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目的评价不同疗程复方嗜酸乳杆菌片联合四联疗法根除幽门螺杆菌(H.pylori)的有效性和安全性。方法选择3个月内行~(13)C-UBT或~(14)C-UBT检测H.pylori结果呈阳性的慢性胃炎患者360例,随机分为3组。其中铋剂四联组患者采用枸橼酸铋钾胶囊220mg/次+埃索美拉唑镁肠溶片20mg/次+阿莫西林胶囊1 000mg/次+呋喃唑酮片100mg/次,每日2次口服,共10d;2周益生菌组患者在上述铋剂四联疗法基础上,自用药第1天开始口服复方嗜酸乳杆菌片1 000mg/次,每日3次,共2周;4周益生菌组患者在铋剂四联疗法基础上,自用药第1天开始口服复方嗜酸乳杆菌片1 000mg/次,每日3次,共4周。治疗结束停药至少4周后行~(13)C-UBT或~(14)C-UBT检测,结果为阴性者视为H.pylori根除成功,观察并记录患者治疗过程中的不良反应。结果铋剂四联组、2周益生菌组和4周益生菌组患者PP分析的根除率分别为91.3%(94/103)、92.7%(101/109)、91.7%(99/108),差异无统计学意义(χ~2=0.148,P=0.929);3组患者ITT分析的根除率分别为78.3%(94/120)、84.2%(101/120)、82.5%(99/120),差异无统计学意义(χ~2=1.447,P=0.485);主要不良反应为腹泻、恶心、腹胀、便秘、呕吐等,停药2周内症状均减轻或消失。2周益生菌组和4周益生菌组患者恶心、腹胀、腹泻的发生率和不良反应的总体发生率均低于铋剂四联组。而2周益生菌组、4周益生菌组患者不良反应的总体发生率以及具体不良反应的发生率之间差异无统计学意义。结论铋剂四联疗法联合复方嗜酸乳杆菌片2周及4周方案均不影响H.pylori的根除率,但均降低了不良反应的总体发生率,考虑到成本—效益比,建议采用联合复方嗜酸乳杆菌片2周方案。
Objective To evaluate the efficacy and safety of different courses of Lactobacillus acidophilus combined with quadruple therapy in the eradication of H. pylori. Methods 360 patients with chronic gastritis who had positive results of H.pylori within ~ 3 months (~ (13) C-UBT or ~ (14) C-UBT) were randomly divided into three groups. One bismuth quadruplex patients with bismuth potassium citrate capsules 220mg / times + esomeprazole magnesium enteric-coated tablets 20mg / times + amoxicillin capsules 1000mg / times + furazolidone tablets 100mg / times, 2 times a day Orally for a total of 10 days. On the basis of the above bismuth quadruple therapy, the patients in the probiotic group of 2 weeks started oral administration of Lactobacillus acidophilus tablets 1 000 mg once daily for 2 weeks On the basis of the bismuth quadruple therapy, probiotics group oral administration of compound acidophilus Lactobacillus tablets 1 000 mg / time, day 3, a total of 4 weeks since the first day of treatment. Patients who were negative for H.pylori eradication were treated with ~ (13) C-UBT or ~ (14) C-UBT after discontinuation of treatment for at least 4 weeks. Observe and record the adverse reactions in the course of treatment. Results The eradication rates of PP in bismuth quadruplex, 2 weeks probiotics and 4 weeks probiotics groups were 91.3% (94/103), 92.7% (101/109) and 91.7% (99/108), respectively The eradication rates of ITT in the three groups were 78.3% (94/120), 84.2% (101/120) and 82.5% (99/120) respectively, with no significant difference (χ ~ 2 = 0.148, P = 0.929) (Χ ~ 2 = 1.447, P = 0.485). The main adverse reactions were diarrhea, nausea, abdominal distension, constipation and vomiting. The symptoms disappeared or disappeared within 2 weeks of withdrawal. The incidence of nausea, bloating, diarrhea and the overall incidence of adverse reactions in the 2-week probiotics and 4-week probiotics groups were lower than those in the bismuth quadruplex group. However, there was no significant difference in the overall incidence of adverse reactions and the incidence of specific adverse reactions between the probiotics group 2 weeks and the probiotics group 4 weeks. Conclusions Both bismuth quadruple therapy combined with Lactobacillus acidophilus for 2 weeks and 4 weeks did not affect the eradication rate of H.pylori, but both reduced the overall incidence of adverse reactions. Considering the cost-benefit ratio, it was suggested that combination Lactobacillus acidophilus tablets 2 weeks program.