Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, 42123 Reggio Emilia, Italy.
World J Gastroenterol. 2012 Sep 7;18(33):4542-8. doi: 10.3748/wjg.v18.i33.4542.
To determine the efficacy of our therapeutic strategy for Helicobacter pylori (H. pylori) eradication and to identify predictive factors for successful eradication.
From April 2006 to June 2010, we retrospectively assessed 2428 consecutive patients (1025 men, 1403 women; mean age 55 years, age range 18-92 years) with gastric histology positive for H. pylori infection referred to our unit for 13-C urea breath test (UBT), after first-line therapy with proton pump inhibitor (PPI) b.i.d. + amoxicillin 1 g b.i.d. + clarithromycin 500 mg b.i.d. for 7 d. Patients who were still positive to UBT were recommended a second-line therapy (PPI b.i.d. + amoxicillin 1 g b.i.d. + tinidazole 500 mg b.i.d. for 14 d). Third choice treatment was empirical with PPI b.i.d. + amoxicillin 1 g b.i.d. + levofloxacin 250 mg b.i.d. for 14 d.
Out of 614 patients, still H. pylori-positive after first-line therapy, only 326 and 19 patients respectively rechecked their H. pylori status by UBT after the suggested second and third-line regimens. "Per protocol" eradication rates for first, second and third-line therapy were 74.7% (95% CI: 72.7%-76.4%), 85.3% (95% CI: 81.1%-89.1%) and 89.5% (95% CI: 74.9%-103%) respectively. The overall percentage of patients with H. pylori eradicated after two treatments was 97.8% (95% CI: 97.1%-98.4%), vs 99.9% (95% CI: 99.8%-100%) after three treatments. The study found that eradication therapy was most effective in patients with ulcer disease (P < 0.05, P = 0.028), especially in those with duodenal ulcer. Smoking habits did not significantly affect the eradication rate.
First-line therapy with amoxicillin and clarithromycin produces an H. pylori eradication rate comparable or superior to other studies and second-line treatment can still be triple therapy with amoxicillin and tinidazole.
确定我们治疗幽门螺杆菌（H. pylori）根除的疗效，并确定成功根除的预测因素。
从 2006 年 4 月至 2010 年 6 月，我们回顾性评估了 2428 例连续患者（1025 例男性，1403 例女性；平均年龄 55 岁，年龄范围 18-92 岁），这些患者的胃组织学检查显示 H. pylori 感染阳性，他们被转介到我们的单位进行 13-C 尿素呼气试验（UBT），此前他们接受了质子泵抑制剂（PPI）b.i.d. +阿莫西林 1 g b.i.d. +克拉霉素 500 mg b.i.d. 为期 7 天的一线治疗。仍对 UBT 呈阳性的患者被建议进行二线治疗（PPI b.i.d. +阿莫西林 1 g b.i.d. +替硝唑 500 mg b.i.d. 为期 14 天）。三线治疗是经验性的，使用 PPI b.i.d. +阿莫西林 1 g b.i.d. +左氧氟沙星 250 mg b.i.d. 为期 14 天。
在接受一线治疗后仍为 H. pylori 阳性的 614 例患者中，仅有 326 例和 19 例患者分别在建议的二线和三线方案后再次通过 UBT 复查其 H. pylori 状态。一线、二线和三线治疗的“按方案”根除率分别为 74.7%（95%CI：72.7%-76.4%）、85.3%（95%CI：81.1%-89.1%）和 89.5%（95%CI：74.9%-103%）。两次治疗后 H. pylori 根除的患者总体百分比为 97.8%（95%CI：97.1%-98.4%），三次治疗后为 99.9%（95%CI：99.8%-100%）。研究发现，根除治疗在溃疡病患者中最有效（P<0.05，P=0.028），尤其是十二指肠溃疡患者。吸烟习惯并不显著影响根除率。
阿莫西林和克拉霉素的一线治疗产生的 H. pylori 根除率与其他研究相当或更高，二线治疗仍然可以是阿莫西林和替硝唑的三联疗法。
