Gisbert J P, Boixeda D, de Rafael L, Redondo C, Martín de Argila C, Bermejo F
Servicio de Gastroenterología, Hospital Ramón y Cajal, Madrid.
Rev Esp Enferm Dig. 1996 May;88(5):317-22.
To study different factors influencing the success of classic triple therapy in Helicobacter pylori eradication.
Fifty-seven duodenal ulcer patients infected with H. pylori were prospectively studied. At endoscopy biopsy specimens were taken from the gastric antrum and body (H & E, Gram stain, and culture). Classic triple therapy was administered (bismuth, tetracyclin, metronidazole). Patients were investigated endoscopically one month after completing therapy, and repeated biopsy specimens from the antrum and body were also obtained.
H. pylori eradication was achieved in 42 patients (74%). In multiple logistic regression analysis metronidazole susceptibility (regr. coef. = 3.4; OR = 29.3) and previous therapy with omeprazol plus amoxycillin (regr. coef. = -1.7; OR = 0.18) were the only variables which correlated with success in H. pylori eradication (chi 2 model = 21; p < 0.001). Additional variables (age, sex, smoking, histologic lesion and ulcer history) were no correlated with H. pylori infection. H. pylori was susceptible to metronidazole in 36 patients (79%). Eradication rates for metronidazole-susceptible and metronidazole-resistant H. pylori isolates were 87% and 25%, respectively (p < 0.001). When previous therapy with omeprazole plus amoxycillin had been administered the eradication rate was lower (61%) than in patients without previous therapy (82%).
Success of classic triple therapy in H. pylori eradication is higher when the organism is metronidazole-susceptible, and lower when previous therapy with omeprazole plus amoxycillin has been administered. This factor, although not fully elucidated, lends no support to choosing triple therapy when eradicating therapy with omeprazole plus amoxycillin fails.
研究影响经典三联疗法根除幽门螺杆菌成功率的不同因素。
对57例感染幽门螺杆菌的十二指肠溃疡患者进行前瞻性研究。在内镜检查时从胃窦和胃体取活检标本（苏木精-伊红染色、革兰氏染色和培养）。给予经典三联疗法（铋剂、四环素、甲硝唑）。患者在完成治疗1个月后接受内镜检查，并再次从胃窦和胃体获取活检标本。
42例患者（74%）实现了幽门螺杆菌根除。在多因素逻辑回归分析中，甲硝唑敏感性（回归系数=3.4；比值比=29.3）和既往使用奥美拉唑加阿莫西林治疗（回归系数=-1.7；比值比=0.18）是与幽门螺杆菌根除成功相关的仅有的变量（卡方模型=21；p<0.001）。其他变量（年龄、性别、吸烟、组织学病变和溃疡病史）与幽门螺杆菌感染无关。36例患者（79%）的幽门螺杆菌对甲硝唑敏感。甲硝唑敏感和耐药的幽门螺杆菌菌株的根除率分别为87%和25%（p<0.001）。既往使用奥美拉唑加阿莫西林治疗时，根除率（61%）低于未接受过既往治疗的患者（82%）。
当幽门螺杆菌对甲硝唑敏感时，经典三联疗法根除幽门螺杆菌的成功率较高；而当既往使用过奥美拉唑加阿莫西林治疗时，成功率较低。尽管这一因素尚未完全阐明，但在奥美拉唑加阿莫西林根除治疗失败时选择三联疗法并无依据。
