马斯特里赫特II治疗方案及不同质子泵抑制剂根除幽门螺杆菌的疗效
Maastricht II treatment scheme and efficacy of different proton pump inhibitors in eradicating Helicobacter pylori.
作者信息
Altintas Engin, Sezgin Orhan, Ulu Oguz, Aydin Ozlem, Camdeviren Handan
机构信息
Department of Gastroenterology, Mersin University, Faculty of Medicine, Turkey.
出版信息
World J Gastroenterol. 2004 Jun 1;10(11):1656-8. doi: 10.3748/wjg.v10.i11.1656.
AIM
The Maastricht II criteria suggest the use of amoxicillin and clarithromycin in addition to a proton pump inhibitor over 7-10 d as a first line therapy in the eradication of Helicobacter pylori (H pylori). For each proton pump inhibitor, various rates of eradication have been reported. The present study was to compare the efficacy of different proton pump inhibitors like omeprazole, lansoprazole and pantoprazole in combination with amoxicillin and clarithromycin in the first line eradication of H pylori and to investigate the success of H pylori eradication in our district.
METHODS
A total of 139 patients were included having a Helicobacter pylori (+) gastroduodenal disorders diagnosed by means of histology and urease test. Besides amoxicillin (1000 mg twice a day) and clarithromycin (500 mg twice a day), they were randomized to take omeprazole (20 mg twice a day), or lansoprazole (30 mg twice a day), or pantoprozole (40 mg twice a day) for 14 d. Four weeks after the therapy, the eradication was assessed by means of histology and urease test. It was evaluated as eradicated if the H pylori was found negative in both. The complaints (pain in epigastrium, nocturnal pain, pyrosis and bloating) were graded in accordance with the Licert scale. The compliance of the patients was recorded.
RESULTS
The eradication was found to be 40.8% in the omeprazole group, 43.5% in the lansoprazole group and 47.4% in the pantoprazole group. Sixty-three out of 139 patients (45%) had eradication. No statistically significant difference was observed between the groups. Significant improvements were seen in terms of the impact on the symptom scores in each group.
CONCLUSION
There was no difference between omeprazole, lansoprazole and pantoprazole in H pylori eradication, and the rate of eradication was as low as 45%. Symptoms were improved independent of the eradication in each treatment group. The low eradication rates suggest that the antibiotic resistance or the genetic differences of the microorganism might be in effect. Further studies are required to verify these suggestions.
目的
马斯特里赫特Ⅱ标准建议，在根除幽门螺杆菌（H pylori）的一线治疗中，除质子泵抑制剂外，还应使用阿莫西林和克拉霉素，疗程为7 - 10天。对于每种质子泵抑制剂，已报道了不同的根除率。本研究旨在比较奥美拉唑、兰索拉唑和泮托拉唑等不同质子泵抑制剂与阿莫西林和克拉霉素联合用于一线根除H pylori的疗效，并调查我区H pylori根除的成功率。
方法
共有139例经组织学和尿素酶试验诊断为幽门螺杆菌（+）的胃十二指肠疾病患者纳入研究。除阿莫西林（每日2次，每次1000 mg）和克拉霉素（每日2次，每次500 mg）外，将他们随机分为服用奥美拉唑（每日2次，每次20 mg）、兰索拉唑（每日2次，每次30 mg）或泮托拉唑（每日2次，每次40 mg），疗程为14天。治疗4周后，通过组织学和尿素酶试验评估根除情况。若两者均显示幽门螺杆菌为阴性，则评估为根除。根据利克特量表对症状（上腹部疼痛、夜间疼痛、烧心和腹胀）进行分级。记录患者的依从性。
结果
奥美拉唑组的根除率为40.8%，兰索拉唑组为43.5%，泮托拉唑组为47.4%。139例患者中有63例（45%）实现了根除。各治疗组之间未观察到统计学上的显著差异。每组在症状评分影响方面均有显著改善。
结论
奥美拉唑、兰索拉唑和泮托拉唑在根除幽门螺杆菌方面无差异，根除率低至45%。每个治疗组的症状改善均与根除情况无关。低根除率表明可能存在抗生素耐药性或微生物的基因差异。需要进一步研究以验证这些推测。
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