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一项关于含铋四联疗法联合荆花胃康治疗新诊断的感染伴消化不良患者的多中心随机对照研究

[A multicenter randomized controlled study of bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang in the treatment of patients newly diagnosed with infection and dyspepsia].

作者信息

Ma P P, Meng L N, Wang M T, Jin H F, Fan Y H, Zha A S, Huo X H, Chen D F, Cao Z Q, Tang X F, Yang P, Shi Z H, Li T W, Meng J, Gan C, Chen G X, Sha W H, Du Q, Li Y, Lyu B

机构信息

Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Key Laboratory for Pathophysiological Research on Digestive System Diseases of Zhejiang Province, Hangzhou 310060, China.

Department of Gastroenterology, Jilin People's Hospital, Jilin 132012, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2021 Jul 13;101(26):2060-2065. doi: 10.3760/cma.j.cn112137-20210305-00563.

DOI:10.3760/cma.j.cn112137-20210305-00563
PMID:34275239
Abstract

To investigate the () eradication rate and improvement of dyspepsia in patients who were newly diagnosed with infection and dyspepsia and treated by bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang(JHWK). Patients who were newly diagnosed with dyspepsia and infection and treated in 16 medical centers in China between December 1, 2017 and September 30, 2019 were randomly divided into two groups. The experimental group received bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days), followed by JHWK (30 days), and the course of treatment was 44 days in total. In the control group, the administration regimen was bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days). The main outcome measure was eradication rate, while the secondary outcome measures were dyspepsia symptom changes and adverse events during the treatment and the 1st month after treatment. A total of 1 054 patients were included in the study. There were 522 cases enrolled in the experimental group, including 224(42.91%) men and 298(57.09%) women, and the age was 53(26, 73) years old; 532 cases enrolled in the control group, including 221(41.54%) men and 311(58.46%) women, and the age was 46(22, 71) years old. Based on PP analysis, it was found that the eradication rate in the experimental group was significantly higher than those in the control group (93.85% vs 87.88%, =0.001). In the group of all enrolled patients, the symptom dyspepsia after eradication was significantly improved compared with that before treatment [4(4, 7) vs 15(10, 22), <0.001], so was the superior and middle abdominal pain [1(1, 4) vs 4(1, 8), <0.001], the postprandial fullness [1(1, 4) vs 4(4, 9), <0.001], the early satiety [1(1, 1) vs 4(1, 4), <0.001], and the heartburn [1(1, 1) vs 1(1, 4), <0.001]. The symptom dyspepsia after treatment was significantly improved compared with that before treatment in the experimental, the control groups, the successful and the unsuccessful eradication groups. The superior and middle abdominal pain after treatment was signifcantly improved than that before treatment [1(1, 2) vs 1(1, 4), <0.001], so were the postprandial fullness [1(1, 3) vs 1(1, 4), =0.002] and the dyspepsia[4(4, 7) VS 7(4, 10), <0.001]. There was no statistically significant difference in the incidence of adverse events between the experimental group and the control group (1.34% vs 0.38%, =0.09). Compared with bismuth-containing quadruple therapy, bismuth-containing quadruple therapy followed by JHWK significantly improves the eradication rate without increasing the incidence of adverse events. eradication therapy can improve symptoms of patients with infection and dyspepsia.

摘要

为探讨新诊断为幽门螺杆菌(Hp)感染并伴有消化不良的患者采用含铋四联疗法后序贯荆花胃康(JHWK)的Hp根除率及消化不良症状改善情况。选取2017年12月1日至2019年9月30日在中国16家医疗中心新诊断为消化不良且Hp感染并接受治疗的患者,随机分为两组。试验组接受含铋四联疗法(埃索美拉唑+阿莫西林+呋喃唑酮+胶体果胶铋胶囊,14天),随后服用JHWK(30天),总疗程共44天。对照组采用含铋四联疗法(埃索美拉唑+阿莫西林+呋喃唑酮+胶体果胶铋胶囊,14天)。主要观察指标为Hp根除率,次要观察指标为治疗期间及治疗后第1个月的消化不良症状变化和不良事件。本研究共纳入1054例患者。试验组522例,其中男性224例(42.91%),女性298例(57.09%),年龄为53(26,73)岁;对照组532例,其中男性221例(41.54%),女性311例(58.46%),年龄为46(22,71)岁。基于PP分析,发现试验组的Hp根除率显著高于对照组(93.85%对87.88%,P=0.001)。在所有纳入患者组中,Hp根除后消化不良症状较治疗前显著改善[4(4,7)对15(10,22),P<0.001],上中腹疼痛[1(1,4)对4(1,8),P<0.001]、餐后饱胀感[1(1,4)对4(4,9),P<0.001]、早饱[1(1,1)对4(1,4),P<0.001]及烧心[1(1,1)对1(1,4),P<0.001]症状亦如此。试验组、对照组、Hp根除成功组及根除失败组治疗后的消化不良症状较治疗前均显著改善。治疗后的上中腹疼痛较治疗前显著改善[1(1,2)对1(1,4),P<0.001],餐后饱胀感[1(1,3)对1(1,4),P=0.002]及消化不良[4(4,7)对7(4,10),P<0.001]症状亦如此。试验组与对照组不良事件发生率差异无统计学意义(1.34%对0.38%,P=0.09)。与含铋四联疗法相比,含铋四联疗法后序贯JHWK可显著提高Hp根除率,且不增加不良事件发生率。Hp根除治疗可改善Hp感染并伴有消化不良患者的症状。

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