| Objective:To investigate the relationship between Helicobacter pylori?H.pylori?intragastric load,different virulence subtypes and H.pylori eradication rate,and to guide clinical drug use.Methods:Selected patients who from the Department of Gastroenterology,Affiliated Hospital of Beihua University for upper digestive symptoms,examined by gastroscopy,13C-urea breath test(13C-UBT)and serum Helicobacter pylori cytotoxin-associated gene A antigen IgG antibodies?HP-CagA-IgG?.According to the inclusion criteria and exclusion criteria,192 patients with chronic gastritis or peptic ulcer with H.pylori infection were selected as the study subjects,and record the results of the 13C-UBT delta over baseline?DOB?.All patients were given a bismuth quadruple therapy?rabeprazole+bismuth+Amoxicillin+Clarithromycin?,10-day or 14-day eradication therapy for H.pylori.H.pylori eradication rate was assessed by 13C-UBT,four weeks the course of treatment,and the patients with peptic ulcer need to continue oral rabeprazole 2-6 weeks.Results:?1?Comparison of general information between the two groups:A total of 192 patients enrolled,93 males and 99 females,aged 19-76years,mean age?49.93±12.66?,chronic active gaatritis 82 cases,110 cases of peptic ulcer,serum anti-cagA positive in 146 cases and negative in 46cases,mean DOB?27.99±24.75?.All patients were randomly divided into two groups according to the course of treatment:10 days and 14 days.A total of 3 patients were missed of 10-day group due to irregular medication and not-reviewing.The actual number was 94 cases in 10-day group,including 46 males and 48 females;aged 21-76 years,mean age?48.41±11.94?,chronic active gaatritis 41 cases,53 cases of peptic ulcer,serum anti-cagA positive in 74 cases and negative in 20 cases,mean DOB?27.26±24.82?.A total of 4 patients were missed of 14-day group due to irregularmedication and not-reviewing.The actual number was 91cases in 14-day group,including 43 males and 48 females;aged 19-74years,mean age?48.41±11.94?,chronic active gaatritis 40 cases,52 cases of peptic ulcer,serum anti-cagA positive in 68 cases and negative in 23cases,mean DOB?28.88±24.86?.Patientsin each group showed no significant difference in age,gender,disease,DOB and serum anti-CagA classification?P>0.05?.?Table 3.2??2?Comparison of H.pylori eradication rate:In the 10-day group,a total of 97 cases,3 patients were missed due to irregular medication and not-reviewing and 78 cases were successfully eradicated.In the 14-day group,a total of95 cases,4 patients were missed due to irregular medication and not-reviewing and 78 cases were successfully eradicated.The H.pylori eradication rates of two groups by Per-protocol?PP?analysis were 82.97%?78/94?,93.41%?85/91?,res-pectively,by intention-to-treat?ITT?analysis were 80.41%?78/97?,89.47%?85/95?,respectively,the difference was not statistically significant?P>0.05?.?Table 3.3??3?Comparison of H.pylori eradication rates with different DOB values:Basal DOB values were categorized as underload?<16?,intermediate load?16-35?,high load?>35?,as suggested in previous studies by Italian scholar Perri et al.[1]and domestic scholars Xiaojuan Li et al.[2]Analysis of the difference of H.pylori eradication rate among different groups of intragastric load,as shown in Table 3.4,in the 10-day group,the eradication rates of H.pylori were different among the groups with intragastric load,and the difference has statistical significance?P<0.05?.However,this difference was not found in the 14-day group?P>0.05?.Taking the DOB value as a stratification factor,analysis of H.pylori eradication rates in the 10-day and 14-day groups,as shown in Table 3.5and Figure 3.3,there was no significant difference in H.pylori eradication rate between low-load group and medium-load group in different courses of treatment?P>0.05?.However,there were significant differences in H.pylori eradication rates among different courses of treatment in the high-load group?P<0.05?.It is indicated that the course of treatment is the influencing factor of eradication rate in the high-load group,and the risk of eradication failure in the 10-day group is 4.000?0.967-16.551?in the14-day group.?4?Comparison of H.pylori eradication rate of different serum CagA antibody status:According to the serum anti-CagA status,they were divided into positive group and negative group.Analysis of the difference of H.pylori eradication rate among different of CagA status,as shown in Table3.6,The H.pylori eradication rate in the positive group was significantly higher than that in the negative group during the 10-day course,and the difference has statistical significance?P<0.05?.This difference was not found during the 14-day treatment?P<0.05?.Taking the CagA status as a stratification factor,analysis of H.pylori eradication rates in the 10-day and 14-day groups,as shown in Table 3.7 and Figure 3.4,only the difference of H.pylori eradication rate among different courses of treatment in negative group was statistically significant?P<0.05?.It is indicated that the course of treatment is the influencing factor of eradication rate in the negative group,and the risk of eradication failure in the 10-day group is 3.088?0.950-10.012?in the 14-day group.?5?Comparison of eradication rates of H.pylori in different courses of treatment by combination of DOB value and serum anti-CagA:Combination of different DOB values and serum anti-CagA status wasdivided into the following six groups:Group A?anti-CagA positive+low load?,Group B?anti-CagA positive+medium load?,group C?anti-CagA positive+high load?,group D?anti-CagA negative+low load?,group E?anti-CagA negative+medium load?,group F?anti-CagA negative+high load?.Taking the CagA status and DOB values as the stratification factor,analysis of H.pylori eradication rates in the 10-day and 14-day groups,as shown in Table 3.8 and Figure 3.5,there was no significant difference in eradication rate between groups A and B in different courses of treatment?P>0.05?.There were significant differences in eradication rates among the other groups in different courses of treatment?P<0.05?.Conclusions:?1?According to the different virulence subtypes of H.pylori,the effect of H.pylori eradication can be predicted.For patients with negative serum anti-CagA,a 14-day is recommended,which can improve the eradication rate.?2?According to H.pylori intragastric load?DOB value?,the H.pylori eradication effect can be predicted,and a 14-day is recommended for high-loaders,which can improve the eradication rate. |
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