| Objective:The aim of this study was to investigate the long-term follow up of HP-IgG after quadruple therapy,and to provide the dynamic change of IgG quantification and its value in monitoring Helicobacter pylori recrudescence or reinfection.Methods:A total of 1046 patients with chronic gastritis and peptic ulcer who were infected HP conformed to the inclusion criteria, patients without penicillin allergy were randomly divided into group A+F,group A+C and group A+L, the rest of the patients with penicillin allergy were divided into group L+F. Except for same esomeprazole(Nexium,Astra Zeneca Pharmaceutical company) 20mg,taken orally half an hour before breakfast and dinner, twice a day and Colloidal Bismuth Pectin Capsules(Hunan warner big pharma co.,LTD)220mg, taken orally half an hour before breakfast and dinner,twice a day.Group A+F(n=275):Amoxicillin (Amoxycillin,Zhuhai federal pharmaceutical Co.,LTD zhongshan branch)1000mg, taken orally after breakfast and dinner, twice a day. Clarithromycin (Klacid,Abbott laboratories co.,LTD.,Shanghai) 500mg, taken orally after breakfast and dinner,twice a day. The duration was 14 days. Group A+C(n=268):Amoxicillin 1000mg, taken orally after breakfast and dinner, twice a day. Furazolidone (Tianjin force pharmaceutical co.,LTD)100mg, taken orally after breakfast and dinner, twice a day.The duration was 14 days. GroupA+L(n=266):Amoxicillin 1000mg, taken orally after breakfast and dinner, twice a day.Levofloxacin(Zhejiang force pharmaceutical co,LTD) 200mg, taken orally after breakfast and dinner, twice a day. The duration was 14 days. Group L+F(n=237):Levofloxacin 200mg, taken orally after breakfast and dinner, twice a day.The duration was 14 days. The outcome of eradication therapy was assessed by 13C-UBT performed at least 4 weeks after discontinuation of treatment. Negative result represented HP eradication, otherwise, positive result represented eradication failure on the contrary. A 18 month follow up was performed for the eradication patients.Detection of serum HP-IgG was carried respectively before treatment and 1 month、3 months、 6 months、 9 months、 12 months and 18 months after eradicative treatment to observe the variation of anti HP-IgG quantification after the treatment and its value for determinating HP recurrence.Statistical Analysis:all the parameters were analyzed by SPSS 17.0, the percentage indicated eradication rate, enumeration data was analyzed by Chi-square test and Fisher, x±s indicated sample average, measurement data was analyzed by t-test.The risk of H. pylori recurrence with time was estimated using the Kaplan-Meier method. To determine the risk factors for recurrence, we used the log-rank test. P<0.05 was considered statistically significant difference.Results:1.the eradication rate of A+F, A+C, A+L,L+C group was 88.36%,89.17%,84.59%,83.54%,and the general eradiction rate was 86.52%.2.The initial HP-IgG quantification 81.85 RU/ml gradually decreased to 5.38 RU/ml at 18 months after HP eradication in those 13-UBT continued negtive.HP-IgG titers abruptly increased in cases with recrudescene and reinfection.3.HP-IgG quantification recurrence is higher than 13C-UBT recurrence, and the difference is signifcant.4.56 patients showed recurrence.The recurrence rate was 6.82%, recurrence rate 1 year after eradication was 5.97%, recurrence rate after 1 year was 0.61%.There are no differences in the recurrence rates according to clinical diagnosis and the regimen used.Conclusion:1.The eradication rate of the different quadruple therapy was all over the standard of consensus by Maastricht>80%.2.HP-IgG serology could be used for the determination of recurrence of HP,HP-IgG monitoring may detect HP recurrence earlier than 13C-UBT.3.The recurrence rate was relatively low after quadruple therapy,most accurred in 1 year after HP eradication,and there are no differences in the recurrence rates according to clinical diagnosis and the regimen used. |
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