【摘要】 目的:观察14 d含多西环素、呋喃唑酮的四联方案对幽门螺杆菌(H.pylori)感染初次根除失败补救治疗的临床疗效及不良反应。方法:选择2018年4月～2019年4月就诊于芜湖市第二人民医院经标准四联方案根除失败的消化性溃疡或慢性萎缩性胃炎H.pylori感染患者120例,将其随机分为观察组和对照组,观察组给予口服艾司奥美拉唑镁肠溶片+多西环素片+呋喃唑酮片+枸橼酸铋钾胶囊治疗;对照组给予口服艾司奥美拉唑镁肠溶片+阿莫西林胶囊+呋喃唑酮片+枸橼酸铋钾胶囊治疗;疗程均为14 d。早、晚餐前30 min服用艾司奥美拉唑镁肠溶片及枸橼酸铋钾胶囊,早、晚餐后即服用抗生素。治疗结束至少停药4周后行碳十四或碳十三呼气试验确定H.pylori根除情况。分析两组方案的疗效、不良反应。应用成本-效果分析法进行两组方案经济效益评价。结果:与对照组相比,观察组按符合方案分析(PP)和意向性分析(ITT)H.pylori根除率升高均有统计学意义(PP:87.93%vs. 71.93%,P<0.05;ITT:85.00%vs. 68.33%,P<0.05),而不良反应发生率差异无统计学意义(20%vs. 15%,P>0.05)。成本-效果比值显示观察组<对照组。结论:14 d含多西环素、呋喃唑酮的四联疗法是一种有效的幽门螺杆菌补救治疗方案,不良反应小,是较为理想的补救治疗方案。但该方案广泛应用于临床还需进一步大样本的临床研究,其安全性还有待进一步观察和研究。更多还原

【Abstract】 Objective: To evaluate the efficacy and adverse reactions of 14-day quadruple therapy containing doxycycline and furazolidone in the treatment of failed eradication of Helicobacter pylori( H. pylori) infection. Methods: 120 patients with medication failure( standard quadruple therapy) of peptic ulcer or H. pylori infection were included from April of 2018 to 2019 in the second hospital of Wuhu city,and randomized into observational group and control group. Patients in the observational group received esomeprazole + doxycycline + furazolidone + bismuth potassium citrate capsule,twice a day for 14 days,and those in the control group were given esomeprazole + amoxicillin + furazolidone and bismuth potassium citrate capsule,twice a day for 14 days. Esomeprazole and bismuth potassium citrate capsules were orally administered half an hour before breakfast and dinner,followed by antibiotics after breakfast and dinner. 14 C or 13 C urea breath test was performed to determine H. pylori status at least 4 weeks following medication withdrawal. The two groups were compared regarding the H. pylori eradication rate and incidence of adverse reactions as well as economic benefits evaluated by cost-effectiveness analysis.Results: Compared with the control group,eradication rate of H. pylori in the observational group was significantly increased by intention-to-treat and perprotocol analysis( PP: 87. 93% vs. 71. 93%,P < 0. 05; ITT: 85. 00% vs. 68. 33%,P < 0. 05). Incidence of adverse reactions remained insignificant between groups( 20% vs. 15%,P > 0. 05),yet cost-effectiveness ratio was reduced in the observational group. Conclusion: The 14-day quadruple regimen containing doxycycline and furazolidone is an effective remedy for H. pylori,with little adverse reactions,and may serve as an optimal remedial therapy.However,this scheme still needs further studies by expanded samples,provided that it were widely used in clinic.更多还原