Progress in eradication of Helicobacter pylori infection in the elderly with Traditional Chinese and Western Medicine
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摘要: 幽门螺杆菌(Helicobacter pylori，Hp)是Ⅰ类致癌因子。抗生素耐药率高、感染率高、耐受性低的特点限制着常规一线抗Hp治疗在老年人群中的应用。老年患者根除Hp可显著降低消化道肿瘤与消化道出血发生的风险，治疗获益确切。目前老年Hp根除的主要方案仍为铋剂四联疗法，加载益生菌或中药可提高根除率、减少不良反应。高剂量二联疗法以其不良反应风险小、疗效肯定的优势或可成为老年Hp根除治疗的另一理想方案。Abstract: Helicobacter pylori(Hp) is anⅠ-type carcinogenic factor. High antibiotic resistance, high infection rate, and low tolerability of eradication therapy in the elderly Hp-infected population limit the use of conventional first-line therapy in the elderly population. The eradication of Hp in elderly patients can still benefit by significantly reducing the incidence of gastrointestinal tumors and the risk of gastrointestinal bleeding. The current primary regimen for Hp eradication in the elderly remains bismuth quadruple therapy, with the loading of probiotics or Traditional Chinese Medicine treatment to improve eradication rates and reduce adverse effects. High-dose dual therapy may be another ideal option for Hp eradication in the elderly due to its low risk of adverse effects and definite efficacy.
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表 2 加载中药的Hp根除治疗方案
文献 组别 治疗方案 样本量/例 根除率/% 不良反应发生率/% 刘书贤等[32] 观察组 奥美拉唑+克拉霉素+甲硝唑+铋剂+黄芪建中 44 97.73 13.64 对照组 奥美拉唑+克拉霉素+甲硝唑+铋剂 44 81.82 11.36 谢红丹等[33] 观察组 奥美拉唑+克拉霉素+阿莫西林+乌梅丸 70 94.29 7.14 对照组 奥美拉唑+克拉霉素+阿莫西林 70 82.86 5.71 闫文慧[34] 观察组 埃索美拉唑+克拉霉素+左氧氟沙星+铋剂+除幽汤 43 90.70 9.30 对照组 埃索美拉唑+克拉霉素+左氧氟沙星+铋剂 43 79.07 4.65 解淑蕊等[35] 观察组 奥美拉唑+克拉霉素+阿莫西林+铋剂+荆花胃康+双歧杆菌 160 91.25 16.25 对照组 奥美拉唑+克拉霉素+阿莫西林+铋剂 160 79.38 31.88 张定荣等[36] 观察组 奥美拉唑+阿莫西林+左氧氟沙星+铋剂+半夏泻心汤 100 97.00 对照组 奥美拉唑+阿莫西林+左氧氟沙星+铋剂 100 85.00 李多等[37] 观察组 雷贝拉唑+克拉霉素+阿莫西林/甲硝唑+铋剂+枳术宽中胶囊 40 87.50 12.50 对照组 雷贝拉唑+克拉霉素+阿莫西林/甲硝唑+铋剂 40 80.00 32.50 姜梅芳[38] 观察组 兰索拉唑+克拉霉素+阿莫西林+荆花胃康 80 96.30 8.75 对照组 兰索拉唑+克拉霉素+阿莫西林+ 80 76.30 3.75 朱春花等[39] 观察组 埃索美拉唑+克拉霉素+阿莫西林克拉维酸钾+铋剂+胃复春片 194 89.18 2.06 对照组 埃索美拉唑+克拉霉素+阿莫西林克拉维酸钾+铋剂+ 益气化瘀解毒方 191 72.77 1.05 谢妲[40] 观察组 雷贝拉唑+克拉霉素+阿莫西林克拉维酸钾+荆花胃康+摩罗丹 40 95.00 对照组 雷贝拉唑+克拉霉素+阿莫西林克拉维酸钾+替普瑞酮 40 80.00 朱友等[41] 观察组 雷贝拉唑+克拉霉素/克林霉素+阿莫西林克拉维酸钾+ 果胶铋+荆花胃康+摩罗丹 40 87.50 对照组 雷贝拉唑+克拉霉素/克林霉素+阿莫西林克拉维酸钾+果胶铋 40 67.50 
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