郭洪礼 张涛 梁红亮

摘 要 目的：觀察瑞巴派特改良四联疗法用于幽门螺旋杆菌（HP）阳性胃溃疡的疗效和安全性。方法：将2018年3月-2020年3月于我院接受治疗的HP阳性胃溃疡患者150例按随机数字表法分为传统组和改良组，每组各75例。传统组患者给予阿莫西林胶囊1.0 g，口服，每天2次+克拉霉素片0.5 g，口服，每天2次+奥美拉唑肠溶胶囊20 mg，口服，每天2次+胶体果胶铋胶囊200 mg，口服，每天2次;改良组患者给予瑞巴派特胶囊0.1 g，口服，每天3次+阿莫西林胶囊+克拉霉素片+奥美拉唑肠溶胶囊（用法用量同传统组）。两组患者均连续用药8周，并于停药2周后复查。观察两组患者停药2周后的HP根除率、总有效率，治疗前及停药2周后的血清胃动素（MTL）、胆囊收缩素（CCK）、胃泌素17（G17）、胃蛋白酶原Ⅰ（PGⅠ）、PGⅡ水平及PGⅠ/PGⅡ比值，并记录不良反应发生情况。结果：改良组患者的HP根除率、总有效率均显著高于传统组（P<0.05）。治疗前，两组患者血清中MTL、CCK、G17、PGⅠ、PGⅡ水平和PGⅠ/PGⅡ比值比较，差异均无统计学意义（P>0.05）。治疗后，两组患者血清中CCK、G17、PGⅠ、PGⅡ水平均显著低于同组治疗前，且改良组显著低于传统组（P<0.05）;MTL水平和PGⅠ/PGⅡ比值均显著高于同组治疗前，且改良组显著高于传统组（P<0.05）。两组患者的不良反应总发生率比较，差异无统计学意义（P>0.05）。结论：瑞巴派特改良四联疗法可显著提高HP阳性胃溃疡患者的疗效及HP根除率，调节其胃肠激素及PG水平，且安全性较好。

关键词 胃溃疡;幽门螺杆菌阳性;瑞巴派特;改良四联疗法;根除率;疗效;安全性

ABSTRACT   OBJECTIVE： To observe the therapeutic efficacy and safety of rebamipide modified quadruple therapy in the treatment of Helicobacter pylori （HP） positive gastric-ulcer. METHODS： Totally 150 patients with HP positive gastric-ulcer in our hospital from Mar. 2018 to Mar. 2020 were randomly divided into traditional group and modified group according to random number table， with 75 cases in each group. Traditional group was given Amoxicillin capsules 1.0 g orally， twice a day+Clarithromycin tablets 0.5 g orally， twice a day+ Omeprazole enteric-coated capsules 20 mg orally， twice a day+Colloidal bismuth pectin capsules 200 mg orally， twice a day. Modified group was additionally given Rebamipide capsules 0.1 g orally， 3 times a day， Amoxicillin capsule， Clarithromycin tablet and Omeprazole enteric-coated capsule （same usage and dosage as traditional group）. Both groups were given medicine for consecutive 8 weeks， and were reexamined 2 weeks after drug withdrawal. After 2 weeks of treatment， HP eradication rate， total response rate， the levels of serum MTL， CCK， G17， PGⅠ and PGⅡ， PGⅠ/Ⅱ were observed in 2 groups. The occurrence of ADR was recorded. RESULTS： HP eradication rate and total response rate of modified group were significantly higher than traditional group （P<0.05）. Before treatment， there was no significant difference in the serum levels of MTL， CCK， G17， PGⅠ or PGⅡ， PGⅠ/PGⅡ between 2 groups （P>0.05）. After treatment， the levels of serum CCK， G17， PGⅠ and PGⅡ in 2 groups were significantly lower than before treatment， and modified group was significantly lower than traditional group （P<0.05）; the serum level of MLT and PGⅠ/PGⅡ were significantly higher than before treatment， and modified group was significantly higher than traditional group （P<0.05）. There was no significant difference in the total incidence of ADR between 2 groups （P>0.05）. CONCLUSIONS： Rebamipide modified quadruple therapy can significantly improve therapeutic efficacy and HP eradication rate of HP positive gastric-ulcer patients， and regulate its gastrointestinal hormone and PG levels with good safety.

KEYWORDS   Gastric-ulcer; Helicobacter pylori positive; Rebamipide; Modified quadruple therapy; Efficacy; Safety

胃溃疡是消化系统常见疾病之一，主要临床表现为周期性上腹部疼痛，且疼痛在餐后加重。有研究显示，多项因素与胃溃疡的发生有关，如感染幽门螺杆菌（HP）、使用非甾体类抗炎药、饮酒等，其中以感染HP较为常见[1]。近年来，随着饮食结构和细菌耐药性的改变，全球HP感染率逐年增加[2-4]。……