| Objective: Through comparison and analysis of the initial effectiveness of thebismuth-containing quadruple therapy in eradicating Hp infection in chronic gastritisand peptic ulcer patients to seek a safe, efficient and economical treatment. Andevaluating the significance of Hp immunoglobulin G(IgG)antibody quantificationdetection in the eradication of Hp by dynamic observation of IgG quantification atdifferent periods of the treatment.Method: A total of582patients with chronic gastritis and peptic ulcer who wereinfected Hp conformed to the inclusion criteria.549patients finished the therapy.456patients without penicillin allergy were randomly divided into group A, group B andgroup C, the rest of the patients with penicillin allergy were divided into group D.Group A(n=152): esomeprazole (Nexium, AstraZeneca Pharmaceutical company)20mg,taken orally half an hour before breakfast and dinner, twice a day. ColloidalBismuth Pectin Capsules(Hunan warner big pharma co.,LTD)200mg, taken orally halfan hour before breakfast and dinner,twice a day. Amoxicillin(Amoxycillin,Zhuhaifederal pharmaceutical Co.,LTD zhongshan branch)1000mg, taken orally afterbreakfast and dinner, twice a day. Clarithromycin (Klacid,Abbott laboratoriesco.,LTD.,Shanghai)500mg, taken orally after breakfast and dinner,twice a day. Theduration was14days. Group B (n=154): esomeprazole20mg,taken orally half an hourbefore breakfast and dinner, twice a day. Colloidal Bismuth Pectin Capsules200mg,taken orally half an hour before breakfast and dinner, twice a day. Amoxicillin1000mg, taken orally after breakfast and dinner, twice a day. Furazolidone (Tianjinforce pharmaceutical co.,LTD)100mg, taken orally after breakfast and dinner, twice aday. The duration was14days. Group C(n=150): esomeprazole20mg,taken orallyhalf an hour before breakfast and dinner,twice a day. Colloidal Bismuth PectinCapsules200mg, taken orally half an hour before breakfast and dinner, twice a day.Amoxicillin1000mg, taken orally after breakfast and dinner, twice a day.Moxifloxacin(Bayer pharmaceutical co.,LTD)400mg, taken orally after breakfast,once a day. The duration was14days. GroupD(n=93): esomeprazole20mg,taken orally half a hour before breakfast and dinner, twice a day. Colloidal Bismuth PectinCapsules200mg, taken orally half a hour before breakfast and dinner, twice a day.Furazolidone100mg, taken orally after breakfast and dinner, twice a day.Moxifloxacin400mg, taken orally after breakfast, once a day The duration was14days. The outcome of eradication therapy was assessed by14C-UBT performed atleast4weeks after discontinuation of treatment. Negative result represented Hperadication, otherwise, positive result represented eradication failure on the contrary.Comparison of four groups of patients with improvement of symptoms, adverse drugreactions in the process of eradication, the eradication rate and cost-effectiveness. Atthe same time,detection of serum Hp-IgG was carried respectively before treatmentand1month,3months,6months after eradicative treatment to observe the variation ofanti-Hp IgG quantification before and after the treatment. All the parameters wereanalyzed by SPSS17.0, the percentage indicated eradication rate, enumeration datawas analyzed by Chi-square test and Fisher, P＜0.05was considered statisticallysignificant difference, x±s indicated sample average, measurement data wasanalyzed by t-test, P＜0.05was considered statistically significant difference.Result:(1).Eradication rate of different therapies: According to the PPanalysis, the eradication rate in group A was85.53%, in group B was92.86%,ingroup C was85.33%, and in group D was84.95%. The eradication rate in group Bwas obviously higher than the other groups (P＜0.05). In group A, group C and groupD,the rates had no remarkable difference. According to the ITT analysis, theeradication rate in group A was80.25%, in group B was87.20%, in group C was81.01%, and in group D was80.61%, the Hp eradication rate showed no significantdifference(P＞0.05).(2) Eradication rate of chronic gastritis and peptic ulcer: Theeradication rate of patients with peptic ulcer was higher than that of patients withchronic gastritis in the4groups, but there was no significant difference(P＞0.05). Theeradication rate of all the patients with peptic ulcer was obviously higher than that ofpatients with chronic gastritis(P＜0.05). The eradication rate of patients with chronicgastritis in the4groups showed no significant difference(P＞0.05). The eradicationrate of patients with peptic ulcer in the4groups also showed no significant difference(P＞0.05).(3)Comparison of Hp-IgG quantification before and aftertreatment:Patients were seperated into eradication group and failed-eradication groupaccording to14C urea breath test at least four weeks after treatment discontinuation.The eradication group contained patients whose14C-UBT showed negative meansand the other group contained patients with positive means. Serum anti-Hp IgGquantification levels between the groups showed no significant difference beforetreatment, but the IgG levels decreased persistently in the eradication group aftertreatment and the antibody levels fallen by32.20%,51.05%and71.63%after1month,3months and6months respectively after eradication treatment than that beforethe therapy. The decline in failed-eradication group was not obvious and the antibodylevels fallen by14.96%,11.22%and7.00%after eradication treatment than thatbefore the therapy.(4)Remission rate of different therapies:The remission rate ofgroup A was89.47%, in group B was90.26%, in group C was89.33%, and in groupD was89.25%,and there was no significant difference(P＞0.05) among the4groups.(5)Incidence of adverse reactions of different therapies:The incidence ofadverse reactions of group A was7.24%,in group B was18.83%, in group C was8.67%, and in group D was21.51%. Incidence of adverse reactions in group B andgroup D were higher than that in group A and group C which did not containfurazolidone. Incidence of adverse reactions between group A and group C,as well asgroup B and group C showed no significant difference(P＞0.05).(6)Cost-effectiveness analysis of different therapies: group A:￥740.66, group B:￥473.17, group C:￥880.66, group D:￥827.13.Among the4groups,the C/E ofgroup B was the lowest.Conclusion:(1)The eradication rate of the different quadruple therapies was allover the standard of consensus by Maastricht＞80%.(2)The eradication rate ofquadruple therapy containing amoxicillin and furazolidone was remarkable higherthan the other three therapies, and the former cost-effectiveness was lower, so it wasrecommended as an efficient and economical first-line therapy in clinical promotionscheme.(3)Different quadruple therapies could all remit symptoms of dyspepsia inpatients with chronic gastritis and peptic ulcer, and had similar remission rate. But the incidence of adverse reactions in the therapies containing bismuth were obviouslyhigh, so the side-effect of furazolidone should be considered before treatment.(4)Theeradication rate of patients with peptic ulcer was higher than that of patients withchronic gastritis.(5)After eradicating Hp infection successfully, the serum anti-Hp IgGquantification was obviously lower than that before treatment, and levels of serumanti-Hp IgG quantification descend gradually as time follows. Dynamic observationof anti-Hp IgG quantification could be treated as a long-term monitoring indicator forevaluating the Hp eradication effect. |
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