Vafaeimanesh Jamshid, Rajabzadeh Rabeah, Ahmadi Anahita, Moshtaghi Mounes, Banikarim Seyedamir, Hajiebrahimi Shahin, Seyyedmajidi Mohammadreza
Department of Internal Medicine, Qom University of Medical Sciences, Qom, Iran.
Arab J Gastroenterol. 2013 Jun;14(2):55-8. doi: 10.1016/j.ajg.2013.03.002. Epub 2013 Apr 25.
The eradication rate of Helicobacter pylori (H. pylori) has been reported as being lower in patients with type 2 diabetes mellitus (DM) than in those without DM. The aim of the study was to assess the efficacy of the two H. pylori eradication regimens in patients without and with type 2 DM and to study the effect of H. pylori treatment on glycaemia control.
A total of 93 consecutive type 2 DM (non-insulin users) and 98 non-diabetic age- and sex-matched patients were enrolled. Patients were randomly assigned to one of the two treatment protocols all given twice daily: (a) a 14-day quadruple therapy comprising of omeprazole 20mg, metronidazole 500mg, amoxicillin 1g and bismuth subcitrate 240mg (OMAB) and (b) a 14-day triple regimen comprising of omeprazole 20mg plus clarithromycin 500mg and amoxicillin 1g (OCA). Cure was defined as a negative (13)C-urea breath test at least 6weeks after treatment.
The H. pylori eradication rate with the OCA regimen was 63% in patients with type 2 DM (non-insulin users) and 87.7% in the control group (p=0.017). The H. pylori eradication rate with the OMAB regimen was 38.2% in patients with type 2 DM and 55.1% in the control group (p<0.001). Mean decrease of fasting plasma glucose and HbA1c level shows no statistically significant difference after H. pylori eradication.
This study suggests that the eradication rate of H. pylori with OCA or OMAB treatment is lower in patients with type 2 diabetes than in non-diabetics and H. pylori treatment in patients with type 2 DM has no role in the control of the glycaemia. The triple therapy (OCA) is superior to the quadruple protocol (OMAB) in H. pylori eradication of both DM and non-DM cases.
据报道，2型糖尿病（DM）患者中幽门螺杆菌（H. pylori）的根除率低于非糖尿病患者。本研究的目的是评估两种幽门螺杆菌根除方案在2型糖尿病患者和非2型糖尿病患者中的疗效，并研究幽门螺杆菌治疗对血糖控制的影响。
连续纳入93例2型糖尿病患者（非胰岛素使用者）和98例年龄及性别匹配的非糖尿病患者。患者被随机分配至两种治疗方案之一，均为每日两次给药：（a）14天四联疗法，包括奥美拉唑20mg、甲硝唑500mg、阿莫西林1g和枸橼酸铋钾240mg（OMAB）；（b）14天三联疗法，包括奥美拉唑20mg加克拉霉素500mg和阿莫西林1g（OCA）。治愈定义为治疗后至少6周（13）C-尿素呼气试验阴性。
2型糖尿病（非胰岛素使用者）患者中，OCA方案的幽门螺杆菌根除率为63%，对照组为87.7%（p = 0.017）。2型糖尿病患者中，OMAB方案的幽门螺杆菌根除率为38.2%，对照组为55.1%（p < 0.001）。根除幽门螺杆菌后，空腹血糖和糖化血红蛋白水平的平均下降无统计学显著差异。
本研究表明，2型糖尿病患者使用OCA或OMAB治疗幽门螺杆菌的根除率低于非糖尿病患者；2型糖尿病患者的幽门螺杆菌治疗对血糖控制无作用。三联疗法（OCA）在根除糖尿病和非糖尿病患者的幽门螺杆菌方面优于四联疗法（OMAB）。
