Sheu B S, Yang H B, Su I J, Shiesh S C, Chi C H, Lin X Z
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Gastrointest Endosc. 1996 Dec;44(6):683-8. doi: 10.1016/s0016-5107(96)70052-4.
We studied whether different initial bacterial densities of Helicobacter pylori would alter the eradication rate of H. pylori by triple therapy (amoxicillin 500 mg t.i.d. and metronidazole 500 mg t.i.d. for 14 days; bismuth subcitrate 120 mg t.i.d. for 28 days) in patients with duodenal ulcer bleeding.
One hundred thirty-six cases with duodenal ulcer bleeding and H. pylori infection (proved by rapid urease test and histology during emergency endoscopy) were studied. One hundred twenty-seven of these patients completed a course of triple therapy. In each case, anti-H. pylori IgG titer, gastric biopsies for H. pylori density (score 1 to 5), and evaluation of severity of gastritis were collected at the first endoscopy and 1 month after completion of the triple therapy.
The ulcer healing rate was 84.3% (107 of 127) at the time of the second evaluation. The eradication rate of H. pylori was 76.4% (97 or 127). Eradication for H. pylori failed in 30 cases. In these eradication failure cases, initial serologic titer and density of H. pylori were higher than those of eradication success cases. The eradication rate of H. pylori decreased as the initial density of H. pylori increased (density of H. pylori: 1, 88.3%; 2, 83.8%; 3, 74.2%; 4, 68%; 5, 50%). At the second evaluation, the serologic titer was lower and continued to decline in eradication success cases whose mean residual titer ratio (100% x follow-up titer/initial titer) was lower than that of eradication failure cases (57.1% +/- 14.6% vs 107.1% +/- 24.1%, p < 0.001). The mean residual titer ratio also disclosed an upward trend as the density of H. pylori increased (density of H. pylori 1 to 5: 57.5%, 66.6%, 73.5%, 75.3%, 81.8%, respectively).
We suggest routine gastric biopsy to detect both the presence of H. pylori and its density inasmuch as quantitative results may predict the usefulness of triple therapy. The higher the H. pylori density, the less effective triple therapy will be at successful eradication of H. pylori.
我们研究了十二指肠溃疡出血患者中幽门螺杆菌不同的初始细菌密度是否会改变三联疗法（阿莫西林500毫克，每日三次，甲硝唑500毫克，每日三次，共14天；枸橼酸铋钾120毫克，每日三次，共28天）对幽门螺杆菌的根除率。
对136例十二指肠溃疡出血且幽门螺杆菌感染（急诊内镜检查时通过快速尿素酶试验和组织学证实）的患者进行研究。其中127例患者完成了一个疗程的三联疗法。在每例患者中，在首次内镜检查时及三联疗法完成后1个月收集抗幽门螺杆菌IgG滴度、用于检测幽门螺杆菌密度的胃活检标本（评分1至5分）以及胃炎严重程度评估。
第二次评估时溃疡愈合率为84.3%（127例中的107例）。幽门螺杆菌根除率为76.4%（127例中的97例）。30例患者幽门螺杆菌根除失败。在这些根除失败的病例中，幽门螺杆菌的初始血清学滴度和密度高于根除成功的病例。幽门螺杆菌的根除率随着幽门螺杆菌初始密度的增加而降低（幽门螺杆菌密度：1级，88.3%；2级，83.8%；3级，74.2%；4级，68%；5级，50%）。在第二次评估时，根除成功病例的血清学滴度较低且持续下降，其平均残余滴度比（100%×随访滴度/初始滴度）低于根除失败病例（57.1%±14.6%对107.1%±24.1%，p<0.001）。平均残余滴度比也随着幽门螺杆菌密度的增加呈上升趋势（幽门螺杆菌密度1至5级分别为：57.5%、66.6%、73.5%、75.3%、81.8%）。
我们建议进行常规胃活检以检测幽门螺杆菌的存在及其密度，因为定量结果可能预测三联疗法的有效性。幽门螺杆菌密度越高，三联疗法成功根除幽门螺杆菌的效果就越差。
