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《国际消化病杂志》[ISSN:1673-534X/CN:31-1953/R]

期数:

2023年06期

页码:

407-411，416

栏目:

论著

出版日期:

2023-12-30

文章信息/Info

Title:

Observation of the efficacy of high-dose dual therapy and bismuth containing quadruple therapy for eradication of Helicobacter pylori

作者:

段 萌; 李佳颖; 霍丽娟

030001 山西太原，山西医科大学第一临床医学院（段萌、李佳颖）；030001 山西太原，山西医科大学第一医院消化内科（霍丽娟）

Author(s):

DUAN Meng;  LI Jiaying; HUO Lijuan.

DUAN Meng, LI Jiaying. the First Clinical Medical College of Shanxi Medical University, Taiyuan 030001, China; HUO Lijuan. Department of Gastroenterology, the First Hospital of Shanxi Medical University, Taiyuan 030001, China

关键词:

幽门螺杆菌; 大剂量二联治疗方案; 伏诺拉生

Keywords:

Helicobacter pylori;  high-dose dual therapy;  Vonoprazan

分类号:

-

DOI:

10.3969/j.issn.1673-534X.2023.06.010

文献标识码:

-

摘要:

目的比较大剂量二联方案（HDDT）与含铋剂四联方案（BQT）的幽门螺杆菌（Hp）根除率和不良反应发生率。方法选择2022年1月至2022年10月在山西医科大学第一医院消化内科门诊首次诊断为Hp阳性的177例患者作为研究对象，随机分为3组：含伏诺拉生大剂量二联组（VPZ-HDDT组）58例（VPZ20mg/次，2次/d＋阿莫西林750mg/次，3次/d）；含PPI大剂量二联组（PPI-HDDT组）62例（艾司奥美拉唑40mg/次，2次/d＋阿莫西林750mg/次，3次/d）；BQT组57例（艾司奥美拉唑40mg/次，1次/d＋阿莫西林1000mg/次，2次/d＋呋喃唑酮100mg/次，2次/d＋胶体果胶铋150mg/次，3次/d）。3组均连续治疗14d，治疗结束至少4周后复查13C或14C尿素呼气试验。治疗第7天和第14天进行电话或门诊随访，记录患者的服药情况和不良反应发生情况。采用意向性治疗（ITT）分析和遵循研究方案（PP）分析这2种方法比较3组的Hp根除率。3组的依从性和不良反应发生率采用对比分析。结果VPZ-HDDT组、PPI-HDDT组、BQT组的PP分析根除率分别为90.7%、89.3%、90.6%（P＝0.961），ITT分析根除率分别为84.5%、80.6%、84.2%（P＝0.719）；在这2种分析方法中，VPZ-HDDT组的根除率均高于PPI-HDDT组和BQT组，但差异均无统计学意义。VPZ-HDDT组、PPI-HDDT组和BQT组的依从性分别为93.1%、90.3%和92.9%，差异无统计学意义（P＝0.815）。VPZ-HDDT组和PPI-HDDT组的不良反应发生率均显著低于BQT组（7.4%、5.3%、18.9%，P＝0.046）。结论HDDT与BQT根除Hp的疗效相当，且不良反应较少，可作为一线Hp根除治疗方案，HDDT有望成为Hp根除治疗的新选择。

Abstract:

Objective? This paper intends to compare the eradication rate and incidence of adverse reactions of Helicobacter pylori (Hp) between the high-dose dual therapy (HDDT) and the bismuth containing quadruple therapy (BQT). Methods? One hundred and seventy-seven patients diagnosed with Hp positive for the first time at the Gastroenterology Outpatient Department of the First Hospital of Shanxi Medical University from January 2022 to October 2022 were selected and randomly divided into 3 groups: 58 cases in the high-dose dual therapy containing vonoprazan group (VPZ-HDDT group) (VPZ 20 mg/time, 2 times/d＋amoxicillin 750 mg/time, 3 times/d), 62 cases in the high-dose dual therapy containing PPI group (PPI-HDDT group) (esomeprazole 40 mg/time, 2 times/d＋amoxicillin 750 mg/time, 3 times/d), and 57 cases in the bismuth-containing quadruple therapy group (BQT group) (esomeprazole 40 mg/time, 1 time/d＋amoxicillin 1 000 mg/time, 2 times/d＋furazolidone 100 mg/time, 2 times/d＋colloidal bismuth 150 mg/time, 3 times/d). The three groups were treated continuously for 14 d, and a 13C or 14C urea breath test was conducted at least 4 weeks after treatment. On the 7th and 14th day of treatment, telephone or outpatient follow-up was conducted to record the medication status and incidence of adverse reactions. The Hp eradication rates of the 3 groups were compared using intent-to-treat (ITT) analysis and protocol compliance (PP) analysis. Comparative analyses were used for adherence and incidence of adverse reactions in the 3 groups. Results? The eradication rates in the PP analysis are 90.7%, 89.3%, and 90.6% in the VPZ-HDDT group, the PPI-HDDT group, and the BQT group, respectively (P＝0.961), and 84.5%, 80.6%, and 84.2% in the ITT analysis, respectively (P＝0.719). The eradication rate in the VPZ-HDDT group is higher than those in the PPI-HDDT group and the BQT group, but the differences are not statistically significant. The adherence rates in the VPZ-HDDT group, the PPI-HDDT group, and the BQT group are 93.1%, 90.3%, and 92.9%, respectively, and the differences are not statistically significant (P＝0.815). The incidence rates of adverse reactions in the VPZ-HDDT group and the PPI-HDDT group are significantly lower than those in the BQT group (7.4% , 5.3%, and 18.9%, P＝0.046). Conclusion? The HDDT is comparable to the BQT for Hp eradication and has fewer adverse effects, and can be used as a first-line Hp eradication treatment regimen. The HDDT is expected to become a new option for Hp eradication.

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备注/Memo

备注/Memo:

通信作者：霍丽娟，Email: mymail5296@163.com

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更新日期/Last Update: 1900-01-01