为期十天的含左氧氟沙星联合治疗可有效根除2型糖尿病患者的幽门螺杆菌。
Ten days of levofloxacin-containing concomitant therapy can achieve effective Helicobacter pylori eradication in patients with type 2 diabetes.
作者信息
Yang Yao-Jong, Wu Chung-Tai, Ou Horng-Yih, Lin Chin-Han, Cheng Hsiu-Chi, Chang Wei-Lun, Chen Wei-Ying, Yang Hsiao-Bai, Lu Cheng-Chan, Sheu Bor-Shyang
机构信息
a Departments of Pediatrics , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.
b Institutes of Clinical Medicine, College of Medicine, National Cheng Kung University , Tainan , Taiwan.
出版信息
Ann Med. 2017 Sep;49(6):479-486. doi: 10.1080/07853890.2017.1294761. Epub 2017 Mar 7.
BACKGROUND
This study investigated whether levofloxacin-containing concomitant therapy can effectively eradicate Helicobacter pylori infection in patients with type 2 diabetes mellitus (T2DM).
METHODS
A total of 797 T2DM patients were screened for anti-H. pylori IgG antibodies, and the presence of H. pylori infection was confirmed by C-urea breath test. We prospectively randomized 114 of these patients to receive either 10 d of levofloxacin-concomitant therapy (n = 55) or sequential therapy (n = 59). Antimicrobial resistance of H. pylori isolates collected from the patients with T2DM (n = 109) and dyspeptic controls without DM (n = 110) was determined using the E-test. This study was approved by our Institutional Review Board (A-BR-103-021).
RESULTS
The H. pylori eradication rates with concomitant therapy were higher than sequential therapy in both intention-to-treat (96.4% versus 81.4%, p = 0.012) and per-protocol (100% versus 85.4%, p = 0.006) analysis. The adverse effects in both groups were similarly mild. In the patients who received sequential therapy, clarithromycin resistance was significantly associated with eradication failure (p = 0.02). There were no significant differences in the antibiotic-resistant rates to amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin between the patients with and without T2DM.
CONCLUSIONS
Ten days of levofloxacin-containing concomitant therapy is an effective and well-tolerated treatment to eradicate H. pylori infection for T2DM patients. Key messages Ten days of levofloxacin-containing concomitant therapy is well tolerated and superior to clarithromycin-containing sequential therapy for first-line H. pylori eradication in patients with type 2 diabetes. Clarithromycin resistance to H. pylori is the main factor associated with eradication failure in clarithromycin-containing sequential therapy in diabetic patients.
背景
本研究调查含左氧氟沙星的联合疗法能否有效根除2型糖尿病（T2DM）患者的幽门螺杆菌感染。
方法
共筛选了797例T2DM患者的抗幽门螺杆菌IgG抗体，并通过C-尿素呼气试验确认幽门螺杆菌感染情况。我们前瞻性地将其中114例患者随机分为两组，分别接受为期10天的左氧氟沙星联合疗法（n = 55）或序贯疗法（n = 59）。采用E-test法测定从T2DM患者（n = 109）和无糖尿病的消化不良对照者（n = 110）中分离出的幽门螺杆菌菌株的耐药性。本研究经我们机构审查委员会批准（A-BR-103-021）。
结果
在意向性分析（96.4%对81.4%，p = 0.012）和符合方案分析（100%对85.4%，p = 0.006）中，联合疗法的幽门螺杆菌根除率均高于序贯疗法。两组的不良反应均同样轻微。在接受序贯疗法的患者中，克拉霉素耐药与根除失败显著相关（p = 0.02）。T2DM患者与非T2DM患者之间对阿莫西林、克拉霉素、甲硝唑、四环素和左氧氟沙星的抗生素耐药率无显著差异。
结论
为期10天的含左氧氟沙星联合疗法是根除T2DM患者幽门螺杆菌感染的一种有效且耐受性良好的治疗方法。关键信息：为期10天的含左氧氟沙星联合疗法耐受性良好，在根除2型糖尿病患者的一线幽门螺杆菌感染方面优于含克拉霉素的序贯疗法。幽门螺杆菌对克拉霉素耐药是糖尿病患者含克拉霉素序贯疗法中根除失败的主要相关因素。
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