Department of Gastroenterology, Kocaeli Derince Research and Education Hospital, Kocaeli, Turkey.
J Clin Pharm Ther. 2012 Jun;37(3):282-5. doi: 10.1111/j.1365-2710.2011.01286.x. Epub 2011 Jul 11.
Helicobacter pylori eradication rates of currently accepted triple therapy regimens vary between geographic locations and do not exceed 70-80%. Eradication rates are much lower in locations where uncontrolled antibiotic use is common such as Turkey. In the present study, we aimed to test whether supplementing vitamins C and E to standard triple therapy, including a proton pump inhibitor plus amoxicillin plus clarithromycin, increased the H. pylori eradication rate.
Two hundred patients infected with H. pylori were randomized into two groups in an open-label trial. In group A, patients (n = 160) were given standard triple therapy, including lansoprazole 30 mg BID plus amoxicillin 1000 mg BID plus clarithromycin 500 mg BID for 14 days, plus vitamin C 500 mg BID plus vitamin E 200 IU BID for 30 days. In group B, patients (n = 40) were given standard triple therapy for 14 days. The success of H. pylori eradication was defined as a negative ¹⁴C-urea breath test result, 4-6 weeks after the completion of therapy. Comaprisons were by both intention-to-treat (ITT) and per-protocol (PP) analysis.
Two hundred patients (137 women, 63 men) were analysed using ITT analysis and 195 patients completed the study. In group A, H. pylori eradication was achieved in 132 of the 160 patients (82·5%) included in ITT analysis and 132 of the 157 patients (84%) included in PP analysis. In group B, H. pylori eradication was achieved in 18 of the 40 patients (45%) included in ITT analysis and 18 of the 38 patients (47·4%) included in PP analysis. Eradication rates were significantly higher in group A than in group B (P < 0·005). Eradication rates were not statistically significant between men and women in both groups.
Adding vitamins C and E to standard triple therapy increases the eradication rate of H. pylori. Vitamins C and E may increase the eradication rate via increasing the effectiveness of the antibiotics by decreasing oxidative stress in the gastric mucosa and strengthening the immune system.
目前被接受的三联疗法根除率在地理位置之间有所不同，不超过 70-80%。在抗生素使用不受控制的地区，如土耳其，根除率要低得多。在本研究中，我们旨在测试补充维生素 C 和 E 是否会增加标准三联疗法（包括质子泵抑制剂加阿莫西林加克拉霉素）对幽门螺杆菌的根除率。
200 例幽门螺杆菌感染患者进行开放性试验，随机分为两组。在 A 组中，患者（n=160）接受标准三联疗法，包括兰索拉唑 30 mg BID 加阿莫西林 1000 mg BID 加克拉霉素 500 mg BID 连用 14 天，加维生素 C 500 mg BID 加维生素 E 200 IU BID 连用 30 天。在 B 组中，患者（n=40）接受标准三联疗法 14 天。幽门螺杆菌根除的成功定义为治疗结束后 4-6 周¹⁴C-尿素呼气试验结果阴性。通过意向治疗（ITT）和方案（PP）分析进行比较。
用 ITT 分析对 200 例患者（137 例女性，63 例男性）进行了分析，195 例患者完成了研究。在 A 组中，ITT 分析中 160 例患者中的 132 例（82.5%）和 PP 分析中 157 例患者中的 132 例（84%）根除了幽门螺杆菌。在 B 组中，ITT 分析中 40 例患者中的 18 例（45%）和 PP 分析中 38 例患者中的 18 例（47.4%）根除了幽门螺杆菌。A 组的根除率明显高于 B 组（P < 0.005）。两组中男性和女性的根除率无统计学差异。
在标准三联疗法中添加维生素 C 和 E 可提高幽门螺杆菌的根除率。维生素 C 和 E 通过减少胃黏膜的氧化应激和增强免疫系统来增加抗生素的有效性，从而提高根除率。
