Fraser A G, Moore L, Hackett M, Hollis B
Department of Medicine, University of Auckland, New Zealand.
Aust N Z J Med. 1999 Aug;29(4):512-6. doi: 10.1111/j.1445-5994.1999.tb00752.x.
Helicobacter pylori eradication treatment has been a rapidly evolving field. Audit of treatment results provides reassurance that trial data can be translated into routine clinical practice.
Data were collected prospectively over five years. Patients were given four different treatment regimens over the audit period 'standard' triple therapy, two types of clarithromycin-based treatment or ranitidine, amoxycillin and metronidazole. Eradication was proven by a urea breath test at least four weeks after completing treatment.
Eradication treatment for H. pylori was given to 665 patients; 89% had follow-up data. H. pylori eradication was significantly associated with treatment type (p<0.0001) and smoking (p=0.04) by univariate analysis, but was not associated with sex, age, alcohol consumption, endoscopic diagnosis, recent treatment with anti-secretory drugs or NSAIDs. By logistic regression analysis, only treatment type was significant (p=0.0001). H. pylori culture and sensitivities were available for 255 patients. Metronidazole resistance was shown for 84 isolates (32%) and clarithromycin resistance for 18 isolates (6.8%). Metronidazole resistance was significantly associated with younger age (p=0.02), ethnicity (p=0.02), female sex (p=0.02), and year of endoscopy (p=0.04), but was not associated with clarithromycin resistance. Clarithromycin resistance was not associated with age, sex, or ethnicity. Metronidazole resistance significantly affected H. pylori eradication for regimens containing metronidazole without clarithromycin. Eradication with metronidazole without clarithromycin was achieved in 90% of sensitive strains but only 55% of resistant strains (p<0.001). Metronidazole resistance was not significantly associated with treatment failure when metronidazole was combined with clarithromycin. Eradication with metronidazole and clarithromycin was achieved in 86% of sensitive strains and 78% of resistant strains (p=0.42).
Treatment type and antibiotic susceptibility are the most important determinants of treatment success.
幽门螺杆菌根除治疗一直是一个快速发展的领域。对治疗结果进行审核可确保试验数据能够转化为常规临床实践。
前瞻性收集了五年的数据。在审核期间，患者接受了四种不同的治疗方案——“标准”三联疗法、两种基于克拉霉素的治疗方案或雷尼替丁、阿莫西林和甲硝唑。在完成治疗至少四周后，通过尿素呼气试验证实根除情况。
665例患者接受了幽门螺杆菌根除治疗；89%有随访数据。单因素分析显示，幽门螺杆菌根除与治疗类型（p<0.0001）和吸烟（p=0.04）显著相关，但与性别、年龄、饮酒、内镜诊断、近期使用抗分泌药物或非甾体抗炎药治疗无关。通过逻辑回归分析，只有治疗类型具有显著性（p=0.0001）。255例患者有幽门螺杆菌培养及药敏结果。84株（32%）显示对甲硝唑耐药，18株（6.8%）对克拉霉素耐药。甲硝唑耐药与年龄较小（p=0.02）、种族（p=0.02）、女性（p=0.02）及内镜检查年份（p=0.04）显著相关，但与克拉霉素耐药无关。克拉霉素耐药与年龄、性别或种族无关。甲硝唑耐药对不含克拉霉素但含甲硝唑的治疗方案中幽门螺杆菌的根除有显著影响。对甲硝唑敏感的菌株，不含克拉霉素时根除率为90%，而耐药菌株仅为55%（p<0.001）。当甲硝唑与克拉霉素联合使用时，甲硝唑耐药与治疗失败无显著相关性。对甲硝唑和克拉霉素敏感的菌株根除率为86%，耐药菌株为78%（p=0.42）。
治疗类型和抗生素敏感性是治疗成功的最重要决定因素。
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