张芝华，张志广，李　熳，田珺琪（天津医科大学第二医院消化内科，天津　300211）



4种含铋剂四联方案根除幽门螺杆菌的临床观察

张芝华，张志广，李熳，田珺琪
（天津医科大学第二医院消化内科，天津300211）

摘要目的：观察和比较4种含铋剂四联方案根除幽门螺旋杆菌（H.pylori）的疗效、不良反应及成本-效果分析。方法：收集行胃镜检查及(13)C-尿素呼气试验证实为H.pylori感染的441例患者的临床资料，所有患者均随机给予10 d含铋剂四联方案，即雷贝拉唑组（A组）和泮托拉唑组（B组），各组内又分为左氧氟沙星组（A1/B1组）和替硝唑组（A2/B2组）。治疗结束后，间隔4周行(13)C -尿素呼气试验复查H.pylori，同时观察治疗过程中不良反应。结果：A1、A2、B1、B2 4组H.pylori根治率按意向性治疗（ITT）分析，依次为79.4%、51.9%、82.4%、57.1%；按方案治疗（PP）分析，依次为83.3%、56.0%、85.7%、58.8%，A1组与A2组、B1组与B2组比较，差异均有统计学意义（P<0.05）；而A1组与B1组、A2组与B2组比较，差异均无统计学意义（P>0.05）。4组均未见明显不良反应。4组成本-效果比以A1组最低。结论：含左氧氟沙星及雷贝拉唑的铋剂四联方案根治率高，成本较低，效价比高。

关键词幽门螺旋杆菌；四联疗法；根除；铋剂；左氧氟沙星

Clinical observation of four bismuth-based quadruple therapies for eradication of Helicobacter pylori

ZHANG Zhi-hua,ZHANG Zhi-guang,LI Man,TIAN Jun-qi
（Department of Gastroenterology，The Second Hospital,Tianjin Medical University,Tianjin 300211，China）

Abstract Objective:To observe and compare the efficacy，adverse reactions and cost-effectiveness analysis of four bismuth-based quadruple therapies to eradicate Helicobacter pylori(H.pylori).Methods：The clinical date of 441 patients were collected；who underwent electronic gastrocope and were diagnosed as H.pylori infection by13C -urea breath test.All of them were randomized to receive 10 days bismuth-basedquadrupletherapy.afterwhich were divided into rabeprazole group(group A)and pantoprazole group（group B）.Each group was stratified into levofloxacin group(A1/B1 group)and tinidazole group(A2/B2 group).13C-urea breath test were performed four weeks after the treatment.Patients’drug adverse reactions were observed and recorded.Results：According to ITT analysis，A1，A2,B1 and B2 the eradication rates of Group were 79.4%，51.9%，82.4% and 57.1% respectively，and according to PP analysis,results were 83.3%，56.0%，85.7%and58.8%,respectively.A1group andA2group,B1groupandB2group,thedifferenceswerestatisticallysignificant（P＜0．05）；A1group andB1group,A2groupand B2group,thedifferenceswerenotstatisticallysignificant（P>0.05）.Therewasnoobviousadversereactioninthe four groups.The lowest Cost-effectiveness in the four groups was found in A1.Conclusion：The quadruple therapy containing both levofloxacinandrabeprazolehasahighereradicationrateandlowercost.

Key words H.pylori；quadruple therapy；eradication；bismuth；levofioxacin

幽门螺杆菌（Helicobacter pylori,H.pylori）感染是一个全球性的普遍问题，流行病学调查显示我国成人感染率高达40%～90%，平均为59%[1]。幽门螺杆菌感染是慢性活动性胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织淋巴瘤（MALT淋巴瘤）的重要致病因子，而且与胃癌的发生密切相关[2]。自幽门螺杆菌发现以来，其根治成为众多专家及临床的研究热点，耐药菌株与根治方法呈现矛与盾的关系，鉴于此，笔者对本院4种常用的含铋剂四联根除方案进行对比研究，以期为临床寻找一种根除率高、价廉、不良反应小、适合我国国情的根除方案，从而为临床医生选择根治方案提供参考。