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[目的]探讨四联疗法对幽门螺杆菌相关性胃溃疡的疗效及对胃黏膜形态学的影响。[方法]将幽门螺杆菌相关性胃溃疡患者80例随机分为四联组和三联组,每组40例。2组患者均服用泮托拉唑、左氧氟沙星和阿莫西林,四联组患者加服果胶铋;比较2组患者治疗前后的胃黏膜形态学情况、疗效、不良反应发生率、复发率。[结果]四联组的治愈率、总有效率均显著高于三联组(P<0.01)。治疗前,2组患者的黏膜厚度、腺体密度、慢性炎症细胞浸润和活动性炎症细胞浸润评分比较差异均无统计学意义(P>0.05);治疗后,2组患者的黏膜厚度、腺体密度、慢性炎症细胞浸润和活性性细胞浸润评分较治疗前均显著性降低(P<0.05或P<0.01),且四联组的慢性炎症细胞浸润和活性性细胞浸润评分均明显低于三联组(P<0.05)。2组患者的不良反应比较无差异(P>0.05),四联组的复发率显著低于三联组(P<0.01)。[结论]四联疗法的治愈率、总有效率较三联疗法更高,复发率更低,且胃黏膜形态改善更显著;可推荐为临床上治疗幽门螺杆菌相关性胃溃疡的首选方法。
[Objective] To investigate the curative effect of quadruple therapy on Helicobacter pylori associated gastric ulcer and its effect on gastric mucosal morphology. [Methods] Eighty patients with Helicobacter pylori-associated gastric ulcer were randomly divided into quadruple and triple groups, 40 in each. The patients in both groups were treated with pantoprazole, levofloxacin and amoxicillin. Patients in quadruplex group were given pectin bismuth. Gastric mucosa morphology, curative effect, incidence of adverse reactions and relapse rate were compared between the two groups before and after treatment. [Results] The cure rate and total effective rate of quadruple group were significantly higher than triple group (P <0.01). Before treatment, mucosal thickness, glandular density, infiltration of chronic inflammatory cells and active inflammatory cell infiltration scores were not significantly different between the two groups (P> 0.05). After treatment, mucosal thickness, The scores of density, chronic inflammatory cell infiltration and active cell infiltration were significantly lower than those before treatment (P <0.05 or P <0.01), and the scores of chronic inflammatory cell infiltration and active cell infiltration in quadruple group were significantly lower than those in triple group (P <0.05). There was no difference in adverse reactions between the two groups (P> 0.05). The recurrence rate of the quadruple group was significantly lower than that of the triple group (P <0.01). [Conclusion] The curative rate and total effective rate of quadruple therapy are higher than triple therapy, the relapse rate is lower and the morphological changes of gastric mucosa are more remarkable. It can be recommended as the first choice for clinical treatment of Helicobacter pylori associated gastric ulcer.