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目的探讨瑞巴派特、双歧杆菌三联活菌联合三联疗法根除幽门螺杆菌(HP)的疗效与安全性。方法选择2015年6月-2017年2月收治的210例HP感染患者随机分成四组,其中A组53例,B组52例,C组52例,D组53例。A组患者给予标准三联疗法(奥美拉唑、阿莫西林、呋喃唑酮);B组在A组基础上给予双歧杆菌三联活菌胶囊口服;C组在A组基础上给予瑞巴派特口服;D组在A组基础上给予双歧杆菌三联活菌及瑞巴派特口服。四组所用药物除瑞巴派特用药为28天外,其余药物均为14天。疗程结束后均停用所有药物并记录胃肠道症状评分情况,观察药物不良反应,于三联疗法停药4周后观察各组HP根除情况。计量资料组间比较采用单因素方差分析,两两比较采用LSD-t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果 A组、B组、C组、D组HP根除率分别为55.77%、78.43%、74.51%、94.34%,差异有统计学意义(P<0.05)。治疗后A组、B组、C组、D组患者胃肠道症状评分分别为(4.58±0.42)、(2.32±0.38)、(2.41±0.39)、(1.05±0.28)分,均较治疗前的(6.68±0.72)、(6.59±0.69)、(6.70±0.64)、(6.63±0.67)分改善,差异均有统计学意义(均P<0.05)。治疗后,各组间比较差异有统计学意义(P<0.05)。B组、C组、D组不良反应发生率分别为7.69%、9.62%、7.55%,明显低于A组的28.30%,差异有统计学意义(P<0.05)。A组治疗第七天及三联疗法疗程结束时菌群失调发生率分别为28.30%、39.62%,明显高于B组、C组、D组的7.69%、15.38%、11.54%、17.31%、3.77%、7.55%,差异均有统计学意义(均P<0.05)。结论瑞巴派特、双歧杆菌三联活菌联合三联疗法可明显提高HP根除率,显著改善临床症状,降低菌群失调发生率,减少不良反应,安全性高。
Objective To investigate the efficacy and safety of rebamipide and Bifidobacterium triple viable combined with triple therapy in the eradication of Helicobacter pylori (HP). Methods A total of 210 patients with HP infection who were admitted to our hospital from June 2015 to February 2017 were randomly divided into four groups, including 53 cases in group A, 52 cases in group B, 52 cases in group C and 53 cases in group D. Group A patients were given standard triple therapy (omeprazole, amoxicillin, furazolidone); group B was given oral administration of live bifidobacterium triple viable capsule on the basis of group A; Group C was given orally on the basis of group A ; Group D was administered orally with Bifidobacterium triple viable bacteria and rebamipide on the basis of group A. In addition to rebamipide medication for the four groups of drugs used for 28 days, the remaining drugs were 14 days. All drugs were discontinued after the end of treatment and gastrointestinal symptoms scores were recorded and adverse drug reactions were observed. HP eradication was observed in all groups after 4 weeks of triple therapy withdrawal. Data were compared between groups using one-way analysis of variance, pairwise comparison using LSD-t test, the group was compared using paired t test, count data usingχ2 test, P <0.05 for the difference was statistically significant. Results The eradication rates of HP in group A, group B, group C and group D were 55.77%, 78.43%, 74.51% and 94.34%, respectively. The difference was statistically significant (P <0.05). The scores of GI scores in group A, group B, group C and group D after treatment were (4.58 ± 0.42), (2.32 ± 0.38), (2.41 ± 0.39) and (1.05 ± 0.28) points, respectively, (6.68 ± 0.72), (6.59 ± 0.69), (6.70 ± 0.64) and (6.63 ± 0.67), respectively. All the differences were statistically significant (all P <0.05). After treatment, the differences between the groups were statistically significant (P <0.05). The incidences of adverse reactions in group B, C and D were 7.69%, 9.62% and 7.55%, respectively, which were significantly lower than those in group A (28.30%, P <0.05). The incidence of flora in group A was 28.30% and 39.62% at the end of the seventh day and triple therapy respectively, which was significantly higher than 7.69%, 15.38%, 11.54%, 17.31% and 3.77 respectively in group B, group C and group D %, 7.55%, respectively, the difference was statistically significant (all P <0.05). Conclusion The combination of rebamipide and Bifidobacterium triple viable triple therapy can significantly improve the HP eradication rate, significantly improve clinical symptoms, reduce the incidence of flora, reduce adverse reactions, and have high safety.