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目的研究幽门螺杆菌(Hp)感染对质子泵抑制剂(PPI)治疗十二指肠球部溃疡效果的影响机理。方法选择符合入选标准的Hp阳性的活动性十二指肠球部溃疡病患者,分为单纯的PPI抑酸治疗组(单一组)和PPI联合抗Hp三联治疗组(联合组),研究二组患者在消化道症状缓解、胃窦内pH值升高、活动期溃疡病灶转变为疤痕期(S期)的比例大小。结果(1)联合组在4周时和6周时患者的上腹部饥饿性隐痛症状的缓解率均明显高于单一组(χ2值分别为6.05和6.54,P值均<0.05)。(2)联合组治疗后6周时的24hpH值<4时间百分比平均值明显低于单一组(χ2值为7.32,P值<0.05)。(3)胃镜直视下观察单一组在治疗后6周时的溃疡总S期获得率为51.8%,明显不及联合组的89.7%(χ2为7.32,P<0.05)。结论Hp主要通过改变患者胃内的pH值高低来影响十二指肠溃疡部的治疗进程。以PPI为基础的三联抗Hp治疗与单纯的PPI治疗相比,能更有效缓解十二指肠溃疡病患者消化道症状,通过升高胃内pH值,提高十二指肠溃疡病患者的治愈率。
Objective To study the effect of Helicobacter pylori (Hp) infection on the efficacy of proton pump inhibitor (PPI) in the treatment of duodenal ulcer. Methods Hp-positive active duodenal ulcer patients who met the inclusion criteria were randomly divided into two groups: the PPI group (single group) and the PPI group (triple group) Patients in the digestive tract symptoms, the pH value of the antrum, the active stage of ulcer lesions into scar (S phase) the proportion of the size. Results (1) The rates of relief of hunger pain in upper abdomen were significantly higher in the combined group at 4 weeks and 6 weeks than those in the single group (χ2 = 6.05 and 6.54, P <0.05 respectively). (2) The mean value of 24hpH value <4 at 6 weeks after treatment in the combination group was significantly lower than that in the single group (χ2 = 7.32, P <0.05). (3) The total S-phase ulceration rate of single group was 51.8% at the 6th week after treatment, which was significantly lower than 89.7% of the combined group (χ2 = 7.32, P <0.05). Conclusion Hp mainly affects the course of treatment of duodenal ulcer by changing the pH value of the patient’s stomach. PPI-based triple anti-Hp treatment compared with simple PPI treatment, can more effectively alleviate gastrointestinal symptoms in patients with duodenal ulcer disease, by increasing the gastric pH, improve the cure of patients with duodenal ulcer rate.