【摘要】 目的评价布拉氏酵母菌联合含艾司奥美拉唑和呋喃唑酮四联疗法对幽门螺杆菌（H. pylori）补救治疗的疗效和安全性。方法前瞻性收集2018年1月至2019年12月于河北医科大学附属邢台市人民医院消化内科就诊的经首次H. pylori根除失败的患者228例,随机数字表法分为3组,各76例。A组:泮托拉唑肠溶片40 mg+阿莫西林胶囊1 000 mg+呋喃唑酮100 mg+胶体果胶铋200 mg,口服,每日2次,疗程14 d。B组:艾司奥美拉唑镁肠溶片20 mg+阿莫西林胶囊1 000 mg+呋喃唑酮100 mg+胶体果胶铋200 mg,口服,每日2次,疗程14 d。C组:在B组用药基础上,同时口服布拉氏酵母菌散500 mg,每日2次,疗程14 d。治疗开始记录患者依从性,治疗结束4周后行¹³C或¹⁴C-尿素呼气试验,判断H. pylori的根除情况,同时观察治疗过程中的不良反应,评估患者对治疗药物的耐受程度。结果 A、B、C组的依从性分别为88.2%、90.8%、97.4%,C组患者依从性高于A组,差异有统计学意义（P <0.05）,C组患者依从性优于B组,但两组相比差异无统计学意义（P> 0.05）。A、B、C组的H. pylori根除率按意向性（ITT）分析分别为67.1%、81.6%、89.5%;按符合方案（PP）分析的根除率分别为76.1%、89.9%、91.9%,B组和C组的根除率均高于A组,差异有统计学意义（P <0.05）; B组与C组的根除率,组间差异无统计学意义（P> 0.05）。A、B、C组不良反应发生率分别为27.0%、22.7%、9.3%。C组不良反应的总体发生率低于A组和B组,差异有统计学意义（P <0.05）; A组与B组总体不良反应发生率比较,差异无统计学意义（P> 0.05）。C组药物耐受程度高于A组和B组,差异有统计学意义（P <0.05）。结论采用布拉氏酵母菌联合含艾司奥美拉唑和呋喃唑酮四联疗法根除H. pylori可以获取较高的根除率,同时可以降低药物不良反应,提高患者药物耐受程度。更多还原

【Abstract】 Objective To appraise the efficacy and safety of Saccharomyces boulardii combined with esomeprazole and furazolidone-containing quadruple therapy in the remedial treatment of H. pylori. Methods From January 2018 to December 2019,228 patients who failed the first eradication of H. pylori who were treated at the Department of Gastroenterology,Xingtai People’s Hospital of Hebei Medical University were prospectively collected and divided into 3 groups by random number table,with 76 cases in each group. Group A received pantoprazole 40 mg + amoxicillin 1 000 mg + furazolidone 100 mg + colloidal bismuth pectin 200 mg,twice daily,oral for 14 days. Group B received esomeprazole 20 mg +amoxicillin 1000 mg + furazolidone 100 mg + colloidal bismuth pectin 200 mg,twice daily,oral for 14 days. Group C received the same quadruple therapy for 14 days as above,as well as Saccharomyces boulardii 500 mg bid for 14 days. Patient compliance was recorded at the beginning of treatment. H. pylori eraddication was assessed by ¹³C/¹⁴C-UBT four weeks after cessation of therapy,and the safety was also evaluated. The patient’s tolerance to the treatment medication was assessed. Results The compliance of groups A,B,and C were 88. 2%,90. 8% and 97. 4%,respectively. The compliance of group C was higher than that of group A,and the difference was statistically significant（P < 0. 05）. The compliance of group C was better than that of group B,but the difference between the two groups was not statistically significant（P > 0. 05）. The eradication rates of H. pylori in groups A,B,and C were 67. 1%,81. 6% and 89. 5% by intention-to-treat（ITT） analysis; the eradication rates by per protocol（PP） analysis were 76. 1%,89. 9% and 91. 9%,respectively. The eradication rate of group B and group C was higher than that of group A,the difference was statistically significant（P < 0. 05）; the eradication rate of group B and group C,there was no significant difference between the groups（P > 0. 05）. The incidence of adverse reactions in groups A,B,and C were 27. 0%,22. 7% and 9. 3%,respectively.The overall incidence of adverse reactions in group C was lower than that of group A and group B,and the difference was statistically significant（P < 0. 05）; the overall incidence of adverse reactions between group A and group B was not statistically significant（P > 0. 05）. The degree of drug tolerance in group C was significantly higher than that in group A and group B,the difference was statistically significant（P < 0. 05）.Conclusion Saccharomyces boulardii combined with esomeprazole and furazolidone-containing quadruple therapy can achieve a higher eradication rate,and can reduce the overall side effect rate and improve the tolerance of patients.更多还原