Broutet N, Tchamgoué S, Pereira E, Lamouliatte H, Salamon R, Mégraud F
Unité d'Epidémiologie des Maladies Digestives, Laboratoire de Bactériologie, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France.
Aliment Pharmacol Ther. 2003 Jan;17(1):99-109. doi: 10.1046/j.1365-2036.2003.01396.x.
To study risk factors for failure of Helicobacter pylori eradication treatment.
Individual data from 2751 patients included in 11 multicentre clinical trials carried out in France and using a triple therapy, were gathered in a unique database. The 27 treatment regimens were regrouped into four categories.
The global failure rate was 25.8% [95% CI: 24-27]. There was a difference in failure rate between duodenal ulcer patients and non-ulcer dyspeptic patients, 21.9% and 33.7%, respectively (P < 10(-6)). In a random-effect model, the risk factors identified for eradication failure in duodenal ulcer patients (n = 1400) were: to be a smoker, and to have received the group 4 treatment, while to receive a 10 day treatment vs. 7 days protected from failure. In non-ulcer dyspeptic patients (n = 913), the group 2 treatment was associated with failure. In both groups, age over 60 was associated with successful H. pylori eradication. There were less strains resistant to clarithromycin in duodenal ulcer patients than in non-ulcer dyspeptic patients. Clarithromycin resistance predicted failure almost perfectly.
Duodenal ulcer and non-ulcer dyspeptic patients should be managed differently in medical practice and considered independently in eradication trials.
研究幽门螺杆菌根除治疗失败的危险因素。
收集了在法国进行的11项多中心临床试验中纳入的2751例患者的个体数据，这些试验采用三联疗法，并将数据汇总到一个独特的数据库中。27种治疗方案被重新分为四类。
总体失败率为25.8%[95%可信区间：24 - 27]。十二指肠溃疡患者和非溃疡性消化不良患者的失败率存在差异，分别为21.9%和33.7%（P < 10⁻⁶）。在随机效应模型中，十二指肠溃疡患者（n = 1400）根除失败的危险因素为：吸烟，接受第4组治疗，而接受10天治疗比7天治疗更能预防失败。在非溃疡性消化不良患者（n = 913）中，第2组治疗与失败相关。在两组中，60岁以上与幽门螺杆菌根除成功相关。十二指肠溃疡患者中对克拉霉素耐药的菌株比非溃疡性消化不良患者少。克拉霉素耐药几乎可以完美预测失败。
在医疗实践中，十二指肠溃疡患者和非溃疡性消化不良患者应区别对待，在根除试验中应分别考虑。
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