幽門螺旋桿菌陽性患者首次根除治療失敗后二線治療方案的循證醫學證據_《中國循證醫學雜志》

作者：

華影 ,  董衛國 , 呂曉光

武漢大學人民醫院消化內科（武漢?430060）;

關鍵詞：

幽門螺旋桿菌感染二線治療循證醫學

DOI：

10.7507/1672-2531.20110082

視頻：

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幽門螺旋桿菌（HP）感染與慢性胃炎、消化性潰瘍及胃癌等常見的上消化道疾病的發生密切相關，而即使使用目前最有效的根治方案，仍有約10%～20%的病人經首次治療后仍然呈HP陽性，因此關于HP的根除治療仍是醫學界的一大難題。本文介紹有關HP感染首次根除治療失敗后的二線治療方案的循證醫學證據，以供臨床參考。這些證據包括馬斯特里赫特共識商討會上提出的四聯方案以及不同臨床隨機對照試驗中更換不同種類抗生素的三聯方案等。

引用本文： 華影,董衛國,呂曉光. 幽門螺旋桿菌陽性患者首次根除治療失敗后二線治療方案的循證醫學證據. 中國循證醫學雜志, 2011, 11(4): 473-476. doi: 10.7507/1672-2531.20110082 復制

1.	1 Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med , 2002, 347(476): 1175-1186.
2.	Lam SK, Talley NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. Gastroenterol Hepatol , 1998, 13(1): 1-12.
3.	Gisbert JP, Gonzalez L, Calvet X, et al . Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: ameta-analysis of eradication of Helicobacter pylori. Aliment Pharmacol Ther , 2000, 14(10): 1319-1328.
4.	Gisbert JP, Pajares JM. Helicobacter pylori”rescue”regimen when proton pump inhibitor-based triple therapies fail. Aliment Pharmacol Ther , 2002, 16(6): 1047–1057.
5.	Malfertheiner P, Megraud F, O’Morain C, et al . Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut , 2007, 56(6): 772-781.
6.	Malfertheiner P, Megraud F, O’Morain C, et al . Current concepts in the management of Helicobacter pylori infection–the Maastricht 2–2000 Consensus Report. Aliment Pharmacol Ther , 2002, 16(2): 167-180.
7.	Rokkas T, Sechopoulos P, Robotis I, et al . Cumulative HP Eradication Rates in Clinical Practice by Adopting First and Second-Line Regimens Proposed by the Maastricht III Consensus and a Third-Line Empirical Regimen. Am J Gastroenterol , 2009, 104(1): 21-25.
8.	Tong JL, Ran ZH, Shen J, et al . Sequential therapy vs. standard triple therapies for Helicobacter pylori infection: a meta-analysis. Journal of Clinical Pharmacy and Therapeutics , 2009, 34(1): 41-53.
9.	Baena JM, Lopez C, Hidalgo A, et al . Relation between alcohol consumption and the success of Helicobacter pylori eradication therapy using comprazole, clarithromycin and amoxicilline for one week. European Journal of Gastroenterology & Hepa-tology , 2002, 14(3): 291-296.
10.	Broutet N, Tchamgoue S, Pereira E, et al . Risk factors for failure of Helicobacter pylori therapy–results of an individual data analysis of 2751patients. Aliment Pharmacol Ther , 2003, 17(1): 99-109.
11.	Namiot Z, Namiot DB, Kemona A, et al . The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication. Pol Arch Med Wewn , 2000, 104(3): 569-574.
12.	Silva FM, Zaterka S, Eisig JN, et al . Factors affecting Helicobacter pylori eradication using a seven-day triple therapy with a proton pump inhibitor,tinidazole and clarithromycin,in Brazilian patients with peptic ulcer. Rev Hosp Clin Fac Med Sao Paulo , 2001, 56(1): 11-16.
13.	Koivisto TT, Rautelin HI, Voutilainen ME, et al . First-line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance:results of three eradication regimens. Aliment Pharmacol Ther , 2005, 21(6): 773-782.
14.	Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther , 2007, 26(3): 343-357.
15.	Wheeldon TU, Granstrom M, Hoang TT, et al . The importance of the level of metronidazole resistance for the success of Helicobacter pylori eradication. Aliment Pharmacol Ther , 2004, 19(12): 1315-1321.
16.	Shirai N, Sugimoto M, Kodaira C, et al . Dual therapy with high doses of rabeprazole and amoxicillin versus triple therapy with rabeprazole,amoxicillin,and metronidazole as a rescue regimen for Helicobacter pylori infection after the standard triple therapy. Eur J Clin Pharmacol , 2007, 63(8): 743-749.
17.	Nagahara A, Miwa H, Ohkura R, et al . Strategy for retreatment of therapeutic failure of eradication of Helicobacter pylori infection. J Gastroenterol Hepatol , 2001, 16(6): 613-618.
18.	Gisbert JP, Gisbert JL, Marcos S, et al . Seven-day ”rescue” therapy after Helicobacter pylori treatment failure: omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole. Aliment Pharmacol Ther , 1999, 13(10): 1311-1316.
19.	Ferri F, Festa V, Merla A, et al . Randomized study of different ‘second-line’ therapies for Helicobacter pylori infection after failure of the standard Maastricht triple therapy. Aliment Pharmacol Ther , 2003, 18(8): 815-820.
20.	Rinaldi V, Zullo A, De Francesco V, et al . Helicobacter pylori eradication with proton pump inhibitor-based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy. Aliment Pharmacol Ther , 1999, 13(2): 163-168.
