目的 分析幽门螺杆菌(Helicobacter pylori, HP)根除治疗失败相关因素，为有效根除Hp提供建议和决策。 方法 对2005年5月-2008年12月经胃镜检查确诊的慢性胃炎或消化性溃疡，且Hp检测阳性并行含质子泵抑制剂三联或四联治疗的患者103例进行研究。治疗结束至少4周后，用14C呼气试验评估Hp是否成功根除，根据测试结果分为治疗失败组33例及治疗成功组70例。运用统一标准的调查表对每位患者进行相关因素调查，就调查表所涉及的因素在根除失败组与成功组间采用单因素及多因素Logistic回归进行分析。 结果 通过单因素分析依从性和饮酒在两组之间有统计学意义(P＜0.05)。Logistic多因素分析发现，依从性差是根除失败的独立危险因素。 结论 依从性差是治疗失败十分重要的影响因素。
ObjectiveTo systematically review the efficacy and safety of probiotics for the treatment of Helicobacter pylori (H.pylori) infection in children. MethodsWe electronically searched The Cochrane Library, PubMed, EMbase, CNKI, VIP and WanFang Data databases to collect randomized controlled trials (RCTs) about probiotics for the treatment of H.pylori infection in children from inception to January 2015. The references of included studies and conference proceedings were manually searched for additional studies. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsA total of twelve RCTs were included, involving 1 227 patients. The result of meta-analysis showed that the probiotics adjuvant therapy group was superior to the control group in H.pylori eradication rates (OR=2.23, 95%CI 1.66 to 2.99, P<0.000 01) and the incidence of adverse effect (OR=0.31, 95%CI 0.18 to 0.53, P<0.000 1). ConclusionCurrent evidence shows that probiotics adjuvant therapy may be a new effective and safe solution in the treatment of H.pylori infections in children. Due to the limited quality and quantity of the included studies, more higher quality studies are needed to verify the above conclusion.
Objective To explore the interference of recent use of antibiotics in the sensitivities of different methods for the detection of Helicobacter pylori (Hp) in children. Methods From June 2015 to December 2017, children who were highly suspected of Hp infection and required gastroscopy were divided into the antibiotic group and the control group according to the recent use of antibiotics, with 200 cases in each group. The use of antibiotics of children in the antibiotic group was analyzed. The children in the two groups completed five methods of Hp detection, including rapid urease test (RUT), 13C-urea breath test (13C-UBT), pathological Warthin-Starry staining, colloidal gold method for measuring Hp immunoglobulin M (IgM) antibody, and enzyme linked immunosorbent assay method for measuring Hp stool antigen (HpSA). Comparative analyses of data were done. Results The positive rate of RUT was 36.5% in the antibiotic group and 75.0% in the control group (P<0.05). The positive rate and value of13C-UBT were 59.0% and 13.6±4.7 in the antibiotic group, and 78.0% and 41.7±6.6 in the control group (P<0.05). The positive rate of pathological biopsy was 48.0% in the antibiotic group and 68.0% in the control group (P<0.05), and L-forms were found in 80.9% of the Hp-positive specimens in the antibiotic group. The positive rate of IgM antibody was 54.5% in the antibiotic group and 65.5% in the control group (P<0.05). The positive rate of HpSA was 38.0% in the antibiotic group and 69.0% in the control group (P<0.05). In the antibiotic group, only 12.5% of the children used antibiotics for eradication of Hp and 87.5% for non Hp eradication. Conclusions Under the interference of antibiotics use, the sensitivity of 13C-UBT is the highest among the five methods for Hp detection, and the sensitivities of RUT and HpSA are very low. For children who could not cooperate with 13C-UBT, the sensitivity of IgM detection is relatively high. For children who need gastroscopy, prolonged chromogenic time for RUT and multi-point pathological biopsy can reduce misdiagnosis.
【摘要】 目的 探讨含铋剂的四联疗法作为一线方案对幽门螺杆菌感染的有效性和安全性。 方法 选择2008年9月-2010年9月间137例确诊幽门螺杆菌感染的初治患者，随机分为RAC组（雷贝拉唑、阿莫西林和克拉霉素）和RBAC组（雷贝拉唑、阿莫西林、克拉霉素和枸橼酸铋钾）。经治疗7 d后比较两组根除率和不良反应发生率。 结果 RAC组和RBAC组的按方案分析根除率分别为77.6%和90.3%，意向性治疗分析根除率分别为72.6%和86.7%。RBAC组的按方案分析和意向性治疗分析根除率均高于RAC组（Plt;0.05）。不良反应发生率分别为1.6%和1.3%（Pgt;0.05）。 结论 以雷贝拉唑、阿莫西林、克拉霉素和枸橼酸铋钾为组合的四联疗法能显著提高幽门螺杆菌感染的初治成功率，不良反应少，安全有效。【Abstract】 Objective To investigate the effectiveness and safety of the quadruple therapy containing a bismuth compound for first-line Helicobacter pylori eradication treatment. Methods A total of 137 patients diagnosed to be Helicobacter pylori-positive between September 2008 and September 2010 were randomized into two groups to receive the combination of rabeprazole, amoxicillin and clarithromycin (RAC group) and the combination of rabeprazole, amoxicillin, clarithromycin and bismuth potassinm citrate (RBAC group) respectively. The efficacy and tolerance were observed after the treatment for 7 days. Results The per protocol (PP) eradication rates of Helicobacter pylori were 86.7% for RAC group and 90.3% for RBAC group (Plt;0.05), respectively. The intention-to-treat protocol (ITT) eradication rates of Helicobacter pylori were 72.6% for RAC group and 86.7% for RBAC group (Plt;0.05), respectively. The was no significant difference in the incidence of side effects between the two groups (1.6% vs. 1.3%, Pgt;0.05). Conclusion The quadruple therapy containing rabeprazole, amoxicillin, clarithromycin and bismuth potassinm citrate provides a good eradication rate of Helicobacter pylori with a good compliance when compared with the standard triple therapy schemes.
