维敏四联治疗Hp相关的消化性溃疡

目的应用维敏胶囊（胶态果胶铋）四联药物疗法治疗Hp相关的消化性溃疡（PU）2wk，停药4wk后经内镜、14C-UBT等方法观察溃疡的愈合及Hp根除的疗效方法经内镜确诊为PU，其中十二指肠溃疡（DU）169例；胃溃疡（GU）89例．受检前2wk内未服抗生素、铋剂及质子泵阻断剂，排除孕妇和溃疡出血者，并镜下活检病理排除恶性溃疡Hp检测：先行快速尿素酶检测（RUT），阳性者再行14C-UBT检测，其中DU的Hp阳性率为95．5％；GU的Hp阳性率为81．0％．四联治疗方法：对Hp阳性PU，给予维敏胶囊100mg，4次／d；兰索拉唑30mg，2次／d；阿莫西林0．5g，4次／d；甲硝唑0．4g，2次／d，疗程为2wk．停药后4wk，同时复查内镜及14G-UBT．结果DU愈合率91．2％，Hp根除率93．0％；GU愈合率86．0％，Hp根除率92．0％．DU和GU愈合率及Hp根除率差异不明显（P＞0．05）；四联疗法后肝肾功能无异常结论Hp与PU关系密切．采用四联治疗Hp相关的PU，有良好效果．14GUBT检测Hp感染具有很高的敏感性和特异性，无创伤性，是治疗后复查Hp的首选方法     

灭Hp胶囊多联治疗Hp阳性消化性溃疡

目的寻求中西医结合治疗Hp相关性消化性溃疡(PU)的理想方案方法采用前瞻性、随机双盲、安慰剂对照研究Hp阳性的PU患者93例被随机分为4组A组(新三联)达克普隆30mg,1次/d+阿莫西林500mg,2次/d+克拉霉素250mg,2次/d,连服10 d;B组(灭Hp胶囊四联)新三联10d+灭Hp胶囊6粒,2次/d,连服28 d;C组(灭Hp胶囊三联)达克普隆30 mg,1次/d+克拉霉素250 mg,2次/d,连服10 d,+灭Hp胶囊6粒,2次/d,连服28 d,D组(安慰剂)胃舒平3片,2次/d,连服28 d.双盲双模拟用药.结果 Hp根治率在B,C组与A组分别为96%,92%和92%;溃疡愈合率分别为100%,92%和88%,三组间差异无显著性,明显高于D组的HP根治率(0%)和溃疡愈合率(20%)(均P＜0.01).B,C组溃疡愈合质量明显优于D组,也优于A组B,C组治疗后胃粘膜磷脂(mg/g,93±26.92±27)、氨基己糖(mg/g,55±20,53±15)和血清表皮因子(EGF)(μg/L,0.7±0.3,0.6±0.4)含量明显高于治疗前磷脂(mg/g,79±23,81±23,均P＜0.01)、氮基己糖(mg/g,40± 14;42±16,均P＜0.01)和EGF(μg/L,0.5±0.2,P＜0.01;0.5±0.3,P＜0.05)含量.A组治疗后仅氨基己糖含量(49 ± 18)高于治疗前(42±16,P＜0.05),磷脂和EGF无明显变化.D组磷脂、氨基已糖和EGF治疗前后无明显变化(P＞0.05)各项检测指标B组优于C组,但无统计学意义治疗期间患者依从性好,无不良反应发生.结论中西医结合灭Hp胶囊三联、四联疗法除了有Hp根除与溃疡愈合率高,而乏副作用外,还具有保护胃粘膜,溃疡愈合质量高的特点,是治疗Hp相关性PU的较为理想方案.     

消化性溃疡治疗的进展

消化性溃疡治疗的进展姚希贤消化性溃疡（ＰＵ）是一种多病因疾病，归纳起来不外胃酸、胃蛋白酶和幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）等攻击因子的增强，胃粘膜屏障、粘膜血流、前列腺素（ＰＧ）、碳酸氢盐分泌和上皮再生等防御因子的减弱。近年来...     

