26例合并HP感染的胆汁反流性胃炎患者抗HP治疗的临床观察(1)
【摘要】目的：观察采用抗HP方法治疗不明原因的合并HP感染的胆汁反流性胃炎患者的疗效情况。方法：将53例不明原因胆汁反流性胃炎合并感染HP的患者按随机数字表法的方法随机分为治疗组和对照组。对照组27例予奥美拉唑、海地特、莫沙必利治疗，治疗组26例在对照组治疗基础上加用阿莫西林、克拉霉素，疗程2周，其余药物与对照组相同，疗程为1个月。观察患者症状改善情况及疗程结束后1月复查胃镜了解胆汁反流及胃黏膜炎症情况、HP转阴情况，并随访6个月观察疾病复发情况。结果：不明原因胆汁反流性胃炎合并感染HP的患者经HP根除治疗同未采用根除治疗比较，前者治愈率、HP转阴率明显好于后者，治愈后6个月复发率前者明显低于后者。结论：不明原因的合并HP感染的胆汁反流性胃炎患者，在常规应用抑酸剂、胃黏膜保护剂和胃动力药物的基础上，应考虑HP根除。
【关键词】 胆汁反流性胃炎；HP;治疗;临床观察
【Abstract】Objective: to observe the treatment by resistance to HP unidentified merger of HP infection bile reverse flow the curative effect of sexual gastritis. Methods: 53 patients with unexplained bile reverse flow sex gastritis amalgamative infection by random Numbers of patients HP method of table method were randomly divided into the treatment group and control group. 27 cases in control group paclobutrazol, Haiti ogilvy &mather pull Homer, mossa will the treatment, the treatment group based in 26 cases of control group therapy combined with amoxicillin, the clarithromycin, treatment two weeks, the rest of the drugs and the control group the same treatment for 1 month. Observation patient's symptoms improved conditions and treatment on January review after signicant understand bile reverse flow and gastric mucosal inflammation, HP, shade, and were followed up for 6 months observation disease recurrence. Results: unexplained bile reverse flow sex gastritis amalgamative infection by HP eradicate the patients HP not with radical therapy treatment compared with shade, HP, the former cure rate was significantly better than the latter, rate of 6 months after curing recurrence rate the former obviously lower than the latter. Conclusion: unexplained merger of HP infection bile reverse flow sex gastritis, in conventional application acid agents and suppression gastric mucosa protectant and stomach, on the basis of dynamic drugs should consider HP eradicated.
【Keywords】Bile reflu gasritis；HP；therapy；clinical observation
【中图分类号】R569【文献标识码】B【文章编号】1005-0515(2011)04-0039-01
胆汁反流性胃炎(bile reflu gasritis，BRG)又称碱性反流性胃炎，是一种常见的胃部疾病，是由于含有胆汁的十二指肠液反流人胃内引起的胃黏膜炎症[1]。目前研究表明胆汁反流性胃炎的发生与胃术后(毕I式、毕Ⅱ式)、胆囊疾病(胆石症、胆囊切除术后)、肠系膜上动脉综合征、糖尿病等疾病相关，而很大部分部分患者发生胆汁反流性胃炎原因不明[2-4]。虽然研究表明胆汁反流性胃炎患者的幽门螺杆菌(Hp)感染率较低，但是研究亦提出对于HP阳性的不明原因的胆汁反流性胃炎患者宜首先根除HP[5]。本报道笔者采用抗HP治疗HP阳性的不明原因的胆汁反流性胃炎患者取得较好疗效，现报告如下：
1 一般资料
1.1 研究对象：对于2007年4月-2010年3月在我院行胃镜检查，有完整病例资料并经病理证实的53例不明原因的合并HP感染的胆汁反流性胃炎患者按随机数字表法的方法随机分为治疗组和对照组。治疗组26例，其中男16例,女10例;平均年龄41.1岁;平均病程8.9个月。对照组27例,其中男15例,女12例;平均年龄40.3岁;平均病程9.2个月,两组病例在性别、年龄、病程及病情方面差异均无统计学意义(P<0.05),具有可比性。
1.2 诊断标准：上腹痛、腹胀、吐苦水、体重下降、烧心、早饱及恶心等症状持续四周及以上；胃镜检查可见黏液池呈黄色或黄绿色胆汁样，胃黏膜上可见胆汁斑，黏膜充血或糜烂，甚至部分患者镜下见胆汁从幽门口反流入胃内[6]。每例取活检3块，其中胃窦大弯侧距幽门约2-4cm内取活俭组织1块，做快速尿素酶检查；在胃窦、胃体处各取组织1块，送常规病理检查。如快速尿素酶检查和病理染色中两项均为阳性者认为存在HP感染。
1.3 排除标准：①排除一个月内有特殊用药史者。②胃镜检查除外上消化道其他器质性病变者。③无胃肠道手术史。④经超声、血液生化等检查除外其他器质性疾病：如胆囊疾病(如胆石症、胆囊切除术后)、肠系膜上动脉综合征、糖尿病等。
