满莉孙长青董禹洋马文波刘建徐宁付红伟朴瑛



抗幽门螺杆菌节拍治疗在防治胃癌化疗致吐中的意义*

满莉①孙长青②董禹洋②马文波②刘建②徐宁②付红伟②朴瑛④

摘要目的：探讨抗幽门螺杆菌节拍治疗相对于常规三联抗幽门螺杆菌（HP）治疗在预防胃癌化疗引起迟发性呕吐中的意义。方法：经14C-尿素呼气试验证实HP感染，经免疫组织化学方法确定为中、重度感染的需首次进行双药联合方案化疗的胃癌患者共69例，分为A、B两组。A组（n=33）采用抗HP节拍治疗，即于化疗第1d开始口服奥美拉唑20 mg 2次/d+阿莫西林0.5 g 2次/d+甲硝唑200 mg 1次/d，口服共14d；B组（n=36）于化疗第1d开始口服奥美拉唑20 mg 2次/d+阿莫西林1 g 2次/d+甲硝唑400 mg 2次/d，口服共7d。两组均同时联合第一代5-HT3拮抗剂格拉司琼3 mg 1次/d，且应用时间均相同。治疗前后分别用免疫组织化学方法评价HP感染情况。结果：A组呕吐患者治疗的总有效率为84.85%，明显高于B组55.56%。A组发生延迟性呕吐需解救治疗的占15.15%，B组占44.44%，A组需解救治疗的比例明显低于B组。A组平均完成化疗周期数明显高于B组（4.5个周期vs.3.1个周期），差异均有统计学意义（P<0.05）。与B组相比较，A组患者HP感染程度明显降低（P<0.05）。结论：在化疗同时采用低剂量、2周抗HP节拍治疗与常规剂量1周方案相比较，可明显减轻胃癌合并HP感染患者化疗相关的迟发性呕吐反应，并可显著降低HP感染程度。

关键词幽门螺杆菌节拍治疗胃癌化疗致吐

*本文课题受辽宁省自然科学基金（编号：201202239）资助

Significance of metronomic therapy against Helicobacter pylori for the prevention and treatment of emetogenic chemotherapy of gastric cancer

Li MAN1, Changqing SUN2, Yuyang DONG3, Wenbo MA3, Jian LIU3, Ning XU3, Hongwei FU3, Ying PIAO4
Correspondence to: Ying PIAO; E-mail: 15309880806@163.com
1Traditional Chinese Medicine Integrated with Western Medicine Specialty, Liaoning University of Traditional Chinese Medicine, Anshan 114033, China;2Clinical Laboratory Center, Anshan Tumor Hospital, Anshan 114034, China;3Department of Oncology, Anshan Tumor Hospital, Anshan 114034, China;4Department of Oncology, General Hospital of Shenyang Command, Shenyang 110016, China
This work was supported by the Natural Science Foundation of Liaoning Province（No.201202239）

Abstract Objective: To investigate the significance of metronomic therapy against Helicobacter pylori（HP）in the prevention of delayed emesis caused by chemotherapy of gastric cancer compared with the routine therapy.Methods: HP infection was confirmed by carbon 14 breath test in 69 patients.Combined chemotherapy was employed for the first time in the patients, who were divided into groups A and B.Metronomic therapy was administered to group A（n=33）.Briefly, triplex medication against Helicobacter bacilli triplex was orally administered: 20 mg of omeprazole and 0.5 g of amoxicillin twice daily, with 200 mg of tinidazole once daily.Oral administration in group A was performed for 14 days from the start of chemotherapy.Simultaneously, 5-HT3antagonists were applied.By contrast, group B（n=36）was treated with the oral triplex medication against Helicobacter bacilli: 20 mg of omeprazole and 1 g of amoxicillin twice daily, with 400 mg of tinidazole once daily.Oral administration in group B was performed for 7 days from the beginning of chemotherapy with simultaneous application of 5-HT3antagonists.Both groups were simultaneously treated with the 5-HT3antagonist granisetron at 3 mg once daily during the administration of anti-HP therapy.HP infection was evaluated by immunohistochemistry before and after treatment.Results: The total effective rate for emesis in group A was 84.85%, which was significantly higher than that in group B（55.56%）.Among the patients in group A, 15.15% demonstrated delayed emesis, compared with 44.44% of the patients in group B; the number of individuals was significantly lower in group A than in group B.The average number of chemotherapy cycles in group A was significantly higher than that in group B at 3.1 cycles; the difference between groups was statistically significant（P<0.05）.In addition, the HP infection in group B was significantly lower than that in group A（P<0.05）.Conclusion: Compared with one week of treatment with the conventional dose, two weeks of low-dose metronomic therapy against HP during chemotherapy can significantly reduce chemotherapy induced delayed emesis and can significantly reduce the degree of HP infection in patients with gastric cancer with HP infection.

Keywords:anti-helicobacter pylori, metronomic therapy, gastric cancer, emetogenic chemotherapy

恶心、呕吐是化疗最常见的不良反应［1］。抗多巴胺药物和抗5-羟色胺类药物可用于抑制化疗引起的恶心、呕吐［2-3］，但其仅对急性呕吐有效［4］，对延迟性呕吐的效果不佳。在世界范围内，胃癌男性发病率占第2位，女性占第4位［5］。且胃癌合并幽门螺杆菌（Hp）感染的比例不断增加，而合并HP感染的胃癌患者在进行化疗时消化道反应明显高于未感染人群。……