韩冰

[摘要] 目的 探討雷贝拉唑联合抗生素序贯疗法治疗幽门螺杆菌阳性的消化性溃疡患者疗效。 方法 选取2017年5月至2019年8月本院消化内科诊治的幽门螺杆菌阳性的消化性溃疡患者230例为研究对象，以1∶1随机双盲法分组，每组各115例。其中对照组应用四联疗法（阿莫西林+克拉霉素+雷贝拉唑+枸橼酸铋钾胶囊），观察组患者应用序贯疗法（先服用雷贝拉唑和阿莫西林1周，后改为服用雷贝拉唑、克拉霉素和甲硝唑1周）。比较两组患者的治疗总有效率、Hp根除率、随访6个月消化溃疡复发率、不良反应总发生率和治疗前后的血清胃泌素、TGF-β1、α-防御素水平。 结果 观察组总有效率为95.65%，对照组的总有效率为93.91%，组间比较差异无统计学意义（P>0.05）;两组的Hp根除率和随访6个月消化性溃疡复发率比较，差异均无统计学意义（P>0.05）;观察组的不良反应总发生率为3.48%，明显低于对照组的10.43%，差异有统计学意义（P<0.05）;两组患者治疗前后的血清胃泌素、TGF-β1水平及α-防御素水平比较，差异均无统计学意义（P>0.05）。 结论 雷贝拉唑与抗生素联合的序贯疗法和四联疗法在Hp阳性消化性溃疡患者治疗中应用疗效相当，但序贯疗法能有效减少不良反应。

[关键词] 雷贝拉唑;四联疗法;序贯疗法;幽门螺杆菌;消化性溃疡;复发率;不良反应

[中图分类号] R573          [文献标识码] B          [文章编号] 1673-9701（2021）03-0038-04

Clinical efficacy of rabeprazole combined with sequential antibiotic therapy in the treatment of Helicobacter pylori-positive peptic ulcer

HAN Bing

Health Management Center， Liaoning Electric Power Central Hospital， Shenyang   110000， China

[Abstract] Objective To explore the curative effect of rabeprazole combined with sequential antibiotic therapy in the treatment of Helicobacter pylori-positive peptic ulcer patients. Methods A total of 230 Helicobacter pylori-positive peptic ulcer patients diagnosed and treated in the Department of Gastroenterology of our hospital from May 2017 to August 2019 were selected as subjects and were grouped by 1∶1 randomized， double-blind method. The control group（n=115） was treated with quadruple therapy（amoxicillin+clarithromycin+rabeprazole+bismuth potassium citrate capsules）， the observation group was treated with sequential therapy（first taking rabeprazole and amoxicillin for one week， then taking rabeprazole， clarithromycin， and metronidazole for one week）. The total effective rate of treatment， Hp eradication rate， peptic ulcer recurrence rate， the total incidence of adverse reactions， and serum gastrin， TGF-β1， and α-defensin levels before and after treatment were compared between the two groups. Results The total effective rate of the observation group and the control group was 95.65% and 93.91%. There was no significant difference between the groups（P>0.05）. There were no significant differences in the Hp eradication rate， and the peptic ulcer recurrence rate during the 6-month follow-up between the observation group and the control group（P>0.05）. The total adverse reaction rate of the observation group was 3.48%， significantly lower than 10.43% of the control group（P<0.05）. There were no significant differences in the the levels of serum gastrin， TGF-β1， and α-defensin between the two groups before and after treatment（P>0.05）. Conclusion Sequential therapy and quadruple therapy of rabeprazole combined with antibiotics have equivalent effects in the treatment of patients with Hp-positive peptic ulcers. Still， sequential treatment can effectively reduce adverse reactions.

[Key words] Rabeprazole; Quadruple therapy; Sequential therapy; Helicobacter pylori; Peptic ulcer; Recurrence rate; Adverse reactions

消化性溃疡（Peptic ulcer，PU）是消化系统的多发病，在各个年龄段均可发病，主要表现为上腹部节律性、周期性的疼痛，并伴有嗳气、反酸等症状，病程长、易反复发作[1-2]。临床研究表明，幽门螺杆菌（Helicobacter pylori，Hp）感染是引发消化性溃疡的主要因素之一，临床治疗中应以抑酸、抗Hp为主[3]。由于临床……