the PAC group, 3 of 4 patients were successfully cured (3/4, 75%); 2 of 2 patients in the PAM group (2/2, 100%) and 1 of 5 patients in the sequential group (1/5, 20%) were also cured. In the concomitant group, all 3 patients failed (0/3, 0%).

CONCLUSION

The eradication rate for the concomitant therapy was much higher than those of the standard triple therapy or sequential therapy (ClinicalTrials.gov number NCT01922765).


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