Bianchi Porro G, Parente F, Lazzaroni M
Gastrointestinal Unit, L Sacco Hospital, Milan, Italy.
Gut. 1987 Jul;28(7):907-11. doi: 10.1136/gut.28.7.907.
The use of tripotassium dicitrato bismuthate (TDB) has been suggested recently for cimetidine resistant duodenal ulcers. This study compares the efficacy of TDB with two different cimetidine dosages in the treatment of duodenal ulcer patients who failed to respond to an eight week therapy with H2-blockers. Fifty two patients (40 men, 12 women) were randomly allocated to one of the following three oral regimens: (1) TDB 120 mg quid, (2) cimetidine 400 mg tid, (3) cimetidine 400 mg with meals plus 800 mg at bedtime. Endoscopy was carried out after four weeks; if the ulcer had not healed patients continued with the same treatment for a further four week period when they were endoscopically reassessed. After four weeks similar percentages of ulcer healing were registered in the two cimetidine schedules (39% with 1.2 g and 44% with 2 g), whereas TDB resulted in a significantly higher healing rate (82%) compared with cimetidine 1.2 g (p = 0.01) and with cimetidine 2 g (p = 0.025). After eight weeks the cumulative percentages of healing were 65% on cimetidine 1.2 g, 75% on cimetidine 2 g, and 94% on TDB (TDB v cimetidine 1.2 p = 0.042). These results confirm previous data that resistant duodenal ulcers are more responsive to an agent which strengthens the mucosal defences than to antisecretory compounds.
最近有人建议使用三钾二枸橼酸铋（TDB）治疗对西咪替丁耐药的十二指肠溃疡。本研究比较了TDB与两种不同剂量西咪替丁在治疗对H2受体阻滞剂进行8周治疗无反应的十二指肠溃疡患者中的疗效。52例患者（40例男性，12例女性）被随机分配至以下三种口服治疗方案之一：（1）TDB 120mg，每日4次；（2）西咪替丁400mg，每日3次；（3）西咪替丁400mg随餐服用加睡前800mg。4周后进行内镜检查；如果溃疡未愈合，患者继续相同治疗4周，之后再次进行内镜评估。4周后，两种西咪替丁治疗方案的溃疡愈合百分比相似（1.2g组为39%，2g组为44%），而与1.2g西咪替丁（p = 0.01）和2g西咪替丁（p = 0.025）相比，TDB的愈合率显著更高（82%）。8周后，1.2g西咪替丁组的累积愈合百分比为65%，2g西咪替丁组为75%，TDB组为94%（TDB与1.2g西咪替丁相比，p = 0.042）。这些结果证实了先前的数据表明，耐药十二指肠溃疡对增强黏膜防御的药物比对抗分泌化合物更敏感。
