初次治疗失败后幽门螺杆菌感染的治愈情况：来自120例患者的单中心研究结果

Cure of Helicobacter pylori infection after failed primary treatment: one-center results from 120 patients.

作者信息

Seppälä K, Kosunen T U, Nuutinen H, Sipponen P, Rautelin H, Sarna S, Hyvärinen H, Färkkilä M, Miettinen T A

机构信息

Dept. of Medicine, Helsinki University Central Hospital, University of Helsinki, Finland.

出版信息

Scand J Gastroenterol. 2000 Sep;35(9):929-34. doi: 10.1080/003655200750022977.

DOI:10.1080/003655200750022977

PMID:11063151

Abstract

BACKGROUND

Treatment with a proton pump inhibitor (PPI) and antimicrobials cures Helicobacter pylori infection in about 90% of patients. This is a retrospective overview of our studies aiming to cure the infection in all compliant patients with failed initial therapy.

METHODS

We retreated 120 (19% of 644) H. pylori-infected patients whose initial therapy had failed. The retreatments included (i) triple therapy (TT): colloidal bismuth subcitrate, metronidazole, amoxicillin (or tetracycline); (ii) quadruple therapy (QT): TT and a PPI; or (iii) high doses of both a PPI and clarithromycin combined with a further 1-3 individually selected antimicrobials. The eradication results were determined after 6-12 months.

RESULTS

The 1st retreatment was successful in 70 of 120 patients. The 2nd retreatment cured 25 of the remaining 42 patients, the 3rd 13 of 17, and the 4th the last 4 patients. The cumulative eradication rate (ITT) was 93% (95% CI: 88.9%-97.9%; 8 patients withdrew after a failed 1st retreatment) and the rate was 100% in the remaining 112 patients who accepted several retreatments. The 1st retreatment with TT cured 23% (95% CI: 12%-34%) of 57 patients and QT 85% (95% CI: 74%-96%) of 41 patients who had initially undergone a failed metronidazole-based treatment. All retreatments were well tolerated.

CONCLUSIONS

In this study, high doses of a PPI and clarithromycin combined with 1-3 antimicrobials according to susceptibility data proved to be the best drug combination in the cure of H. pylori infection after failed primary treatment. Giving imidazole- and bismuth-based QT (without clarithromycin) as the first-line treatment of H. pylori infection ensures that the number of failures remains low.

摘要

背景

质子泵抑制剂（PPI）与抗菌药物联合治疗可使约90%的幽门螺杆菌感染患者得到治愈。这是一项回顾性研究，旨在治愈所有初始治疗失败但依从性良好的患者。

方法

我们对120例（占644例的19%）初始治疗失败的幽门螺杆菌感染患者进行了再次治疗。再次治疗方案包括：（i）三联疗法（TT）：枸橼酸铋钾、甲硝唑、阿莫西林（或四环素）；（ii）四联疗法（QT）：TT加一种PPI；或（iii）高剂量PPI和克拉霉素联合另外1 - 3种根据药敏选择的抗菌药物。在6 - 12个月后确定根除结果。

结果

120例患者中，首次再次治疗有70例成功。第二次再次治疗使其余42例患者中的25例治愈，第三次使17例中的13例治愈，第四次使最后4例患者治愈。累积根除率（意向性分析）为93%（95%置信区间：88.9% - 97.9%；8例患者在首次再次治疗失败后退出），在接受多次再次治疗的其余112例患者中根除率为100%。首次用TT再次治疗使57例最初基于甲硝唑治疗失败的患者中的23%（95%置信区间：12% - 34%）治愈，用QT使41例患者中的85%（95%置信区间：74% - 96%）治愈。所有再次治疗耐受性良好。