幽门螺旋杆菌根除治疗现状及影响因素分析

Current rate of Helicobacter pylori eradication and its influencing factors: a retrospective study

摘要:

目的 调查幽门螺旋杆菌的根除治疗现状及影响因素。方法 选取2014 年1 月-2015 年12 月于北京大学人民医院门诊首次根除幽门螺旋杆菌的患者3 998 例。所有患者均使用含有铋剂的四联方 案，疗程7 ～ 14 d。治疗后停药4 ～ 12 周通过13C 呼吸试验评价根除治疗效果。结果 含有阿莫西林的方 案总体根除率为77.6%，不含阿莫西林的方案总体根除率为69.8%，两方案根除率比较有差异（P <0.05）。 结论 目前临床上幽门螺旋杆菌根除率低。使用阿莫西林和适当延长疗程可提高疗效。

Abstract:

Objective To investigate the current eradication rate of Helicobacter pylori and its influencing factors in Peking University People’s Hospital. Methods A retrospective study was performed on 3,998 Helicobacter pylori -positive patients admitted to our hospital for initial eradication treatment between January 2014 and December 2015. All the patients were given quadruple therapy containing bismuth for a course of 7-14 d. The eradication effect was evaluated by 13C-urea Breath Test within 4-12 weeks after treatment. Results All of 3,998 patients received standard 7-14 day quadruple therapy: proton pump inhibitor (PPI)+2 antibiotics+bismuth. In total, the eradication rate was 74.9%. The eradication rates of regimens containing Amoxicillin plus Clindamycin, Amoxicillin plus Levofloxacin and Amoxicillin plus Metronidazole/Tinidazole were 77.8%, 80.6% and 71.8%, respectively (P > 0.05). The eradication rates of regimens containing Clindamycin plus Levofloxacin, Clindamycin plus Metronidazole/ Tinidazole and Levofloxacin plus Metronidazole/Tinidazole were 70.5%, 55.7% and 74.7%, respectively (P > 0.05). Amoxicillin-containing regimens had a higher total eradication rate than the regimens without Amoxicillin (77.6% vs 69.8%, P < 0.05). Multivariate logistic regression analysis showed that the duration of therapy and the choice of antibiotics were independent predictors of treatment failure. Conclusions The current quadruple therapy has a very high failure rate in Beijing, China. Amoxicillin-containing regimens and longer treatment duration may increase the eradication rate.