摘要

三联疗法被推荐为根除幽门螺杆菌最有效的治疗方法。然而，尽管取得了较高的根除效果，但仍有约10%的患者未能治愈。奥美拉唑可提高单、双抗生素方案的疗效，尤其与克拉霉素、硝基咪唑联合使用时疗效显著。本研究探讨奥美拉唑联合三联疗法的疗效。一项前瞻性、随机、无盲、单中心试验对连续出现消化不良和幽门螺杆菌感染症状的患者进行了研究，这些患者经快速脲酶试验、微生物培养和组织学评估证实。患者给予5次/天，12天疗程的胶状亚柠檬酸铋咀嚼片(108 mg)，盐酸四环素(250 mg)和甲硝唑(200 mg)，与奥美拉唑20 mg(每日2次(三联疗法+奥美拉唑)或法莫替丁40 mg(三联疗法+法莫替丁)夜间服用。使用标准问卷形式确定依从性和副作用。165例三联疗法+奥美拉唑患者中有125例，171例三联疗法+法莫替丁患者中有124例在治疗结束4周后再次进行活检。通过尿素酶试验、培养和组织学评估，三联疗法+奥美拉唑患者实现根除的比例显著高于124例三联疗法+法莫替丁患者中的110例(89%)(p = 0.006;30例三联疗法+奥美拉唑(24%)和26例三联疗法+法莫替丁(21%)的新生甲硝唑耐药幽门螺杆菌患者纳入研究。 Side effects were mild and infrequent and were comparable in both groups, although pain in duodenal ulcer, gastric ulcer, and oesophagitis patients seemed to subside earlier in those taking omeprazole. Compliance (>95% of drugs taken) was achieved by 98% of patients of both groups. A 12 days regimen of triple therapy with omeprazole is more effective in achieving H pylori eradication than is triple therapy plus famotidine. Use of 20 mg omeprazole twice daily rather than 40 mg famotidine with a 12 day, low dose triple therapy enhances eradication to over 97% whether the H pylori is metronidazole sensitive or resistant.