标题：雷贝拉唑四联疗法治疗HP感染合并2型糖尿病疗效观察

      作者：阎小宁 1，陈强 1，郭艺静 2    北京中医药大学孙思邈医院消化内科 1、内分泌科 2，陕西 铜川 727100

      卷次： 2019年30卷20期

      【摘要】 目的 观察雷贝拉唑四联疗法治疗幽门螺旋杆(HP)感染合并2型糖尿病患者的临床疗效，为患者用药提供指导。方法 选取2017年10月至2018年12月期间北京中医药大学孙思邈医院消化内科收治的Hp感染合并2型糖尿病患者90例作为观察组，Hp感染不合并2型糖尿病患者90例作为对照组，两组患者均给予口服雷贝拉唑10 mg+阿莫西林1 g+枸橼酸铋钾300 mg+克拉霉素500 mg，2次/d，连续服用2周，最后再服用雷贝拉唑3周。观察组患者同时给予基础的降糖药物治疗。停止用药 1个月后复查进行Hp13碳-呼气实验(13C-UBT)，并测定观察组患者糖化血红蛋白水平(HbA1c)，比较两组患者Hp清除和溃疡愈合情况，以及用药不良反应和复发情况。结果 治疗后，对照组患者的溃疡面愈合的总有效率为92.22%，明显高于观察组的82.22%，差异有统计学意义(P<0.05)；治疗后，观察组中病程短，HbA1c水平低的患者的Hp清除率明显高于病程长、HbA1c水平高的患者，差异有统计学意义(P<0.05)；治疗后，对照组患者的Hp清除率为85.56%，明显高于观察组的72.22%，而复发率为4.44%，明显低于观察组的 16.67%，差异均有统计学意义(P<0.05)；对照组患者不良反应发生率为 12.22%，略高于观察组的11.11%，差异无统计学意义(P>0.05)。结论 Hp感染合并2型糖尿病患者应用雷贝拉唑四联疗法的Hp清除率和溃疡愈合情况疗效不及Hp感染不合并2型糖尿病者。因此，临床上应根据2型糖尿病和Hp感染的双重特点综合制定用药方案，以提高临床治疗效果疗效。
      【关键词】 2型糖尿病；雷贝拉唑；四联疗法；幽门螺杆菌；预后
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2019）20—2616—03

Therapeutic effect and prognosis of Rabeprazole quadruple therapy for Helicobacter pylori combined with type 2diabetes mellitus.
YAN Xiao-ning 1, CHEN Qiang 1, GUO Yi-jing 2. GI Medicine 1, Department of Endocrinology 2, the SunSimiao Hospital of Beijing University of Traditional Chinese Medicine, Tongchuan 727100, Shaanxi, CHINA
【Abstract】 Objective To analyze the efficacy and prognosis of Rabeprazole quadruple therapy for patients ofHelicobacter pylori (HP) combined with type 2 diabetes mellitus, and to provide medication guidance for the patients.Methods Ninety patients of Hp with type 2 diabetes mellitus treated in the Sun Simiao Hospital of Beijing Universityof Traditional Chinese Medicine from October 2017 to December 2018 were selected as the observation group, and 90patients of Hp without type 2 diabetes mellitus were enrolled as the control group. All patients of two groups were givenoral rabeprazole 10 mg+amoxicillin 1 g+bismuth potassium citrate 300 mg+clarithromycin 500 mg twice daily for 2week, and finally Rabeprazole for 3 weeks. Patients in the observation group were further given the basic hypoglycemicmedication. After stopping the drug for 1 month, the 13C-urea breath test (13C-UBT) was performed, and the hemoglobinA1c (HbA1c) level was detected in the observation group. The Hp clearance and ulcer healing were compared betweenthe two groups, as well as the occurrence and recurrence of adverse drug reactions. Results After treatment, the total ef-fective rate of ulcer healing in the control group (92.22%) was significantly higher than that in the observation group(82.22%), and the difference was statistically significant (P<0.05). After treatment, the negative conversion rate of Hp inpatients with short course of disease and low level of HbA1c in the observation group was significantly higher than thatin patients with long course and high level of HbA1c (P<0.05). After treatment, the Hp clearance rate (85.56%) in thecontrol group was significantly higher than that in the observation group (72.22%), and the recurrence rate of the controlgroup (4.44%) was significantly lower than that of the observation group (16.67%), both with statistically significant dif-ferences (P<0.05). After treatment, the incidence of adverse reactions in the control group (12.22%) were slightly higherthan that in the observation group (11.11% ), and there was no significant difference (P>0.05). Conclusion The Hpclearance rate and ulcer healing of patients with Hp combined with type 2 diabetes mellitus undergoing Rabeprazole qua-druple therapy were inferior to those with Hp not associated with type 2 diabetes mellitus. Therefore, it is necessary tocomprehensively formulate a drug regimen based on the dual characteristics of type 2 diabetes mellitus and Hp infection,and ultimately improve the patient's efficacy and prognosis.
      【Key words】 Type 2 diabetes mellitus; Rabeprazole; Guadruple therapy; Helicobacter pylori; Prognosis