Jang Kyeong Ah, Maeng Keun Young, Lee Dong Seok, Lee Han Hee, Cheung Dae Young, Kim Tae Ho
Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Helicobacter Up Gastrointest Res. 2025 Sep;25(3):261-267. doi: 10.7704/kjhugr.2025.0022. Epub 2025 Sep 1.
For patients with clarithromycin-resistant Helicobacter pylori infection, a 2-week bismuth quadruple therapy (2W-PBMT) is typically recommended. However, a recent Korean guideline suggests a 1-week metronidazole-based regimen (PMA) as an alternative. This study aimed to evaluate whether a 1-week PMA plus bismuth (1W-PBMA) could achieve comparable efficacy to the conventional 2W-PBMT.
This study retrospectively analyzed medical records from two academic hospitals and employed propensity score matching (PSM) to minimize confounding variables.
A total of 121 patients with confirmed H. pylori infection and clarithromycin resistance-related genetic mutations were identified via polymerase chain reaction. After excluding six patients with the A2142G mutation, 115 patients with the A2143G mutation were enrolled. Among them, 82 patients who received an eradication regimen were included in the final analysis. Fifty-one patients received the conventional 2W-PBMT, while 31 received the 1W-PBMA regimen. PSM resulted in 25 matched cases in each group. Before PSM, eradication rates were 70.6% (2W-PBMT) vs. 77.4% (1W-PBMA) in the intention-to-treat (ITT) analysis and 94.7% vs. 85.7% in the per-protocol (PP) analysis, with no significant differences. After PSM, ITT eradication rates were 68.0% (2W-PBMT) vs. 80.0% (1W-PBMA), while PP eradication rates were 94.4% vs. 87.0%, again showing no statistical significance. Medication adherence exceeded 85% in both groups, with comparable incidences of adverse events. However, the 2W-PBMT group had a slightly higher discontinuation rate due to intolerable side effects.
In patients with H. pylori infection harboring the A2143G point mutation, the 1W-PBMA regimen demonstrated comparable eradication efficacy to the 2W-PBMT regimen, with potentially fewer intolerable adverse effects and improved adherence.
对于克拉霉素耐药的幽门螺杆菌感染患者，通常推荐采用为期2周的铋剂四联疗法（2W-PBMT）。然而，韩国最近的一项指南建议采用为期1周的基于甲硝唑的方案（PMA）作为替代方案。本研究旨在评估为期1周的PMA加铋剂方案（1W-PBMA）是否能达到与传统2W-PBMT相当的疗效。
本研究回顾性分析了两家学术医院的病历，并采用倾向评分匹配（PSM）来尽量减少混杂变量。
通过聚合酶链反应共鉴定出121例确诊幽门螺杆菌感染且有克拉霉素耐药相关基因突变的患者。排除6例A2142G突变患者后，纳入115例A2143G突变患者。其中，82例接受根除方案的患者纳入最终分析。51例患者接受传统2W-PBMT，31例接受1W-PBMA方案。PSM后每组有25例匹配病例。PSM前，意向性分析（ITT）中的根除率分别为70.6%（2W-PBMT）和77.4%（1W-PBMA），符合方案分析（PP）中的根除率分别为94.7%和85.7%，无显著差异。PSM后，ITT根除率分别为68.0%（2W-PBMT）和80.0%（1W-PBMA），PP根除率分别为94.4%和87.0%，同样无统计学意义。两组的药物依从性均超过85%，不良事件发生率相当。然而，2W-PBMT组因无法耐受的副作用导致的停药率略高。
在携带A2143G点突变的幽门螺杆菌感染患者中，1W-PBMA方案显示出与2W-PBMT方案相当的根除疗效，可能具有更少无法耐受的不良反应和更好的依从性。
