摘要 目的：对比四联疗法和序贯疗法对根除服用非甾体类消炎药（NSAID）人群幽门螺杆菌(Hp)，改善其消化道不良症状及促进消化性溃疡愈合的临床效果。  方法：对有消化不良症状的服用非甾体类消炎药物患者行胃镜检查、快速尿激酶及13C 呼气试验检查，将155例幽门螺杆菌阳性合并有慢性胃炎或消化性溃疡患者作为研究对象，随机分为两组，A组采用四联疗法， B组采用序贯疗法。A组予雷贝拉唑+克拉霉素+阿莫西林+枸橼酸铋钾治疗10 天；B组前5天予雷贝拉唑+阿莫西林，后5天予雷贝拉唑+克拉霉素+甲硝唑。治疗结束后，予雷贝拉唑和胃黏膜保护剂治疗8周。停药4周后，复查胃镜、13C呼气试验，观察和比较两组Hp根除率、消化不良症状缓解率及溃疡愈合率。结果：A 、B两组Hp根除率分别为（ITT 分析：86.7 %和81.9 %；PP分析：87.8 %和84.3%)；症状缓解率为（81.9%对79.2%)：胃溃疡愈合率为（68.8%对66.7%），十二指肠球部潰疡的愈合率为（68.2%对70.0%），两组患者间Hp根除率、症状缓解率及溃疡愈合率比较均未见明显统计学差异(P>0.05)。四联疗法组和序贯疗法组不良反应的发生率分别为4.9%和4.3%。两组比较无明显差异(P>0.05)。结论：四联疗法和序贯疗法对长期服用非甾体类消炎药物人群的Hp根除疗效、消化不良症状的缓解及促进溃疡愈合的治疗作用均无明显差异。

ABSTRACT Objective: To assess the efficacy of quadruple therapy and sequential therapy in the eradication of helicobacter pylori, symptoms relieve rates and ulcer healing rates in patients receiving long-term non-steroidal anti-inflammatory drugs treatment. Methods: Patients receiving long-term NSAID treatment with dyspeptic symptoms underwent endoscopy, rapid urease test (RUT) and 13C-urea breath test (13C -UBT). Patients diagnosed as Hp infection and also with chronic gastritis or peptic ulcer were enrolled in this study and divided into two groups. In group A, patients received quadruple therapy (rabeprazole , clarithromycin, amoxicillin and bismuth subcitrate for 10 days); in group B, patients received sequential trerapy (rabeprozol and amoxicilin for the first 5 days, rabeprazole, clarithromycin and metronidazole for the next 5 days). All patients were given rabeprazole and mucosal protective therapy as maintenance treatment after eradication therapy for 8 weeks. Patients re-examined endoscopy, rapid urease (RUT) and 13C-urea breath test(13C -UBT) 4 weeks after the treatment. The Hp eradication rate, remission of clinical symptoms and ulcer healing were assed. Results: No statistical difference was observed in the Hp eradication rates between group A and group B on both ITT analysis (86.7 % vs.81.9 %) and PP analysis (87.8 % Vs. 84.3 %). There was no difference between the two groups in the symptoms remission rates (81.9 % vs.79.2 %) and the ulcer healing rates, including the stomach ulcer (68.8 % vs. 66.7 %) and the duodenal ulcer (68.2 % vs.70.0 %). No significant difference was found in the incidence rates of adverse reactions between two groups(P>0.05). Conclusion: There was no difference in the Hp eradication, remission of clinical symptoms and ulcer healing between quadruple therapy and sequential therapy in patients receiving long-term non-steroidal anti-inflammatory drugs treatment.