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目的比较四联疗法和序贯疗法根除幽门螺杆菌(H.pylori)的疗效及安全性。方法102例幽门螺杆菌阳性的初治患者随机分为两组，四联疗法A组及序贯疗法B组，四联疗法组给予埃索美拉唑20mg+克拉霉素500mg+阿莫西林1000mg+枸橼酸铋钾220mg，均为2次/d，共10d。序贯疗法组前5d给予埃索美拉唑20 mg和阿莫西林1000mg，后5d给予埃索美拉唑20 mg、克拉霉素500 mg和甲硝唑400 mg，均为2次/d口服。根除治疗结束至少4w后复查13C-尿素呼气试验或胃镜，确定H.pylori感染是否根除成功。对H.pylori根除率进行意向治疗(ITT)分析和符合方案(PP)分析比较。结果意向性分析显示四联疗法组及序贯疗法组的Hp根除率分别是86.3%(44/51)、76.4%(39/51)。符合方案分析显示四联疗法组及序贯疗法组的Hp根除率分别是91.7%(44/48)及82.9%(39/47)。意向性分析及符合方案分析表明四联疗法组HP根除率高于序贯疗法组，差异有统计学意义(<0.05)。结论含铋剂四联方案为临床根治Hp的一线治疗方案,序贯方案并未得到更好的根除疗效。“,”Objective To compare the ef ect and safety of quadruple therapy and sequential therapy for Helicobacter pylori eradication. Methods 102 Helicobacter pylori infected patients were randomized divided into 2 groups. Patients in group A were treated with quadruple regimen, esomeprazole 20mg, clarithromycin 500mg, amoxicil in 1000mg and bismuth potassium citrate 220mg, for 10 days. Patients in group B received sequential regimen, esomeprazole 20mg plus amoxicil in 1000mg for the first 5 days, and fol owed by esomeprazole 20mg, clarithromycin 500mg and metronidazole 400mg for the last 5days.Al drugs were given twice daily. Helicobacter pylori was rechecked by 13C-Urea breath test or endoscopy at least 4 weeks after the eradicative treatment. H.pylori eradication rates were compared with the intention-to-treat(ITT)and per protocol(PP)analysis.Results According to ITT analysis, the eradication rates of H.pylori in quadruple therapy group and sequential therapy group were 86.3%(44/51)and 76.4%(39/51)respectively.According to PP analysis,the eradication rates of H.pylori in quadruple therapy group and sequential therapy group were 91.7%(44/48)and 82.9%(39/47). Intention to treat analysis, and in accordance with the scheme analysis showed that quadruple therapy group HP eradicate rate was higher than that of the sequential therapy group, the dif erence was statistical y significant ( <0.05).Conclusion The first line of treatment containing bismuth quadrupletherapy for clinical cure Hp, sequential regimen did not get bet er curative ef ect of eradication.