内科

【摘要】目的比较艾普拉唑、抗生素序贯疗法或抗生素三联疗法联合益生菌治疗幽门螺杆菌(Hp）感染性慢性萎缩性胃炎（CAG）患者的临床效果。方法选取2015年7月至2016年12月焦作市第二人民医院消化科收治的CAG患者160例，采用随机数字表法分为序贯治疗组、序贯联用组、三联治疗组和三联联用组，每组40例。序贯治疗组患者接受艾普拉唑、抗生素序贯治疗；序贯联用组患者在接受艾普拉唑、抗生素序贯治疗的基础上加用双歧三联活菌胶囊治疗；三联治疗组患者使用抗生素（奥美拉唑、阿莫西林、克拉霉素）三联疗法治疗；三联联用组患者在抗生素三联治疗的基础上加用双歧三联活菌胶囊治疗。比较四组患者血清肿瘤坏死因子α（TNFα）、白细胞介素-6（IL6）、C反应蛋白（CRP）和胃泌素（GS）水平的变化情况以及Hp根除情况、临床疗效及不良反应发生情况。结果治疗10 d后，序贯治疗组和序贯联用组患者血清TNFα、IL6、CRP水平显著低于于三联治疗组和三联联用组（P＜0.05），序贯联用组和三联联用组患者血清GS水平显著高于序贯治疗组和三联治疗组（P＜0.05）；序贯联用组患者Hp根除率显著高于三联治疗组（P＜0.05）。四组患者的治疗有效率由高到低顺序为：序贯联用组＞序贯治疗组＞三联联用组＞三联治疗组，但各组之间比较差异无统计学意义（P＞0.05）；四组患者不良反应率由低到高顺序为：序贯联用组＜序贯治疗组＜三联联用组＜三联治疗组，但各组之间比较差异无统计学意义（P＞0.05）。结论艾普拉唑、抗生素序贯疗法联合益生菌治疗CAG患者，能比较有效地降低血清TNFα、IL6、CRP水平，提高血清GS水平，促进患者胃功能的恢复，取得较好的临床疗效。在临床实践中，可根据CAG患者的具体情况选择合适的治疗方式。

【Abstract】ObjectiveTo compare the effect of sequential therapy with Ilaprazole and antibiotic or triple therapy of antibiotics combined with probiotics in the treatment of Hp infected chronic atrophic gastritis. MethodsA total of 160 CAG patients admitted to Jiaozuo Second People’s Hospital from July 2015 to December 2016 were divided into sequential treatment group, sequential combination group, triple therapy group and triple combination group by random number table method, 40 cases in each group. The sequential therapy group were treated with Ilaprazole, sequential antibiotic therapy. The sequential combination group were treated with Ilaprazole, sequential antibiotic therapy and Bifid Triple Viable capsule(BIFICO) . The triple therapy group were treated with antibiotics (omeprazole, amoxicillin, clarithromycin) triple therapy. The triple combination group were treated with triple therapy of antibiotics and BIFICO. Tumor necrosis factorα (TNFα) and interleukin 6 (IL6), C reactive protein (CRP) and gastrin (GS) levels, Hp eradication incidence, clinical efficacy and adverse reactions were compared between the four groups. ResultsAfter treatment of 10d, the serum levels of TNF, IL6 and CRP in the sequential treatment group and the sequential combination group were lower than those in triple therapy group and triple combination group (P＜0.05). The serum GS levels of the sequential combination group and the triple combination group were higher than those of the sequential treatment group and the triple therapy group (P＜0.05). The eradication rate of Hp in the sequential combination group was higher than that in the triple therapy group (P＜0.05). The sorting of effective rate of the four groups: the sequential combination group＞the sequential treatment group＞the triple combination group ＞ the triple treatment group, but there was no significant difference between groups (P＞0.05). Adverse reaction rate: the sequential combination group＜the sequential treatment group ＜ the triple combination group＜the triple treatment group, but there was no significant difference between groups (P＞0.05). ConclusionSequential therapy with Ilaprazole and antibiotic combined with probiotics in the treatment of CAG can effectively reduce the serum levels of TNFα, IL6 and CRP, improve the serum level of GS, promote the recovery of gastric function, and achieve better clinical efficacy. According to the specific situation of patients with CAG, choose the appropriate treatment.