2 方法
2.1 治疗方法：对照组27例予奥美拉唑20mg，口服，2次/d；海地特1.0g，口服，3次/d；莫沙必利5mg，口服，3次/d。治疗组26例在对照组治疗基础上加用阿莫西林1.0g，口服，2次/d；克拉霉素0.5g，口服，2次/d，疗程2周，其余药物与对照组相同，疗程为1个月。, http://www.100md.com(李明华 刘向阳)
【关键词】 胆汁反流性胃炎；HP;治疗;临床观察
【Abstract】Objective: to observe the treatment by resistance to HP unidentified merger of HP infection bile reverse flow the curative effect of sexual gastritis. Methods: 53 patients with unexplained bile reverse flow sex gastritis amalgamative infection by random Numbers of patients HP method of table method were randomly divided into the treatment group and control group. 27 cases in control group paclobutrazol, Haiti ogilvy &mather pull Homer, mossa will the treatment, the treatment group based in 26 cases of control group therapy combined with amoxicillin, the clarithromycin, treatment two weeks, the rest of the drugs and the control group the same treatment for 1 month. Observation patient's symptoms improved conditions and treatment on January review after signicant understand bile reverse flow and gastric mucosal inflammation, HP, shade, and were followed up for 6 months observation disease recurrence. Results: unexplained bile reverse flow sex gastritis amalgamative infection by HP eradicate the patients HP not with radical therapy treatment compared with shade, HP, the former cure rate was significantly better than the latter, rate of 6 months after curing recurrence rate the former obviously lower than the latter. Conclusion: unexplained merger of HP infection bile reverse flow sex gastritis, in conventional application acid agents and suppression gastric mucosa protectant and stomach, on the basis of dynamic drugs should consider HP eradicated.
【Keywords】Bile reflu gasritis；HP；therapy；clinical observation
【中图分类号】R569【文献标识码】B【文章编号】1005-0515(2011)04-0039-01
胆汁反流性胃炎(bile reflu gasritis，BRG)又称碱性反流性胃炎，是一种常见的胃部疾病，是由于含有胆汁的十二指肠液反流人胃内引起的胃黏膜炎症[1]。目前研究表明胆汁反流性胃炎的发生与胃术后(毕I式、毕Ⅱ式)、胆囊疾病(胆石症、胆囊切除术后)、肠系膜上动脉综合征、糖尿病等疾病相关，而很大部分部分患者发生胆汁反流性胃炎原因不明[2-4]。虽然研究表明胆汁反流性胃炎患者的幽门螺杆菌(Hp)感染率较低，但是研究亦提出对于HP阳性的不明原因的胆汁反流性胃炎患者宜首先根除HP[5]。本报道笔者采用抗HP治疗HP阳性的不明原因的胆汁反流性胃炎患者取得较好疗效，现报告如下：
1 一般资料
1.1 研究对象：对于2007年4月-2010年3月在我院行胃镜检查，有完整病例资料并经病理证实的53例不明原因的合并HP感染的胆汁反流性胃炎患者按随机数字表法的方法随机分为治疗组和对照组。治疗组26例，其中男16例,女10例;平均年龄41.1岁;平均病程8.9个月。对照组27例,其中男15例,女12例;平均年龄40.3岁;平均病程9.2个月,两组病例在性别、年龄、病程及病情方面差异均无统计学意义(P<0.05),具有可比性。
1.2 诊断标准：上腹痛、腹胀、吐苦水、体重下降、烧心、早饱及恶心等症状持续四周及以上；胃镜检查可见黏液池呈黄色或黄绿色胆汁样，胃黏膜上可见胆汁斑，黏膜充血或糜烂，甚至部分患者镜下见胆汁从幽门口反流入胃内[6]。每例取活检3块，其中胃窦大弯侧距幽门约2-4cm内取活俭组织1块，做快速尿素酶检查；在胃窦、胃体处各取组织1块，送常规病理检查。如快速尿素酶检查和病理染色中两项均为阳性者认为存在HP感染。
1.3 排除标准：①排除一个月内有特殊用药史者。②胃镜检查除外上消化道其他器质性病变者。③无胃肠道手术史。④经超声、血液生化等检查除外其他器质性疾病：如胆囊疾病(如胆石症、胆囊切除术后)、肠系膜上动脉综合征、糖尿病等。
2 方法
2.1 治疗方法：对照组27例予奥美拉唑20mg，口服，2次/d；海地特1.0g，口服，3次/d；莫沙必利5mg，口服，3次/d。治疗组26例在对照组治疗基础上加用阿莫西林1.0g，口服，2次/d；克拉霉素0.5g，口服，2次/d，疗程2周，其余药物与对照组相同，疗程为1个月。, http://www.100md.com(李明华 刘向阳)