胃宝口服液及系列胶囊治疗慢性胃炎和消化性溃疡150例

目的观察辨病与辨证相结合使用胃宝口服液及系列胶囊治疗慢性胃炎和消化性溃疡的治疗效果.方法慢性胃炎和消化性溃疡150例,应用胃宝口服液及系列胶囊进行治疗.其中慢性浅表性胃炎活动期80例(53.3%),胆汁反流性胃炎24例(16.0%),萎缩性胃炎3例(2.0%),疣状胃炎14例(9.3%),胃炎合并溃疡29例(19.3%).男95例,女55例,年龄16岁～70岁,平均年龄39.8岁,病程3mo～28a,平均15a±10.5a.根据胃痛疾病的基本病机及患者的不同临床表现,辨证分型为基础型、痛型、胀型、虚型和瘀型.在150例患者中痛型31例,痛胀并见型75列,虚型33例,瘀型11例针对五个证型分别制成胃宝口服液(柴胡、枳实、白芍、焦术、公英等8味中药组成)及胃宝系列胶囊,即胃宝止痛胶囊(元胡、浙贝、香椽、川朴等),胃宝消胀胶囊(木香、莱菔子、腹皮、灵仙等),胃宝补脾胶囊(台参,黄芪、山药、扁豆等),胃宝化瘀胶囊(蒲黄、灵脂、焦楂、丹参等).在治疗时将胃宝口服液做为基础用药,同时视辨证结果加用相应胶囊.3wk为1疗程,疗程结束后,对患者的临床症状,体征及上消化道造影或内镜提示的结果进行比较分析.结果经胃宝口服液及系列胶囊治疗3wk后,治愈122例,好转27例,无效1例,总有效率为99.3%.经统计学处理,P<0.01.结论胃宝口服液及系列胶囊对慢性胃炎和消化性溃疡有着良好的治疗作用.     

畅中胶囊合西药治疗消化性溃疡71例

[目的]观察畅中胶囊合西药治疗消化性溃疡（PU）的临床疗效和2年内的复发率。[方法]对135例PU患者采用随机、对照实验的方法，用中药畅中胶囊加奥美拉唑20mg，qd，治疗4周，观察临床症状、内镜下的成熟度以及2年内的复发率。[结果]两组症状均有明显减轻，但治疗组临床症状改善显著（P〈0．05）；内镜下治疗组获得＆期较对照组多（P〈0．05）；2年内复发率治疗组低于对照组，但差异无统计学意义。[结论]畅中胶囊治疗PU有较好的近、远期疗效。     

中西医结合治疗消化性溃疡疗效观察

[目的]观察中西医结合治疗消化性溃疡的临床疗效.[方法]236例经胃镜确诊的消化性溃疡患者随机分为治疗组(119例)、对照组(117例),分别给予自拟中药胃肠康加雷尼替丁、单用雷尼替丁治疗30 d,疗程结束后复查胃镜,进行疗效比较.[结果]治疗组治愈78例,好转33例,无效8例,总有效率93.3%;对照组分别为47、39、31例,73.5%,两组治愈率及总有效率比较,P＜0.01.1年后随访,治疗组复发率为14.1%,明显低于对照组的55.3%(P＜0.01).[结论]中西医结合治疗消化性溃疡不良反应小,疗效显著稳定,复发率低.     

消化性溃疡的病因及治疗

消化性溃疡的病因及治疗山东省出版总社门诊部（２５０００１）杨进军王玮山东省农业发展银行卫生所马亚玉消化性溃疡（ＰＵ）发病率高，具有自然缓解和反复发作的特点。近２０年来，其病因、治疗的研究进展较快，现结合文献浅述如下。１病因本世纪初，ＰＵ的发病机理曾被...     

Effects of killing Helicobacter pyloriquadruple therapy on peptic ulcer： A randomized double-blind clinical trial

AIM: To study the therapeutic efficacy of a Chinese and Western integrated regimen, killing Helicobacter pylori quadruple therapy on H pylori-associated peptic ulcers (PU). METHODS: With prospective and double-blind controlled method, seventy-five active PU patients with H pylori infection were randomized to receive one of the following three regimens: (1) new triple therapy (group A: lansoprazole 30 mg qd, plus clarithromycin 250 mg bid, plus amoxycillin 500 mg tid, each for 10 d); (2) killing Hp quadruple therapy(group B: the three above drugs plus killing H pylori capsule 6 capsules bid for 4 wk) and (3) placebo(group C: gastropine 3 tablets bid for 4 wk). H pylori eradication and ulcer healing quality were evaluated under an endoscope 4 wk after treatment. The patients were followed up for 5 years. RESULTS: Both the healing rate of PU and H pylori eradication rate in group B were significantly higher than those in group C (100% and 96.4% vs20% and 0%, respectively,P<0.005), but there was no significant difference compared to those in group A (88% and 92%, P>0.05). The healing quality of ulcer in group B was superior to that in groups C and A (P<0.05). The recurrence rate of PU in group B (4%) was lower than that in group A (10%) and group C (100%,P<0.01). CONCLUSION: Killing Helicobacter pylori quadruple therapy can not only promote the eradication of H pylori and healing quality of ulcer but also reduce recurrence rate of ulcer.     

