使用三联疗法治疗幽门螺杆菌一线根除率的变化——东京都市区的一项多中心研究（东京幽门螺杆菌研究组）

Changes in the first line Helicobacter pylori eradication rates using the triple therapy-a multicenter study in the Tokyo metropolitan area (Tokyo Helicobacter pylori study group).

作者信息

Kawai Takashi, Takahashi Shin'ichi, Suzuki Hidekazu, Sasaki Hitoshi, Nagahara Akihito, Asaoka Daisuke, Matsuhisa Takeshi, Masaoaka Tatsuhiro, Nishizawa Toshihiro, Suzuki Masayuki, Ito Masayoshi, Kurihara Naoto, Omata Fumio, Mizuno Shigeaki, Torii Akira, Kawakami Kohei, Ohkusa Toshifumi, Tokunaga Kengo, Mine Tetsuya, Sakaki Nobuhiro

机构信息

Endoscopy Center, Tokyo Medical University, Tokyo, Japan.

出版信息

J Gastroenterol Hepatol. 2014 Dec;29 Suppl 4:29-32. doi: 10.1111/jgh.12796.

DOI:10.1111/jgh.12796

PMID:25521730

Abstract

BACKGROUND AND AIM

Helicobacter pylori (H. pylori) infection is a strong risk factor for the development of gastric cancer. In 2013, the Japanese government approved H. pylori eradication therapy in patients with chronic gastritis as well as peptic ulcer. However, the continuing decline in eradication rates for first-line H. pylori eradication therapies is an urgent problem. In this study, we investigated changes in the first-line eradication rate from 2001 to 2010.

METHODS

Eradication rates for 7-day triple therapy [proton pump inhibitor (rabeprazole 20 mg, lansoprazole 60 mg, or omeprazole 40 mg)+amoxicillin 1500 mg + clarithromycin (CAM) 400 or 800 mg, daily] were collated from 14 hospitals in the Tokyo metropolitan area. The urea breath test was used for the evaluation of eradication. The cut-off value was less than 2.5%.

RESULTS

The yearly eradication rates (intention to treat/per protocol) were 78.5/79.5% (2001, n=242), 71.2%/72.9% (2002, n=208), 67.8%/70.5% (2003, n=183), 75.6%/84.6% (2004, n=131), 56.4%/70.5% (2005, n=114), 70.5%/75.8% (2006, n=271), 67.4%/82.0% (2007, n=135), 64.0%/76.3% (2008, n=261), 60.5%/74.3% (2009, n=329), and 66.5%/78.8% (2010, n=370), respectively. Examination of eradication rates according to CAM dosage revealed an eradication rate of 65.6% (383/584) for CAM 400 mg daily, and 68.5% (1124/1642) for CAM 800 mg daily, with no significant difference seen between dosages.

CONCLUSION

In recent years, eradication rates for first-line triple therapy have obviously decreased, but no noticeable decrease has occurred after 2001.

摘要

背景与目的

幽门螺杆菌（H. pylori）感染是胃癌发生的一个重要危险因素。2013年，日本政府批准了对慢性胃炎和消化性溃疡患者进行幽门螺杆菌根除治疗。然而，一线幽门螺杆菌根除治疗的根除率持续下降是一个亟待解决的问题。在本研究中，我们调查了2001年至2010年一线根除率的变化情况。

方法

整理了东京都市区14家医院7天三联疗法[质子泵抑制剂（雷贝拉唑20mg、兰索拉唑60mg或奥美拉唑40mg）+阿莫西林1500mg +克拉霉素（CAM）400或800mg，每日]的根除率。采用尿素呼气试验评估根除情况。临界值设定为低于2.5%。

结果

每年的根除率（意向性治疗/符合方案）分别为78.5%/79.5%（2001年，n = 242）、71.2%/72.9%（2002年，n = 208）、67.8%/70.5%（2003年，n = 183）、75.6%/84.6%（2004年，n = 131）、56.4%/70.5%（2005年，n = 114）、70.5%/75.8%（2006年，n = 271）、67.4%/82.0%（2007年，n = 135）、64.0%/76.3%（2008年，n = 261）、60.5%/74.3%（2009年，n = 329）和66.5%/78.8%（2010年，n = 370）。根据CAM剂量对根除率进行分析，结果显示每日服用400mg CAM的根除率为65.6%（383/584），每日服用800mg CAM的根除率为68.5%（1124/1642），不同剂量之间未见显著差异。