Pilotto A, Di Mario F, Franceschi M, Leandro G, Soffiati G, Scagnelli M, Bozzola L, Valerio G
Department of Geriatrics, S. Bortolo Hospital, Vicenza, Italy.
Aliment Pharmacol Ther. 1996 Dec;10(6):1021-7. doi: 10.1046/j.1365-2036.1996.88260000.x.
Specific data on anti-H. pylori treatments in elderly people are very scarce. The aim of the study was to evaluate in the elderly the efficacy of different anti-H. pylori therapies and the behaviour of serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio induced by the anti-H. pylori treatment.
One hundred and twenty-one dyspeptic patients aged > 60 years (mean age, 73 years; range, 61-89 years) with H. pylori-positive gastric ulcers (17 patients), duodenal ulcers (33 patients) or chronic gastritis (71 patients) were treated with one of the following anti-H. pylori treatments: (A) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days; (B) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 mg q.d.s. for 7 days; (C) omeprazole 40 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 q.d.s. for 7 days; (D) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days; (E) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days plus metronidazole 250 q.d.s. for 7 days; and (F) omeprazole 40 mg/day plus clarithromycin 250 mg b.d. for 7 days plus metronidazole 250 mg q.d.s. for 7 days. At the baseline and 2 months after therapy, endoscopy and serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio were measured.
Ten patients (8.2%) dropped out of the study. Six patients (4.9%) reported side-effects. The eradication rates of the six regimens, expressed using intention-to-treat and per protocol analysis, were, respectively: (A) 39% and 44%; (B) 50% and 56%; (C) 65% and 77%; (D) 47% and 50%; (E) 85% and 90%; and (F) 83% and 87%. The triple therapy for regimens E and F was significantly more effective than dual therapies (regimens A and D; intention-to-treat = P < 0.007, per protocol = P < 0.001) or the triple therapy for regimens B and C (intention-to-treat = P < 0.009, per protocol = P < 0.03). Patients cured of H. pylori infection showed a significant decrease in the activity of gastritis (P < 0.0001), a significant drop in IgG anti-H. pylori (P = 0.0004) and pepsinogen C (P < 0.0001), and an increase in PGA/PGC ratio (P < 0.001), while patients remaining H. pylori-positive showed no changes in the serum parameters.
In the elderly, triple therapy with omeprazole+metronidazole+clarithromycin for 1 week is well tolerated and highly effective; anti-H. pylori antibody and PGC serum levels decrease soon after anti-H. pylori therapy only in patients cured of H. pylori infection.
关于老年人抗幽门螺杆菌治疗的具体数据非常稀少。本研究的目的是评估不同抗幽门螺杆菌疗法在老年人中的疗效，以及抗幽门螺杆菌治疗诱导的血清抗幽门螺杆菌抗体、胃蛋白酶原A和C以及PGA/PGC比值的变化情况。
121例年龄>60岁（平均年龄73岁；范围61 - 89岁）的消化不良患者，其中患有幽门螺杆菌阳性胃溃疡的有17例，十二指肠溃疡的有33例，慢性胃炎的有71例，接受了以下抗幽门螺杆菌治疗方案中的一种：（A）奥美拉唑20毫克/天加阿奇霉素500毫克/天，共3天；（B）奥美拉唑20毫克/天加阿奇霉素500毫克/天，共3天，再加甲硝唑250毫克，每日4次，共7天；（C）奥美拉唑40毫克/天加阿奇霉素500毫克/天，共3天，再加甲硝唑250毫克，每日4次，共7天；（D）奥美拉唑20毫克/天加克拉霉素250毫克，每日2次，共7天；（E）奥美拉唑20毫克/天加克拉霉素250毫克，每日2次，共7天，再加甲硝唑250毫克，每日4次，共7天；（F）奥美拉唑40毫克/天加克拉霉素250毫克，每日2次，共7天，再加甲硝唑250毫克，每日4次，共7天。在基线和治疗后2个月时，进行了内镜检查，并检测了血清抗幽门螺杆菌抗体、胃蛋白酶原A和C以及PGA/PGC比值。
10例患者（8.2%）退出研究。6例患者（4.9%）报告有副作用。采用意向性分析和符合方案分析得出的六种治疗方案的根除率分别为：（A）39%和44%；（B）50%和56%；（C）65%和77%；（D）47%和50%；（E）85%和90%；（F）83%和87%。方案E和F的三联疗法明显比双联疗法（方案A和D；意向性分析P<0.007，符合方案分析P<0.001）或方案B和C的三联疗法更有效（意向性分析P<0.009，符合方案分析P<0.03）。幽门螺杆菌感染治愈的患者胃炎活动度显著降低（P<0.0001），抗幽门螺杆菌IgG和胃蛋白酶原C显著下降（P = 0.0004和P<0.0001），PGA/PGC比值升高（P<0.001），而幽门螺杆菌仍为阳性的患者血清参数无变化。
在老年人中，奥美拉唑+甲硝唑+克拉霉素三联疗法治疗1周耐受性良好且疗效显著；仅在幽门螺杆菌感染治愈的患者中，抗幽门螺杆菌治疗后抗幽门螺杆菌抗体和PGC血清水平会很快下降。