21.	Zullo A, Hassan C, Campo SM, et al . A triple therapy regimen after failed Helicobacter pylori treatments. Aliment Pharmacol Ther , 2001, 15(8): 1193-1197.
22.	Wong MW, Gu Q, Lam SK, et al . Randomized controlled study of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy as second-line treatment for Helicobacter pylori infection. Aliment Pharmacol Ther , 2003, 17(4): 553-560.
23.	Isakov V, Domareva I, Koudryavtseva L, et al . Furazolidone-based triple ”rescue therapy” vs. quadruple ” rescueTherapy” for the eradication of Helicobacter pylori resistant to metronidazole. Aliment Pharmacol Ther , 2002, 16(7): 1277-1282.
24.	Miehlke S, Hansky K, Schneider-Brachert W, et al . Randomized trial of rifabutin-based triple therapy and high-dose dual therapy for rescue treatment of Helicobacter pylori resistant to both metronidazole and clarithromycin. Aliment Pharmacol Ther , 2006, 24(2): 395-403.
25.	Chao HK, Huang MH, Kuo FC, et al . Efficacy of levofloxacin-based rescue therapy for Helicobacter pylori infection after standard triple therapy: a randomized controlled trial. J Antimicrol Chemo , 2009, 63(5): 1017-1024.
26.	Gisbert JP, DE LA, Morena F. Systematic review and meta-analysis:levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther , 2006, 23(8): 1283-1285.
27.	Chi HC, Lin YC, Sheu BS, et al . Quadruple therapy containing amoxicillin and tetracycline is an effective regimen to rescue failed triple therapy by overcoming the antimicrobial resistance of Helicobacter pylori. Aliment Pharmacol Ther , 2003, 18(3): 347-353.
28.	Farup PG, Tholfsen J, Wetternus S, et al . Comparison of three triple regimens with omeprazole or ranitidine bismuth citrate for Helicobacter pylori eradication. Scand J Gastroenterol , 2002, 37(12): 1374-1379.
29.	Gisbert JP, Boixeda D, Bermejo F, et al . Re-treatment after Helicobacter pylori eradication failure. Eur J Gastroenterol Hepatol , 1999, 11(9): 1049-1054.
30.	Calvet X, Ducons J, Guardiola J, et al . One-week triple vs.quadruple therapy for Helicobacter pylori infection–arandomized trial. Aliment Pharmacol Ther , 2002, 16(7): 1261-1267.
31.	Katelaris PH, Forbes GM, Talley NJ, et al . A randomized comparison of quadruple and triple therapies for Helicobacter pylori eradication: The QUADRATE Study. Gastroenterology , 2002, 123(6): 1763-1769.
32.	Fischbach LA, Van Zanten SV, Dickason J, et al . Meta-analysis:the efficacy,adverse events,and adherence related to first-line anti-Helicobacter pylori quadruple therapies. Aliment Pharmacol Ther , 2004, 20(10): 1071-1082.
33.	Phillips PH, Whitehead MW, Doig LA, et al . Is eradication of Helicobacter pylori with colloidal bismuth subcitrate quadruple therapy safe?. Helicobacter , 2001, 6(2): 151-156.
34.	Hung K, Wong M. One-week ranitidine bismuth citrate,amoxicillin and metronidazole triple therapy for the treatment of Helicobacter pylori infection in Chinese. Aliment Pharmacol Ther , 2002, 16(12): 2067-2072.
35.	Alarcon T, Domingo D, Lopez-Brea M. Antibiotic resistance problems with Helicobacter pylori. Int J Antimicrob Agents , 1999, 12(1): 19-26.
36.	Peitz U, Hackelsberger A, Malfertheiner PA. Practical approach to patients with refractory Helicobacter pylori infection, or who are re-infected after standard therapy. Drugs , 1999, 57(6): 905-920.
37.	Deltenre M, Ntounda R, Jonas C, et al . Eradication of Helicobacter pylori: why does it fail?. Ital J Gastroenterol Hepatol , 1998, 30(Suppl.3): S326-328.
38.	Gomollón F, Valdeperez J. Cost-effectiveness analysis of 2 strategies of Helicobacter pylori eradication: results of a prospective and randomized study in primary care. Med Clin , 2000, 115(1): 1-6.
39.	Huang JQ, Hunt RH. Treatment after failure: the problem of ’non-responders’. Gut , 1999, 45(Suppl. 1): 140-144.
40.	Graham DY, Lew GM, Malaty HM, et al . Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology , 1992, 102(2): 493-496.
41.	Wermeille J, Dederding JP, Cunningham M, et al . Failure of Helicobacter pylori eradication in an ambulatory population:Is poor compliance the main cause?. Digestion , 1998, 59(Suppl.3): 437.
42.	Battaglia G, Di Mario F, Vigneri S, et al . Strategy for the retreatment of failed Helicobacter pylori eradication therapy:a case series. Ital J Gastroenterol Hepatol , 1998, 30(4): 370-374.

