双歧杆菌联合标准四联疗法根治80例幽门螺杆菌患者的临床研究

荆佳晨+冯珍

摘 要 目的：观察双歧杆菌联合标准四联疗法根治幽门螺杆菌（Helicobacter pylori， Hp）的临床疗效。方法：将160 例Hp阳性患者随机分为A、B组各 80 例。A组口服埃索美拉唑、胶体果胶铋、阿莫西林、克拉霉素；B组在A组基础上加服双歧杆菌活菌胶囊，共用药14 d。治疗结束后4周再次行13C呼气检测Hp，比较各组的Hp根除率及不良反应发生率。结果：A组Hp根除率91.8%，B组Hp根除率92.3%，两组Hp根除率无统计学差异；IV级不良反应发生率A组高于B组，其中腹泻、恶心、腹胀、口腔异味的发生率，A组明显高于B组，差异有统计学意义。结论：双歧杆菌联合标准四联疗法未能提高Hp根除率，但明显提高治疗完成率和降低不良反应发生率。

关键词 幽门螺杆菌 四联疗法 双歧杆菌

中图分类号：R282.71； R517.9 文献标识码：A 文章编号：1006-1533（2017）07-0027-03

Clinical study on Bifidobacterium combined with standard quadruple therapy for the treatment of 80 cases of Helicobacter pylori infection*

JING Jiachen**， FENG Zhen***

（Department of Gastroenterology， Central Hospital of Shanghai Xuhui District， Shanghai 200031， China）

ABSTRACT Objective： To observe the clinical efficacy of Bifidobacterium combined with standard quadruple therapy in the treatment of Helicobacter pylori （Hp） infection. Methods： One hundred and sixty cases of patients with Hp infection were randomly divided into group A and B with 80 cases each. All the patients were treated for 14 days with oral administration of esomeprazole， colloidal bismuth pectin， amoxicillin and clarithromycin and meanwhile the patients in group B were additionally given Bifidobacterium capsule. Hp infection was detected by 13C exhalation test at 4 weeks after treatment. The eradication rate of Hp and the incidence of adverse reactions were compared between the two groups. Results： The comparison of eradication rate of Hp between group A and B showed no significant differences （91.8% vs 92.3%）. The incidence of grade IV adverse reactions was higher in group A than in group B， in which the incidence of diarrhea， nausea， abdominal distension and oral odor was significantly higher in group A than in group B （P<0.05）. Conclusion： Bifidobacterium combined with standard quadruple therapy can not improve the eradication rate of Hp， but significantly improve the completion rate of the treatment and reduce the incidence of adverse reactions.

KEY WORDS Helicobacter pylori； quadruple therapy； Bifidobacterium

幽門螺杆菌（Helicobacter pylori， Hp）是公认的胃黏膜疾病的病因之一，慢性胃炎、消化性溃疡、胃癌、胃黏膜相关淋巴组织淋巴瘤、非溃疡性消化不良等胃病均与之密切相关。我国自然人群Hp的感染率约54.76%，现症感染率达到42%～64%[1]。因此，制定一个有效、可行的Hp根治方案非常重要。目前推荐的质子泵抑制剂、铋剂联合两种抗菌药物的四联方案可获得较高的根除率，但随着抗菌药物的广泛应用出现了越来越多的耐药，影响Hp的根除效果，而且该方案经常出现相关的胃肠功能紊乱及胃肠道菌群失调等不良反应，如腹泻、恶心、呕吐、腹痛等。已有研究报道一些益生菌如乳酸杆菌、双歧杆菌对Hp具有间接或直接的抑制作用。本研究的目的在于观察标准四联抗菌方案联合双歧杆菌对Hp的根除率及不良反应的影响，以探讨益生菌制剂的临床应用。……