Ulcer healing after treatment with sucralfate emulsion or ranitidine. Randomized controlled study in peptic ulcer disease

A randomized trial with a blind observer compared the efficacy of an emulsion containing micronized sucralfate (1 g four times daily) and ranitidine (150 mg twice daily) in the short-term healing of peptic ulcer. Patients with a minimum ulcer size of 5 mm located in the duodenal bulb, the pyloric canal, or in the prepyloric area within a distance of 2 cm from the pylorus were included. A total of 97 patients were randomized and 85 completed the trial. The endoscopically proven healing rate at 2 weeks of 41% for both sucralfate and ranitidine improved to 76% for sucralfate and 73% for ranitidine at 4 weeks and to 95% and 96%, respectively, at 12 weeks. The difference between the two treatment groups was not statistically significant, and the 95% confidence interval for the difference in ulcer healing efficacy of sucralfate emulsion compared with ranitidine was -0.15 to +0.21 at 4 weeks and -0.10 to +0.08 at 12 weeks.     

CagA+Hp感染与消化性溃疡

目的本文旨在探讨十二指肠球部溃疡、胃溃疡等与产细胞毒相关蛋白A幽门螺旋杆菌(CagA+Hp)感染的关系.方法分为三组即无症状对照组、十二指肠球部溃疡及胃溃疡组,Hp感染以快速尿素酶试验(RUT)、14C-呼气试验(14C-URT)和(或)病理特殊染色确定,CagA+Hp感染则进一步通过检测血清CagA IgG加以确定.分别计算各组Hp及CagA+Hp的感染率及Ca-gA+Hp占Hp感染的比例,并作组间比较.结果消化性溃疡时,Hp及CagA+Hp的感染率以及CagA+Hp与Hp感染者之比率均明显高于正常对照组,统计学差异显著(P＜0.01).结论Hp与十二指肠球部溃疡及胃溃疡的发生高度相关,其感染率达90%以上,其中产CagA型Hp又占九成以上,可见CagA+Hp感染与消化性溃疡关系密切,这在消化溃疡的防治中应引起足够的重视.     

毫米波加药物治疗Hp+消化性溃疡50例

目的探讨幽门螺杆菌阳性（Ｈｐ＋）的消化性溃疡（ＰＵ）愈合和复发的物理治疗（毫米波ｍｍＷ）及其联合药物治疗的前景．方法本组ＰＵ９３例采用ｍｍＷ辐射探头对ＰＵ患者体表胃投影区照射３０ｍｉｎ，（ｎ＝５０）每日１～２次，联合药物（甲哨唑＋西咪替丁）在Ｈｐ＋的ＰＵ愈合和复发的疗效进行研究，并与对照组４３例进行比较．结果ｍｍＷ治疗及联合药物治疗组与对照组单用药物Ｈ２受体阻滞剂西咪替丁相比较，结果治疗组溃疡愈合率及Ｈｐ根除率１００％（５０／５０）及９８％（４９／５０）．１年后复发率为４％（２／５０）；而对照组溃疡愈合率９０５％（３８／４３），Ｈｐ根除率５０８％（２５／４３），１年后复发率２０９％（９／４３）．说明Ｈｐ根除与溃疡复发有一定关系，２组相比有显著差异（Ｐ＜００５～００１）．结论ｍｍＶ联合药物治疗Ｈｐ＋ＰＵ愈合和复发优于单用Ｈ２受体阻滞剂．     

Effect of the eradication ofHelicobacter pylori on duodenal ulcer healing and ulcer relapse: Randomized controlled study in Japan

