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目的评价含铋剂的不同抗生素的四联方案根除幽门螺杆菌(Hp)的有效性和安全性。方法将120例Hp感染初次治疗患者随机均分为4组,分别接受了下述7天含铋剂的四联方案:LBAC组:兰索拉唑(15mg)+果胶铋(0.1g)+阿莫西林(1g)+克拉霉素(0.5g)bid。LBAM组:兰索拉唑(15mg)+果胶铋(0.1g)+阿莫西林(1.0g)+甲硝唑(0.4g)bid。LBCM组:兰索拉唑(15mg)+果胶铋(0.1g)+克拉霉素(0.5g)+甲硝唑(0.4g)bid。LBLG组:兰索拉唑(15mg)+果胶铋(0.1g)+左旋氧氟沙星(0.2g)+庆大霉素(40mg)bid。4周后通过14C尿素酶呼吸试验判断根除成功与否。结果 LBAC组22例根除成功,7例发生不良反应。LBAM组18例根除成功,3例发生不良反应。LBCM组14例根除成功,13例发生不良反应。LBLG组21例根除成功,2例发生不良反应。结论含克拉霉素、阿莫西林的铋剂方案与含左氧氟沙星、庆大霉素的铋剂方案根除Hp疗效相同,含克拉霉素、甲硝唑的四联方案根除率低,应予以放弃。
Objective To evaluate the effectiveness and safety of a four-drug regimen containing different antibiotics containing bismuth in the eradication of Helicobacter pylori (Hp). Methods A total of 120 patients with primary Hp infection were randomly divided into 4 groups and received the following four-day bismuth-containing regimen: LBAC group: lansoprazole (15 mg) + pectin bismuth (0.1 g) + Amoxicillin (1 g) + clarithromycin (0.5 g) bid. LBAM group: Lansoprazole (15 mg) + pectin bismuth (0.1 g) + amoxicillin (1.0 g) + metronidazole (0.4 g) bid. LBCM group: Lansoprazole (15 mg) + bismuth pectate (0.1 g) + clarithromycin (0.5 g) + metronidazole (0.4 g) bid. LBLG group: Lansoprazole (15 mg) + pectin bismuth (0.1 g) + levofloxacin (0.2 g) + gentamicin (40 mg) bid. Four weeks later, the 14 C urease respiration test was used to determine whether the eradication was successful or not. Results In the LBAC group, 22 cases were successfully eradicated and 7 cases had adverse reactions. In the LBAM group, eradication was successful in 18 cases and adverse reactions in 3 cases. In the LBCM group, 14 cases were successfully eradicated and 13 cases had adverse reactions. In the LBLG group, 21 cases were successfully eradicated and 2 cases had adverse reactions. Conclusions The bismuth-containing regimen containing clarithromycin and amoxicillin has the same efficacy as eradication of Hp with the levofloxacin and gentamicin-containing bismuth regimen. The eradication rate of clarithromycin and metronidazole containing the quadruple regimen is low and should be abandoned.