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目的观察根除幽门螺杆菌(Hp)对糖尿病胃轻瘫(DGP)患者的治疗作用及胃黏膜组织学改变对疗效的影响。方法 纳入100例Hp阳性DGP患者。治疗前胃镜及病理组织学检查以了解胃黏膜炎症情况。随机分为A、B两组。A组给予莫沙比利及雷尼替丁枸橼酸铋三联根除Hp治疗。B组采用莫沙比利及雷尼替丁枸橼酸铋治疗。记录患者治疗前、治疗4周及停药4周时的症状积分。结果 92例完成实验。A组治疗4周后症状积分明显下降(P<0.01),与停药4周后相比差异无统计学意义(P>0.05),二者均明显低于B组同期(P分别<0.05,<0.01)。B组症状积分在治疗4周后明显下降(P<0.01),停药4周后明显高于治疗4周后(P<0.05)。A组胃黏膜有活动性炎症的患者治疗4周后及停药4周后症状积分均明显低于B组(P<0.05或0.01)。非活动性炎症患者与B组差别无统计学意义(P>0.05)。中重度活动性炎症组停药4周后症状积分明显低于轻度组(P<0.05);轻度活动性炎症组及非活动性炎症组均较治疗4周后明显升高(P<0.01),中重度活动性炎症组症状积分无明显变化(P>0.05)。结论 对Hp阳性的DGP患者,尤其是胃黏膜炎症活动度高者,根除Hp可明显提高疗效,并有效防止停药后症状复发。
Objective To observe the therapeutic effect of eradication of Helicobacter pylori (Hp) on diabetic gastroparesis (DGP) and the effect of gastric mucosal histology on the curative effect. Methods 100 Hp-positive DGP patients were enrolled. Gastroscopy before treatment and histopathological examination to understand the gastric mucosal inflammation. Randomly divided into A, B two groups. Group A was given mosapride and ranitidine bismuth citrate triple therapy in addition to Hp. Group B was treated with mosapride and ranitidine bismuth citrate. Record patients before treatment, treatment for 4 weeks and withdrawal symptoms 4 weeks. Results 92 cases completed the experiment. After 4 weeks of treatment, the score of symptom in group A decreased significantly (P <0.01), and there was no significant difference between the two groups after 4 weeks of treatment (P> 0.05) <0.01). Symptoms in group B decreased significantly after 4 weeks of treatment (P <0.01), and were significantly higher after 4 weeks of treatment than those of 4 weeks after treatment (P <0.05). Patients in group A had active inflammation after 4 weeks of treatment and after 4 weeks of treatment, and their symptom scores were significantly lower than those in group B (P <0.05 or 0.01). There was no significant difference between inactive patients and group B (P> 0.05). Symptom scores of moderately and severely active inflammatory group were significantly lower than those of mild group (P <0.05) after 4 weeks’ withdrawal; mild active inflammation group and inactive inflammation group were significantly increased after 4 weeks of treatment (P <0.01) ), Moderate to severe active inflammation group had no significant change in symptom score (P> 0.05). Conclusions Hp-positive DGP patients, especially those with high gastric mucosal inflammation activity, can effectively improve the curative effect of Hp eradication and effectively prevent recurrence of symptoms after drug withdrawal.