多西环素与四环素在根除幽门螺杆菌治疗中的临床疗效与安全性研究

左毅　林金球　何锋　农金飞　梁列新　赵军

【摘要】 目的 比較多西环素与四环素在四联方案根除幽门螺杆菌感染中的疗效和安全性。方法 选取经行14C呼气试验检查明确为幽门螺杆菌感染的患者110例，按随机数字表分为多西环素组（n=55）及四环素组（n=55），多西环素组给予雷贝拉唑10 mg，bid+胶体果胶铋200 mg，bid+呋喃唑酮0.1 g，bid+多西环素0.1 g，bid;四环素组给予雷贝拉唑10 mg，bid+胶体果胶铋200 mg，bid+呋喃唑酮0.1 g，bid+四环素0.5 g，tid;疗程均为14天。治疗结束后停药1个月，再次行14C呼气试验检查确定治疗效果，比较两组幽门螺杆菌的根除率，记录两组病人的不良反应，并计算两组治疗的成本-效果比（C/E）。结果 多西环素组根除率为92.16%，四环素组根除率为90.00%;多西环素组和四环素组不良反应发生率分别为 7.3%（4/55）、9.1%（5/55），二者在根除率及不良反应方面比较差异无统计学意义（P>0.05）。多西环素组C/E值为145.90，四环素C/E值为160.41，多西环素组的C/E值较低，性价比更高。结论 含多西环素的四联疗法在根除幽门螺杆菌感染上具有较理想的根除率、良好的安全性以及更好的性价比，尤其值得在基层医院推广。

【关键词】 多西环素;四环素;幽门螺杆菌感染

中图分类号：R573.6   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.02.013

【Abstract】 Objective To compare the efficacy and safety of doxycycline and tetracycline in the eradication of Helicobacter pylori infection in the tetralogy therapy. Methods 110 patients with Helicobacter pylori infection， who had been identified by 14 C-urea breath test （14C-UBT）， were divided into doxycycline group （n = 55） and tetracycline group （n = 55） according to random number table. The doxycycline group were treated with rabeprazole （10 mg）， bid + colloidal bismuth pectin （200 mg）， bid + furazolidone （0.1 g）， bid + doxycycline （0.1 g）， and bid. And the tetracycline group were treated with rabeprazole （10 mg）， bid + colloidal bismuth pectin （200 mg）， bid + furazolidone （0.1 g）， bid + tetracycline （0.1 g）， tid. Both groups were treated for 14 days. One month after the end of treatment， 14C-UBT was performed again to determine the therapeutic effect. The eradication rate of Helicobacter pylori was compared between the two groups， the adverse reactions of the two groups were recorded， and the cost-effectiveness ratio （C/E） of the two groups was calculated.Results The eradication rate of the doxycycline group was 92.16%， and that of the tetracycline group was 90.00%， the incidence of adverse reactions in the doxycycline group and the tetracycline group was 7.3% （4/55） and 9.1% （5/55）， respectively， and there was no statistically significant difference in eradication rates and adverse reactions between the two groups （P > 0.05）. The C/E value of the doxycycline group was 145.90， and that of tetracycline group was 160.41， the C/E value was lower and cost performance was higher in the doxycycline group. Conclusion Tetralogy therapy containing doxycycline has ideal eradication rate， good safety and better cost performance in the eradication of Helicobacter pylori infection， which is especially worthy of clinical promotion in primary hospitals.

【Key words】 doxycycline; tetracycline; Helicobacter pylori infection

幽门螺杆菌（Helicobacter pylori，H.pylori）是一种螺旋形，革兰氏染色阴性的微需氧细菌，最早由澳大利亚学者WARREN和MARSHALL于1983年发现[1]，迄今已与人类共存了相当长的时间。幽门螺杆菌感染会在所有定植者中引起慢性活动性胃炎[2]，最常见的有萎缩性胃炎、消化性溃疡[3]。1994年幽门螺杆菌已被世界卫生组织癌症研究机构（IARC）定义为Ⅰ型致癌物[4～5]，其参与胃癌（GC）、胃黏膜相关淋巴样组织（MALT）淋巴瘤[1]的发生及发展。而根……