伏诺拉生对幽门螺杆菌根除率和肠道菌群的影响

Effect of vonoprazan on eradication rates of Helicobacter pylori and gut microbiota

摘要:

目的 探讨伏诺拉生对幽门螺杆菌（Hp）根除率和肠道菌群的影响。方法 选取2021年1月—2023年1月徐州市第一人民医院收治的92例Hp患者，根据治疗方式不同分为对照组和观察组，各46例。对照组采用以质子泵抑制剂雷贝拉唑为基础的四联疗法，观察组采用伏诺拉生联合阿莫西林二联疗法，两组均治疗2周。比较两组溃疡症状改善时间、Hp根除率和复发率；通过胃电图检查患者正常慢波、节律过缓及节律过速百分比，测定胃蛋白酶原Ⅰ（PGⅠ）、胃蛋白酶原Ⅱ（PGⅡ）水平，并计算胃蛋白酶原比（PGR），比较两组患者的胃肠动力学和胃功能情况；取患者粪便标本，通过聚合酶链反应测定16S rDNA 拷贝数，比较两组患者双歧杆菌属、乳酸杆菌属、大肠杆菌属和肠球杆菌属数量。结果 观察组治疗总有效率高于对照组（P <0.05）。观察组溃疡改善时间短于对照组（P <0.05），复发率低于对照组（P <0.05），Hp根除率高于对照组（P <0.05）。观察组治疗前后PGⅠ、PGⅡ和PGR的差值高于对照组（P <0.05）。观察组治疗前后正常慢波百分比、节律过缓百分比、节律过速百分比的差值高于对照组（P <0.05）。观察组治疗前后双歧杆菌属、乳酸杆菌属、大肠杆菌属、肠球杆菌属的差值高于对照组（P <0.05）。观察组不良反应总发生率低于对照组（P <0.05）。结论 伏诺拉生可以有效提高患者Hp根除率，并改善其肠道菌群情况，对提高患者胃肠功能有重要影响。

Abstract:

Objective To explore the effect of vonoprazan on the eradication rates of Helicobacter pylori (Hp) and gut microbiota.Methods Ninety-two patients with Helicobacter pylori infection treated in our hospital from January 2021 to January 2023 were selected for the study. They were divided into a control group and an observation group based on the treatment method, with 46 patients in each group. Patients in the control group were treated with the quadruple therapy based on the proton pump inhibitor rabeprazole, and the observation group was treated with vonoprazan plus amoxicillin. Both groups were treated for 2 weeks. The time to improvement of ulcers, and eradication rates and recurrence rates of Helicobacter pylori infection were compared between the two groups. The frequencies of normal gastric slow waves, bradygastria, and tachygastria were assessed using electrogastrography. The levels of pepsinogen I (PG Ⅰ) and pepsinogen II (PG Ⅱ) were determined, and the pepsinogen I to pepsinogen II ratio (PGR) was calculated. The gastrointestinal motility and gastric function of the two groups were compared. Stool samples from patients were taken to measure the 16S rDNA copy number using the polymerase chain reaction (PCR) technology. The quantities of Bifidobacterium, Lactobacillus, Escherichia coli, and Enterococcus were compared between the two groups.Results The overall effective rate of the observation group was higher than that of the control group (P < 0.05). The time to improvement of ulcers in the observation group was shorter than that in the control group (P < 0.05). Compared with the control group, the recurrence rate of Helicobacter pylori infection was lower (P < 0.05) and the eradication rate of Helicobacter pylori was higher in the observation group (P < 0.05). The differences of the levels of PG Ⅰ and PG Ⅱ as well as the PGR before and after the treatment were higher in the observation group than in the control group (P < 0.05). The differences of the frequencies of normal gastric slow waves, bradygastria, and tachygastria before and after the treatment in the observation group were higher than those in the control group (P < 0.05). The differences of the quantities of Bifidobacterium, Lactobacillus, Escherichia coli, and Enterococcus before and after the treatment in the observation group were also higher than those in the control group (P < 0.05). The overall incidence of adverse reactions in the observation group was lower than that in the control group (P < 0.05).Conclusions Vonoprazan effectively increases the eradication rate of Helicobacter pylori in infected patients and improves their gut microbiota composition, significantly contributing to the enhancement in the gastrointestinal function.