Chen Ming-Cheh, Lei Wei-Yi, Lin Jen-Shung, Yi Chih-Hsun, Wu Deng-Chyang, Hu Chi-Tan
Division of Hepatology and Gastroenterology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Lo-Hsu Foundation, No. 83, Nanchang Street, Luodong, Yilan 265, Taiwan.
Division of Gastroenterology, Department of Internal Medicine, Hualien Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, No. 707, Section 3, ChungYang Road, Hualien 970, Taiwan ; Research Center of Hepatology, Hualien Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, No. 707, Section 3, ChungYang Road, Hualien 970, Taiwan.
Biomed Res Int. 2014;2014:158520. doi: 10.1155/2014/158520. Epub 2014 Jun 5.
The resistance rates of Helicobacter pylori to amoxicillin and metronidazole therapy are higher in eastern Taiwan as compared to national and worldwide rates. The high resistance rate in this territory justified a search for a better eradication regimen. We conducted an open-labeled, prospective, randomized, and controlled study in a tertiary referral hospital in eastern Taiwan. Between December 2007 and December 2009, a total of 153 Helicobacter pylori-positive, therapy-naïve patients with a positive rapid urease test were recruited for random assignment to two seven-day treatment groups: levofloxacin (500 mg), amoxicillin/clavulanate (875 mg/125 mg), and rabeprazole (20 mg) twice per day (LAcR) or clarithyromicin (500 mg), amoxicillin (1000 mg), and rabeprazole (20 mg) twice per day (CAR). Helicobacter pylori eradication was assessed using the (13)C-urea breath test or rapid urease test performed at least 4 weeks after the end of treatment. After exclusion, 146 patients were enrolled and allocated in the study. The Helicobacter pylori eradication rates analyzed by both intention to treat (78.1% versus 57.5%, P = 0.008) and perprotocol (80.9% versus 61.8%, P = 0.014) were significantly higher for the LAcR group. In conclusion, the seven-day LAcR regimen provided improved Helicobacter pylori eradication efficacy when compared with the standard CAR triple therapy in eastern Taiwan.
与全国及全球水平相比，台湾东部幽门螺杆菌对阿莫西林和甲硝唑治疗的耐药率更高。该地区的高耐药率使得人们有必要寻找更好的根除方案。我们在台湾东部的一家三级转诊医院进行了一项开放标签、前瞻性、随机对照研究。2007年12月至2009年12月期间，共招募了153例幽门螺杆菌阳性、初次接受治疗且快速尿素酶试验呈阳性的患者，随机分配至两个为期7天的治疗组：左氧氟沙星（500毫克）、阿莫西林/克拉维酸（875毫克/125毫克）和雷贝拉唑（20毫克），每日2次（LAcR），或克拉霉素（500毫克）、阿莫西林（1000毫克）和雷贝拉唑（20毫克），每日2次（CAR）。在治疗结束至少4周后，采用（13）C-尿素呼气试验或快速尿素酶试验评估幽门螺杆菌根除情况。排除部分患者后，146例患者被纳入研究。按意向性分析（78.1%对57.5%，P = 0.008）和符合方案分析（80.9%对61.8%，P = 0.014），LAcR组的幽门螺杆菌根除率均显著更高。总之，与标准的CAR三联疗法相比，为期7天的LAcR方案在台湾东部提高了幽门螺杆菌的根除疗效。