Objective To evaluate the efficacy and safety of high-dose dual therapy (HDDT) in the treatment of Helicobacter pylori (HP) infection. Methods The clinical data of patients with HP infection who were treated in Suining Central Hospital between June 2020 and August 2021 were retrospectively collected. They were divided into HDDT group and bismuth-containing quadruple therapy (BQT) group according to the treatment regimen. The efficacy and adverse reactions of the two treatment regimens were observed. Results A total of 520 patients were included. Among them, there were 284 cases in the HDDT group and 236 cases in the BQT group. By propensity score matching, 223 pairs of patients were successfully matched. The eradication rates of HDDT and BQT were 74.4% and 77.1%, respectively (χ2=0.440, P=0.507), and the incidence of adverse reactions were 9.9% and 16.6%, respectively (χ2=4.395, P=0.036). Conclusion The efficacy of HDDT and BQT in the treatment of HP infection is comparable, but the former has fewer adverse reactions.
【摘要】目的探讨幽门螺杆菌(Hp)感染的根除与治疗糖尿病性胃轻瘫疗效的关系。方法 采用碳14呼气试验测定出67例糖尿病性胃轻瘫并Hp感染患者,经正规抗Hp治疗后进行疗效分析。结果67例中,Hp根除41例,症状明显改善33例,症状无明显改善8例;Hp未根除26例,症状明显改善17例,症状无明显改善9例。结论 糖尿病性胃轻瘫并Hp感染者经有效抗Hp治疗,对提高该病疗效有明显作用
【摘要】 目的 观察根除幽门螺杆菌对糖尿病胃轻瘫（DGP）的治疗作用。 方法 选择2008年3月-2010年1月100例幽门螺杆菌阳性DGP患者。随机分为A、B两组。A组给予莫沙比利5 mg，3次/d，4周，及根除幽门螺杆菌治疗（埃索美拉唑 20 mg+克拉霉素 500 mg+阿莫西林1.0 g，12次/d）2周。B组采用莫沙比利5 mg，3次/d，4周。记录患者治疗前、治疗4周及停药4周时的症状积分。 结果 92例完成实验。A组症状积分治疗4周后明显下降（Plt;0.01），与停药4周后相比差异无统计学意义（Pgt;0.05），二者均明显低于B组同期（Plt;0.05、lt;0.01）。B组症状积分治疗4周后明显下降（Plt;0.01），停药4周后明显高于治疗4周后（Plt;0.05），但仍低于治疗前（Plt;0.05）。A组治疗4周及停药4周后显效率及总有效率分别为57.4%及91.5%、40.4%及83%，明显高于B组35.6%及75.6%、15.6%及53.3%（Plt;0.05）。 结论 对幽门螺杆菌阳性的DGP患者根除幽门螺杆菌可明显提高疗效，并有效防止停药后症状复发。【Abstract】 Objective To explore the therapeutic effect of helicobacter pylori (H.pylori) eradication on diabetic gastroparesis (DGP) patients. Methods A total of 100 DGP patients with H.pylori infection diagnosed between March 2008 and January 2010 were included and randomly divided into two groups. The patients in group A underwent the treatment with mosapride 5 mg (thrice per day) for four weeks and H.pylori eradication therapy (esomeprazole 20 mg, twice per day; clarithromycin 500 mg, twice per day; amoxicillin 1.0 g, twice per day for two weeks). The patients in group B was administered with mosapride 5 mg (thrice per day) for four weeks. The symptom scores (SS) were recorded pretreatment, 4 weeks later and 4 weeks after stopping treatment. Results Ninety-two patients finished the study. The SS in group A decreased significantly (Plt;0.01) 4 weeks after the treatment and didn’t differ much from that 4 weeks after stopping the treatment. Both of the SS were lower than those in group B at the same time. In group B, compared with that before the treatment, the SS were much lower than that 4 weeks after the treatment (Plt;0.01) and 4 weeks after stopping the treatment (Plt;0.05); the former was significantly lower than the latter (Plt;0.05). The marked efficacy rate and total efficacy rate in group A were higher than those in group B (4-week treatment: 57.4% and 91.5% vs. 35.6% and 75.6%, 4 weeks after stopping the treatment: 40.4% and 83% vs. 15.6% and 53.3%) (Plt;0.05). Conclusion H.pylori eradication can increase the therapeutic effect on H.pylori positive patients with DGP and reduce the recurrence of the symptoms remarkably.