Annibale B, D'Ambra G, Luzzi I, Marcheggiano A, Iannoni C, Paoletti M, Anania M C, Marignani M, Delle Fave G
Cattedra di Gastroenterologia I, Clinica Chirurgica IV Universita La Sapienza, and Laboratorio di Microbiologia Istituto Superiore Sanita, Roma, Italy.
Am J Gastroenterol. 1997 May;92(5):790-4.
It has been reported that pretreatment with omeprazole could decrease the efficacy of Helicobacter pylori eradication. Our aim was to compare the efficacy, safety, and tolerability of the eradicating regimen, omeprazole/amoxicillin/metronidazole. The two antibiotics were scheduled either during the first or during the last 2 wk of omeprazole administration.
In this prospective controlled study conducted in a single center, 78 symptomatic peptic ulcer patients were treated for 4 wk with omeprazole 40 mg o.m.; the patients were randomly assigned to receive amoxicillin 1 g t.i.d. postprandially and metronidazole 250 mg t.i.d. postprandially, either during the first 2 wk (group A, n = 40) or the last 2 wk of therapy with omeprazole (group B, n = 38). H. pylori status was assessed by culture, histology, urease test, and IgG antibodies. Each patient's course was followed for 1 yr.
H. pylori infection was cured in 97.4% of group A (95% CI: 0.84-0.99) and in 89% of group B (95% CI: 0.73-0.96, p = 0.28). Healing was achieved in 80% of the patients in group A (95% CI: 0.63-0.90) and in 75.7% of patients in group B (95% CI: 0.60-0.90, p = 0.60) At 12-month follow-up, 72 patients were evaluated: 37/38 (97%) of patients in group A and 33/33 (100%) in group B were confirmed as cured of the infection (NS). Peptic ulcer healing rate reached 100% in the two groups. Furthermore, between the two groups, there were no significant differences in symptom relief or improvement. Both regimens were well tolerated, and no patient had to be withdrawn from therapy because of an adverse event. Minor side-effects appeared to be similar in the two groups (40% vs. 38%).
This randomized study clearly indicates that omeprazole pretreatment does not significantly reduce the efficacy of eradicating therapy for H. pylori in peptic ulcer patients.
据报道，奥美拉唑预处理可能会降低幽门螺杆菌根除疗效。我们的目的是比较奥美拉唑/阿莫西林/甲硝唑根除方案的疗效、安全性和耐受性。两种抗生素分别安排在奥美拉唑给药的前2周或后2周使用。
在单中心进行的这项前瞻性对照研究中，78例有症状的消化性溃疡患者接受4周的奥美拉唑40mg口服治疗；患者被随机分配，分别在治疗前2周（A组，n = 40）或奥美拉唑治疗的后2周（B组，n = 38），接受阿莫西林1g每日3次餐后服用和甲硝唑250mg每日3次餐后服用。通过培养、组织学、尿素酶试验和IgG抗体评估幽门螺杆菌感染状况。对每位患者随访1年。
A组97.4%的患者幽门螺杆菌感染治愈（95%CI：0.84 - 0.99），B组为89%（95%CI：0.73 - 0.96，p = 0.28）。A组80%的患者溃疡愈合（95%CI：0.63 - 0.90），B组为75.7%（95%CI：0.60 - 0.90，p = 0.60）。在12个月的随访中，评估了72例患者：A组37/38（97%）的患者和B组33/33（100%）的患者被确认感染治愈（无显著性差异）。两组消化性溃疡愈合率均达到100%。此外，两组之间在症状缓解或改善方面无显著差异。两种治疗方案耐受性均良好，没有患者因不良事件而退出治疗。两组轻微副作用发生率相似（40%对38%）。
这项随机研究明确表明，奥美拉唑预处理不会显著降低消化性溃疡患者幽门螺杆菌根除治疗的疗效。
