摘要
目的研究克拉霉素、阿莫西林、奥美拉唑三联短程疗法对幽门螺杆菌(Hp)感染的根除率及远期疗效,探讨初治失败后治疗方案的选择.方法经胃镜检查、组织活检确诊为Hp感染患儿92例,男60例,女32例.分为克拉霉素组70例,用克拉霉素、阿莫西林、奥美拉唑三联1周疗法;甲硝唑组22例,用甲硝唑、阿莫西林、奥美拉唑三联2周疗法.停药后4周,分别在1～30个月进行复查,检测Hp根除率.对2组初治失败者进行复治,甲硝唑组采用克拉霉素三联1周疗法;克拉霉素组增加克拉霉素剂量和延长奥美拉唑疗程.复治再失败者采用铋剂四联疗法.结果克拉霉素组Hp根除率91.4%(64/70)较甲硝唑组72.7%(16/22)高,有显著性差异(χ2=5.16 P＜0.05).克拉霉素组18例Hp根除患儿,30个月内随访复发率5.6%(1/18).本组共12例根除失败,采用3种复治方案后,根除率分别为83.3%(5/6)、66.7%(4/6)、100.0%(3/3).结论克拉霉素三联1周短程疗法是根除儿童Hp感染的理想治疗方案.适当增加克拉霉素剂量和延长奥美拉唑疗程可提高根除率.采用铋剂四联疗法对克拉霉素耐药者有效.
Objective To evaluate the eradication rate and long-term therapeutic effect of a triple therapy consisted of clarithromycin （CLA）, amoxicillin （AMO）and omeperazole on Hp infection, and explore the ahemative therapeutic programs and their effects after first therapeutic failure. Methods A total of 92 children with Hp infection were divided into two groups： 70 children were given the triple therapy for one week （CLA group） ;Twenty- two children were given another triple therapy composed of metronidazoole （MET）, AMO and omeperazole for two weeks （MET group）. All of the children were followed up for 1 - 30 months after the therapies ended. Children of the two groups who were therapeutic failure were given retreatment as follows. CLA triple therapy were given for one week to the children who were failure after MET triple therapy; increased doses of CLA with longer treatment course was given to the children who were failure after CLA triple therapy. A tetra therapy consisted of colloidal bismuth subcitrate （CBS）, furazolidone （FUR） ,omeperazole and AMO was given to children in whom the retreatment failed. Results The Hp eradication rate of CLA group waa 91.4 % （64/70）, and t he Hp eradication rate of MET group was 72.7 % （ 16/22 ）. There was significant difference between eradication rate of the two groups（χ^2 = 5.16 P〈 0.05）. The recurrence rate of 18 Hp eradicated children treated with CLA triple therapy was 5.6% （ 1/18）during the 30 months follow- up. The eradication rate of the three retreatment progran~ for 12 children was 83.3% （5/6） ,66.7% （4/6）and 100.0% （3/3）, respectively. Conclusions CLA,AMO and omeperazole triple therapy for one week is the best to eradicate Hp infection. Proper increase of CLA dose and longer therapeutic course may increase the eradication rate. CBS, FUR, AMO and omeperazole tetra therapeutic program may be used as an ahemative treatment in patients who develop resistance to CLA triple therapy.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2005年第9期845-847,共3页
Journal of Applied Clinical Pediatrics
关键词
儿童
螺杆菌
幽门
螺杆菌感染
克拉霉素
children
helicobacter pylori
helicobacter infection
clarthromycin
