作　　者： ;

机构地区： 南方医科大学南方医院

出　　处： 《临床军医杂志》 2018年第6期639-641,共3页

摘　　要： 目的探讨雷贝拉唑四联疗法根除幽门螺杆菌(HP)感染对胃肠微生态的影响。方法选取自2016年1月至2017年1月收疗的60例胃、十二指肠溃疡HP感染患者为研究对象,均采用雷贝拉唑+阿莫西林克拉维酸钾+克拉霉素+枸橼酸铋钾四联HP根除治疗。评价临床疗效、治疗前后临床症状评分以及不良反应发生情况。收集治疗前后新鲜粪便,接种于选择性培养基观察胃肠道需氧菌、厌氧菌菌落数量,对常见细菌进行药敏试验,比较治疗前后对常见抗菌药物的耐药性。结果治疗后,临床症状缓解率为93.3%(56/60);HP根除率为90.0%(54/60);治疗期间,患者发生口干3例、头晕1例、呕吐2例、腹泻1例、皮疹1例,不良反应发生率为13.3%(8/60)。治疗后,腹胀、腹痛、嗳气、纳差评分均较治疗前显著降低,差异有统计学意义(P<0.01)。治疗后,葡萄球菌、肠球菌、消化球菌、梭菌菌落数量较治疗前增加,乳杆菌、肠杆菌、真杆菌菌落数量较治疗前降低,差异有统计学意义(P<0.01);治疗前后酵母菌、双歧杆菌、拟杆菌菌落数量比较,差异无统计学意义(P>0.05)。治疗后,超广谱内酰氨酶阳性的常见菌种对常见抗菌药物耐药率均较治疗前显著提升,差异有统计学意义(P<0.05)。结论雷贝拉唑四联根除幽门螺杆菌感染能有效根除HP,改善临床症状,但HP根除后可造成肠道菌群失调,增加耐药菌株。 Objective To investigate the effect of rabeprazole-based quadruple therapy on gastrointestinal microbiota in helicobacter pylori（ HP） infection eradication. Methods A retrospective study was performed on 60 cases of patients with gastric or duodenal ulcer with HP infection who were admitted from January 2016 to January 2017. All patients received the rabeprazole ＋ amoxicillin ＋ clavulanate ＋ bismuth potassium combined treatment of HP infection eradication. The clinical efficacy,clinical symptom score before and after treatment and incidence of adverse reactions were evaluated. Fresh stool of patients before and after treatment were adopted to select sorts aerobes and anaerobes representative in intestines flora and cultivate them separately for antimicrobial sensitive test. Then the resistance to common antibacterials were compared. Results After treatment,the clinical treatment efficiency and HP clearance rate was93. 3%（ 56/60） and 90. 0%（ 54/60）,respectively. During the treatment,there were 3 cases of dry mouth,1 case of dizziness,2 cases of vomiting,1 case of diarrhea and 1 case of rash,the incidence of adverse reaction was 13. 3%（ 8/60）. The abdominal distension,abdominal pain,belching and anorexia score were significantly reduced after treatment,and the difference was statistically significant（ P〈 0. 01）. The number of staphylococcus,enterococcus,peptococcus,clostridium colonies increased,the number of lactobacilli,enterobacter and eubacterium colonies reduced,and the difference was statistically significant before and after treatment（ P〈 0. 01）. There was no significant difference in the number of yeast,bifidobacterium and bacteroides（ P〉 0. 05）. The common antimicrobial resistance rate of ESBLs-positive strain increased significantly（ P〈 0. 05）. Conclusion Rabeprazole-based quadruple therapy has a significant effect in HP eradication,it can cause intestinal flora imbalance and increase the resistance strain after the eradication of HP.

关 键 词： 雷贝拉唑 四联 根除幽门螺杆菌 胃肠微生态

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