摘要
目的探讨铝碳酸镁联合幽门螺杆菌(Hp)根治对Hp感染并十二指肠溃疡(DU)病人胃窦炎症程度、炎症介质、胃肠激素水平等和环氧化酶-2(Cox-2)的影响。方法选取2014年8月至2017年2月上海市第一人民医院宝山分院接诊的240例Hp感染并DU病人采用随机数字表法分为观察组(120例)和对照组(120例),对照组给予奥美拉唑、阿莫西林、克拉霉素、胶体果胶铋四联根治治疗,观察组加用铝碳酸镁,均治疗4周,比较两组临床疗效、Hp根除率、胃窦炎症程度及溃疡面积,采用放射免疫法测定血浆和胃窦黏膜组织生长抑素(SST)、促胃液素-17(Gas-17)水平,采用酶联免疫检测法测定胃窦黏膜匀浆液中热休克蛋白(HSP 60)、肿瘤坏死因子-α(TNF-α)、可溶性血管细胞黏附分子-1(VCAM-1)、白细胞介素-6(IL-6)及血清Cox-2水平。结果观察组临床疗效94.17%优于对照组80.83%(P<0.05),观察组和对照组治疗后Hp根除率比较,差异无统计学意义(85.83%比78.33%,P>0.05);两组病人胃窦黏膜组织的慢性炎症、活动性炎症程度均低于治疗前(P<0.05),且观察组慢性炎症、活动性炎症程度明显低于对照组(P<0.05);两组DU病人治疗后溃疡面积均低于治疗前(P<0.05),观察组溃疡面积缩小幅度大于对照组(P<0.05);观察组治疗后血浆胃泌素Gas-17、胃窦黏膜组织Gas-17、血清Cox-2水平均低于治疗前和对照组(P<0.05);观察组治疗后TNF-α、IL-6、HSP 60、VCAM-1水平显著低于治疗前和对照组(P<0.05)。结论铝碳酸镁、奥美拉唑、阿莫西林、克拉霉素、胶体果胶铋五联疗法可有效改善Hp感染并DU病人的胃窦炎症程度,减少炎症介质的释放,还能调节胃肠激素和血清Cox-2水平,治疗效果较好。
Objective To investigate the effect of hydrotalcite combined with Helicobacter pylori(Hp)eradication on the degree of antral gastritis,inflammatory mediators,levels of gastrointestinal hormones and cyclooxygenase-2(Cox-2)in patients with Hp infection and duodenal ulcer(DU).Methods 240 patients with Hp infection and DU who were treated in the gastroenterology department of Baoshan District Branch of Shanghai First People’s Hospital from Aug. 2014 to Feb. 2017 were randomly divided into the observation group(120 cases)and the control group(120 cases).The control group was given quadruple eradication of omeprazole,amoxicillin,clarithromycin and colloidal bismuth pectin,and the observation group was additionally given hydrotalcite.Clinical efficacy,Hp eradication,degree of antral gastritis and ulcer area were compared between the two groups.The levels of somatostatin(SST)and gastrin-17(Gas-17)in plasma and antral mucosa were determined by radioimmunoassay.The levels of heat shock protein(HSP 60),tumor necrosis factor-α(TNF-α),soluble vascular cell adhesion molecule-1(VCAM-1),interleukin-6(IL-6)and serum Cox-2 in gastric antrum mucosa homogenate were determined by enzyme-linked immunosorbent assay.Results The clinical efficacy in the observation group was better than that in the control group(94.17% vs. 80.83%,P<0.05),and there was no significant difference in the eradication rate of Hp between the two groups(85.83% vs. 78.33%,P>0.05).The degrees of chronic inflammation and active inflammation of gastric antral mucosal tissues in two groups were lower than those before treatment(P<0.05),and the degrees of chronic inflammation and active inflammation in the observation group were significantly lower than those in the control group(P< 0.05).The ulcer area of DU patients after treatment in the two groups was lower than that before treatment(P<0.05),and the reduction of ulcer area in observation group was smaller than that in control group(P<0.05).The levels of plasma gastrin(Gas-17),gastric antral mucosa Gas-17 and serum Cox-2 in the observation group were lower than those before treatment and those in the control group(P<0.05).The levels of TNF-α,IL-6,HSP 60 and VCAM-1 in the observation group were significantly lower than those before treatment and those in the control group after treatment(P<0.05).Conclusion Quintuplet therapy of hydrotalcite,omeprazole,amoxicillin,clarithromycin,colloidal pectin can improve the degree of antral gastritis in patients with Hp infection and DU,reduce the release of inflammatory mediators,and regulate the levels of gastrointestinal hormones and serum Cox-2,and the curative effect is good.
作者
樊冬杰
黄玉伟
FAN Dongjie;HUANG Yuwei(Department of Gastroenterology,Baoshan District Branch of Shanghai First People’s Hospital,Shanghai 200940,China)
出处
《安徽医药》
CAS
2020年第2期393-397,共5页
Anhui Medical and Pharmaceutical Journal
关键词
十二指肠溃疡
药物疗法
联合
幽门螺杆菌
奥美拉唑
阿莫西林
克拉霉素
铋
铝碳酸镁
幽门螺杆菌根治
Duodenal ulcer
Drug therapy,combination
Helicobacter pylori
Omeprazole
Amoxicillin
Clarithromycin
Bismuth
Hydrotalcite
Radical treatment of helicobacter pylori
