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目的:对比四联疗法和序贯疗法对根除服用非甾体类消炎药(NSAID)人群幽门螺杆菌(Hp),改善其消化道不良症状及促进消化性溃疡愈合的临床效果。方法:对有消化不良症状的服用非甾体类消炎药物患者行胃镜检查、快速尿激酶及13C呼气试验检查,将155例幽门螺杆菌阳性合并有慢性胃炎或消化性溃疡患者作为研究对象,随机分为两组,A组采用四联疗法,B组采用序贯疗法。A组予雷贝拉唑+克拉霉素+阿莫西林+枸橼酸铋钾治疗10天;B组前5天予雷贝拉唑+阿莫西林,后5天予雷贝拉唑+克拉霉素+甲硝唑。治疗结束后,予雷贝拉唑和胃黏膜保护剂治疗8周。停药4周后,复查胃镜、13C呼气试验,观察和比较两组Hp根除率、消化不良症状缓解率及溃疡愈合率。结果:A、B两组Hp根除率分别为(ITT分析:86.7%和81.9%;PP分析:87.8%和84.3%);症状缓解率为(81.9%对79.2%);胃溃疡愈合率为(68.8%对66.7%),十二指肠球部溃疡的愈合率为(68.2%对70.0%),两组患者间Hp根除率、症状缓解率及溃疡愈合率比较均未见明显统计学差异(P>0.05)。四联疗法组和序贯疗法组不良反应的发生率分别为4.9%和4.3%。两组比较无明显差异(P>0.05)。结论:四联疗法和序贯疗法对长期服用非甾体类消炎药物人群的Hp根除疗效、消化不良症状的缓解及促进溃疡愈合的治疗作用均无明显差异。
OBJECTIVE: To compare the efficacy of quadruple therapy with sequential therapy in the eradication of Helicobacter pylori (Hp) in non-steroidal anti-inflammatory drugs (NSAID), to improve the gastrointestinal symptoms and promote the healing of peptic ulcer. Methods: Gastroscopy, rapid urokinase and 13C breath test were used in patients with dyspeptic symptoms taking non-steroidal anti-inflammatory drugs. 155 patients with chronic Helicobacter pylori-positive chronic gastritis or peptic ulcer were enrolled in this study. Randomly divided into two groups, A group with quadruple therapy, B group using sequential therapy. Group A received rabeprazole + clarithromycin + amoxicillin + bismuth potassium citrate for 10 days; group B received rabeprazole + amoxicillin for the first 5 days and rabeprazole + carat Mycin + metronidazole. After treatment, rabeprazole and gastric mucosal protective agent were treated for 8 weeks. Four weeks after withdrawal, gastroscopy and 13C breath test were reviewed. Hp eradication rate, remission rate of dyspepsia and ulcer healing rate were observed and compared between the two groups. Results: The Hp eradication rates in groups A and B were (ITT analysis: 86.7% and 81.9%; PP analysis: 87.8% and 84.3%, respectively); symptom relief rate was 81.9% and 79.2% 68.8% vs. 66.7%). The healing rate of duodenal ulcer was (68.2% vs 70.0%). There was no significant difference between the two groups in the eradication rate of Hp, the rate of symptom relief and the healing rate of ulcer P> 0.05). The rates of adverse reactions in the quadruple therapy and sequential therapy groups were 4.9% and 4.3%, respectively. There was no significant difference between the two groups (P> 0.05). Conclusions: There is no significant difference between quadruple therapy and sequential therapy on the efficacy of Hp eradication, alleviation of dyspeptic symptoms and the promotion of ulcer healing in long-term non-steroidal anti-inflammatory drugs.