黄连素联合四联疗法在幽门螺杆菌一线治疗中的作用研究

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摘要目的探讨黄连素联合四联疗法作为幽门螺杆菌（Hp）一线治疗的效果和安全性。方法收集上海中医药大学附属普陀医院2018年11月～2019年11月Hp阳性的慢性胃炎患者100例，采用随机数字表法将其分为试验组和对照组，每组50例。对照组采用四联疗法，试验组在对照组的基础上加用黄连素，评估两组根除率、临床疗效和不良反应发生率。琼脂稀释法对Hp临床分离株行三种常用抗生素的药敏试验，分析耐药性及对两组根除率的影响。结果试验组按意向治疗分析，Hp根除率高于对照组，差异有统计学意义（P ＜ 0.05）；按方案分析，两组Hp根除率比较，差异无统计学意义（P ＞ 0.05）。两组临床疗效比较，差异无统计学意义（P ＞ 0.05）。两组不良反应总发生率比较，差异无统计学意义（P ＞ 0.05），其中试验组恶心、腹泻的发生率明显低于对照组，差异有统计学意义（P ＜ 0.05）。Hp对克拉霉素、甲硝唑和阿莫西林的耐药率分别为32.0%、64.0%、0.0%。在克拉霉素耐药菌株中，试验组根除率明显高于对照组，差异有统计学意义（P ＜ 0.05）。结论黄连素联合四联疗法可提高Hp根除率，且安全性高，可作为Hp克拉霉素高耐药地区一线治疗的可选方案。

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	徐小青周帆吴小溪陆娟曹勤

关键词 ：幽门螺杆菌, 四联疗法, 黄连素, 克拉霉素, 耐药性

Abstract：Objective To investigate the efficacy and safety of Berberine combined with Quadruple therapy as a primary therapy for Helicobacter pylori（Hp） eradication. Methods A total of 100 Hp infected patients with chronic gastritis diagnosed by gastroscopy were enrolled in Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from November 2018 to November 2019. They were divided into the experimental group and the control group by random number table method, with 50 cases in each group. The control group was treated with Quadruple therapy，while the experimental group was treated with Berberine on the basis of the control group． The curative effect, eradication rate and adverse reactions of two groups were assessed. The drug resistance of Hp were tested for three common antibiotics by the agar dilution method, and the effect of antibiotic resistance on the eradication rate of the two groups was analyzed. Results According to the treatment intention analysis, the Hp eradication rate in the experimental group was higher than that in the control group, and the difference was statistically significant (P ＜ 0.05); according to the per-protocol analysis, there was no statistically significant difference in Hp eradication rate between the two groups (P ＞ 0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P ＞ 0.05), and the incidence of nausea and diarrhea in the experimental group was significantly lower than that in the control group (P ＜ 0.05). The resistant rates of Hp to Clarithromycin, Metronidazole and Amoxicillin were 32.0%, 64.0%, 0.0%, respectively. The eradication rate of the experimental group was significantly higher than that in the control group in patients with clarithromycin-resistant strains (P ＜ 0.05). Conclusion Berberine combined with Quadruple therapy can increase the eradication rate of Hp and has high safety. It can be used as an option for first-line treatment in areas with high resistance to Hp Clarithromycin.

Key words： Helicobacter pylori Quadruple therapy Berberine Clarithromycin Drug resistance

基金资助:国家自然科学基金资助项目（81603468）。

通讯作者: 曹勤（1965.5-），男，主任医师；研究方向：幽门螺杆菌相关的基础及临床研究。

作者简介: 徐小青（1984.11-），女，硕士；研究方向：幽门螺杆菌相关的基础及临床研究。

引用本文:

徐小青周帆吴小溪陆娟曹勤. 黄连素联合四联疗法在幽门螺杆菌一线治疗中的作用研究[J]. 中国医药导报, 2020, 17(19): 78-81.
XU Xiaoqing ZHOU Fan WU Xiaoxi LU Juan CAO Qin. Study on the role of Berberine combined with Quadruple therapy in initial Helicobacter pylori eradication . 中国医药导报, 2020, 17(19): 78-81.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I19/78

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