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目的研究不同剂量埃索美拉唑四联方案治疗维吾尔族幽门螺杆菌(H.pylori)的效果。方法选取喀什地区第二人民医院2015年8月至2016年5月诊治的H.pylori阳性的维吾尔族浅表性胃炎患者248例为研究对象,按照随机数表法将其分为单剂量组(82例)、标准剂量组(83例)及大剂量组(83例)。单剂量组患者给予埃索美拉唑肠溶片(40 mg,1次/天)联合阿莫西林胶囊、克拉霉素缓释片及胃铋镁颗粒治疗;标准剂量组患者给予埃索美拉唑肠溶片(20 mg,2次/天)联合阿莫西林胶囊、克拉霉素缓释片及胃铋镁颗粒治疗;大剂量组患者给予埃索美拉唑肠溶片(40 mg,2次/天)联合阿莫西林胶囊、克拉霉素缓释片及胃铋镁颗粒治疗。三组患者疗程均为14天。比较三组患者治疗后H.pylori根除率、临床疗效、症状积分及药物不良反应发生情况。结果意向处理分析(intentionto-treat analysis,ITT)显示,单剂量组、标准剂量组及大剂量组患者H.pylori根除率分别为74.39%(61/82)、81.92%(68/83)及89.16%(74/83)。符合方案集分析(per-protocol analysis,PP)显示,单剂量组、标准剂量组及大剂量组患者H.pylori根除率分别为79.22%(61/77)、87.18%(68/78)及96.10%(74/77),三组间两两比较均有显著差异(P<0.05)。H.pylori根除治疗4周后,单剂量组患者上腹痛、上腹烧灼感、上腹胀、恶心呕吐症状积分及总积分较入组时均明显降低(P<0.05);标准剂量组和大剂量组患者的各项消化不良症状积分和症状总积分较入组时均显著降低(P<0.01),且均明显低于单剂量组(P<0.01);大剂量组患者上腹痛、上腹烧灼感、上腹胀症状积分及总积分较标准剂量组明显降低(P<0.01)。H.pylori根除治疗4周后,单剂量组、标准剂量组及大剂量组患者的总有效率分别为45.5%、75.6%及87.0%,三组间两两比较差异均具有显著性(P<0.05)。三组患者不良反应发生率比较均无显著差异(P>0.05)。结论根除H.pylori治疗可明显改善新疆维吾尔自治区维吾尔族患者H.pylori胃炎伴消化不良症状,以大剂量埃索美拉唑为基础的四联方案可提高维吾尔族患者H.pylori根除率和H.pylori胃炎伴消化不良症状的临床疗效,且安全性高。
Objective To investigate the effect of different doses of esomeprazole quadruple regimen in the treatment of Uygur H.pylori. Methods A total of 248 patients with H.pylori-positive superficial gastritis diagnosed by H.pylori who were diagnosed and treated in the Second People’s Hospital of Kashgar from August 2015 to May 2016 were selected as the study subjects and divided into single dose group 82 cases), standard dose group (83 cases) and high dose group (83 cases). Patients in the single-dose group were given esomeprazole enteric-coated tablets (40 mg once daily) in combination with amoxicillin capsules, clarithromycin sustained-release tablets and magnesium bismuth microgranules. Patients in the standard dose group were given esomeprazole (20 mg twice daily) were given amoxicillin capsules, clarithromycin sustained-release tablets and magnesium bismuth microgranules. Patients in the high-dose group were given esomeprazole enteric-coated tablets (40 mg, 2 Times / day) combined with amoxicillin capsules, clarithromycin sustained-release tablets and bismuth magnesium particles treatment. Three groups of patients were treated for 14 days. The eradication rates of H.pylori, clinical efficacy, symptom scores and adverse drug reactions were compared between the three groups after treatment. Results The intention to treat analysis (ITT) showed that the H.pylori eradication rates of single dose group, standard dose group and high dose group were 74.39% (61/82), 81.92% (68/83) and 89.16 % (74/83). Per-protocol analysis (PP) showed that H.pylori eradication rates were 79.22% (61/77), 87.18% (68/78), and 96.10 in the single dose group, the standard dose group and the high dose group, respectively % (74/77). There was significant difference between the three groups (P <0.05). After 4 weeks of H.pylori eradication treatment, the scores of upper abdominal pain, upper abdominal burning, abdominal distension, nausea and vomiting, and total score of the single dose group were significantly lower than those of the control group (P <0.05). The standard dose group and the high dose The total scores of indigestion symptom scores and symptom scores in the group of patients were significantly lower than those in the single group (P <0.01), and were significantly lower than those in the single dose group (P <0.01). The patients in the high dose group had upper abdominal pain, Symptoms, abdominal distension symptom score and total score were significantly lower than the standard dose group (P <0.01). After 4 weeks of H.pylori eradication treatment, the total effective rates of single dose group, standard dose group and high dose group were 45.5%, 75.6% and 87.0%, respectively, with significant differences between the two groups (P < 0.05). The incidence of adverse reactions in the three groups showed no significant difference (P> 0.05). Conclusions The eradication of H.pylori treatment can significantly improve the H.pylori gastritis with dyspeptic symptoms in Uigur patients in Xinjiang Uygur Autonomous Region. High dose esomeprazole-based quadruple regimen can improve the H.pylori eradication rate and H Gastric inflammation with dyspepsia symptoms clinical efficacy, and high safety.