To investigate the effect of the eradication ofHelicobacter pylori on the healing and relapse of duodenal ulcers. 50 patients with active duodenal ulcer andH. pylori infection were randomly allocated to two treatment groups. One group (cimetidine group) received cimetidine 400mg twice daily for 6 weeks and the other group (double-therapy group) received 300mg amoxicillin granules and 250 mg metronidazole thrice daily for 2 weeks, in addition to the same regimen of cimetidine as the cimetidine group. Forty-two patients completed the study. After confirmation of ulcer scar, all patients were followed up for 6 months while receiving treatment with teprenone, an agent that does not affect acid secretion or the eradication ofH. pylori. The healing rates at 6 weeks were 90% in the cimetidine group and 95.5% in the double-therapy group.H. pylori eradication occurred in 0% of the cimetidine group and in 73.7% of the double-therapy group (P-0.004). The cumulative relapse rates in the two groups at 6 months were 64.3% and 11.1%, respectively (P=0.0007). In the double-therapy group, the cumulative relapse rate at 6 months in the patients in whomH. pylori persisted was 50% (2/4); the rate was 0% (0/14) in the patients in whomH. pylori had been eradicated (P=0.005). Histological gastritis significantly improved compared with the baseline in the double-therapy group, but no such improvement was seen in the cimetidine group. White scarring was found in 7.1% of the cimetidine group and in 83.3% of the double-therapy group after 6 months (P=0.0001). The eradication ofH. pylori markedly decreased the relapse rate in duodenal ulcer patients, and it significantly improved both the grade of gastritis and the quality of the ulcer scar.     

四联Hp根除治疗对十二指肠溃疡患者胃排空功能及炎症因子的影响

目的观察四联Hp根除治疗对十二指肠溃疡(DU)患者胃排空功能及炎症因子的影响。方法将2015-02~2017-07该院收治的84例DU患者作为研究对象,依据随机数字表法将其分为两组,各42例。对照组采取奥美拉唑、阿莫西林、克拉霉素治疗,观察组则加以胶体果胶铋的四联Hp根除治疗。比较两组临床疗效、Hp根除率、治疗前后胃排空功能及炎症因子水平。结果两组临床疗效、Hp根除率对比,观察组高于对照组,差异有统计学意义(P0.05)。治疗前两组胃排空时间(T)、胃窦收缩频率(F)、热休克蛋白(HSP60)、肿瘤坏死因子-α(TNF-α)对比,差异无统计学意义(P0.05)。治疗后观察组T、F、HSP60、TNF-α低于对照组,差异有统计学意义(P0.05)。结论将四联疗法用于DU治疗中根除Hp效果良好,并可提升DU患者胃排空功能,下调机体内炎症因子水平。     

甘羟铝片联合四联药物治疗复发性消化性溃疡的疗效观察

目的 观察甘羟铝片联合四联药物(质子泵抑制剂、枸橼酸铋钾、呋喃唑酮、阿莫西林)治疗复发性消化性溃疡的疗效.方法 选取复发性消化性溃疡患者84例,随机分治疗组和对照组,分别给予甘羟铝片联合四联疗法或以四联疗法治疗,总疗程均为14 d.结果 疗程结束时,治疗组总有效率为97.6%,对照组总有效率为88.1%,两组疗效差异无统计学意义(P>0.05),但是治疗组症状完全缓解天数少于对照组(P<0.05).两组幽门螺杆菌转阴率和溃疡愈合率差异无统计学意义(P>0.05).结论 以甘羟铝片联合四联疗法与以四联疗法治疗复发性消化性溃疡均安全、有效,但是以甘羟铝片联合四联疗法缓解症状更快,依从性更好,是治疗复发性消化性溃疡较好的方案.     

蒲元和胃胶囊对消化性溃疡愈合质量的影响

[目的]研究蒲元和胃胶囊对消化性溃疡（PU）愈合质量的影响。[方法]选取PU患者167例,随机分为治疗组90例和对照组77例,2组患者均采用幽门螺杆菌（Hp）标准根除方案（雷贝拉唑、克拉霉素、阿莫西林）治疗1周,Hp阴性者不用。对照组继续服用雷贝拉唑钠肠溶片3周,治疗组服用雷贝拉唑钠肠溶片联合蒲元和胃胶囊3周。治疗4周后复查,观察胃镜下溃疡愈合情况和再生黏膜成熟程度。[结果]治疗组和对照组的胃溃疡总愈合率分别为89.47%和82.35%（P〉0.05）;瘢痕期（S期）Sc百分比分别为47.37%和23.53%（P〈0.05）。治疗组和对照组的十二指肠球部溃疡总愈合率分别为92.31%和86.05%（P〉0.05）;Sc百分比分别为48.08%和27.91%（P〈0.05）。[结论]蒲元和胃胶囊治疗PU能在溃疡愈合基础上显著提高愈合质量。