Higuchi K, Fujiwara Y, Tominaga K, Watanabe T, Shiba M, Nakamura S, Oshitani N, Matsumoto T, Arakawa T
Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
Aliment Pharmacol Ther. 2003 Jan;17(1):111-7. doi: 10.1046/j.1365-2036.2003.01402.x.
In Helicobacter pylori infection, the effect of short-term triple therapy with proton pump inhibitor plus two antibiotics on gastric ulcer healing is not well known.
To compare 1-week triple therapy with 8-week proton pump inhibitor therapy on gastric ulcer healing in infected patients.
We randomly assigned 120 patients with H. pylori and gastric ulcers to proton pump inhibitor plus amoxicillin and clarithromycin for 1 week (n = 61) or proton pump inhibitor alone for 8 weeks (n = 59), with endoscopic assessment of ulcer healing 8 weeks after the start of treatment.
Triple therapy eradicated H. pylori in 51 patients [intention-to-treat, 84%; 95% confidence interval (CI), 75-93%]. At 8 weeks, gastric ulcers were healed in 30 patients given triple therapy (49%; 95% CI, 37-62%) and in 49 patients given proton pump inhibitor (83%; 95% CI, 73-93%, P < 0.001). Healing rates in the triple therapy and proton pump inhibitor-only groups were 89% and 100%, respectively, for ulcers of < 1.0 cm in diameter, 54% and 77% for ulcers of 1.0 to < 1.5 cm in diameter, and 5% and 77% (P < 0.001) for ulcers of > or = 1.5 cm in diameter.
One-week triple therapy healed most ulcers of < 1.0 cm, but not ulcers of > or = 1.5 cm. Short-term therapy is effective for gastric ulcers of < 1.0 cm, but, for larger ulcers, follow-up therapy to suppress acid is needed.
在幽门螺杆菌感染中，质子泵抑制剂加两种抗生素的短期三联疗法对胃溃疡愈合的影响尚不清楚。
比较1周三联疗法与8周质子泵抑制剂疗法对感染患者胃溃疡愈合的效果。
我们将120例幽门螺杆菌感染且患有胃溃疡的患者随机分为两组，一组接受质子泵抑制剂加阿莫西林和克拉霉素治疗1周（n = 61），另一组仅接受质子泵抑制剂治疗8周（n = 59），在治疗开始8周后进行内镜评估溃疡愈合情况。
三联疗法使51例患者的幽门螺杆菌根除（意向性治疗分析，84%；95%置信区间[CI]，75 - 93%）。8周时，接受三联疗法的30例患者胃溃疡愈合（49%；95%CI，37 - 62%），接受质子泵抑制剂治疗的49例患者胃溃疡愈合（83%；95%CI，73 - 93%，P < 0.001）。对于直径<1.0 cm的溃疡，三联疗法组和仅用质子泵抑制剂组的愈合率分别为89%和100%；对于直径1.0至<1.5 cm的溃疡，愈合率分别为54%和77%；对于直径≥1.5 cm的溃疡，愈合率分别为5%和77%（P < 0.001）。
1周三联疗法可使大多数直径<1.0 cm的溃疡愈合，但不能使直径≥1.5 cm的溃疡愈合。短期疗法对直径<1.0 cm的胃溃疡有效，但对于较大的溃疡，需要后续的抑酸治疗。
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