1. 1 Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med , 2002, 347(476): 1175-1186.
2. Lam SK, Talley NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. Gastroenterol Hepatol , 1998, 13(1): 1-12.
3. Gisbert JP, Gonzalez L, Calvet X, et al . Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: ameta-analysis of eradication of Helicobacter pylori. Aliment Pharmacol Ther , 2000, 14(10): 1319-1328.
4. Gisbert JP, Pajares JM. Helicobacter pylori”rescue”regimen when proton pump inhibitor-based triple therapies fail. Aliment Pharmacol Ther , 2002, 16(6): 1047–1057.
5. Malfertheiner P, Megraud F, O’Morain C, et al . Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut , 2007, 56(6): 772-781.
6. Malfertheiner P, Megraud F, O’Morain C, et al . Current concepts in the management of Helicobacter pylori infection–the Maastricht 2–2000 Consensus Report. Aliment Pharmacol Ther , 2002, 16(2): 167-180.
7. Rokkas T, Sechopoulos P, Robotis I, et al . Cumulative HP Eradication Rates in Clinical Practice by Adopting First and Second-Line Regimens Proposed by the Maastricht III Consensus and a Third-Line Empirical Regimen. Am J Gastroenterol , 2009, 104(1): 21-25.
8. Tong JL, Ran ZH, Shen J, et al . Sequential therapy vs. standard triple therapies for Helicobacter pylori infection: a meta-analysis. Journal of Clinical Pharmacy and Therapeutics , 2009, 34(1): 41-53.
9. Baena JM, Lopez C, Hidalgo A, et al . Relation between alcohol consumption and the success of Helicobacter pylori eradication therapy using comprazole, clarithromycin and amoxicilline for one week. European Journal of Gastroenterology & Hepa-tology , 2002, 14(3): 291-296.
10. Broutet N, Tchamgoue S, Pereira E, et al . Risk factors for failure of Helicobacter pylori therapy–results of an individual data analysis of 2751patients. Aliment Pharmacol Ther , 2003, 17(1): 99-109.
11. Namiot Z, Namiot DB, Kemona A, et al . The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication. Pol Arch Med Wewn , 2000, 104(3): 569-574.
12. Silva FM, Zaterka S, Eisig JN, et al . Factors affecting Helicobacter pylori eradication using a seven-day triple therapy with a proton pump inhibitor,tinidazole and clarithromycin,in Brazilian patients with peptic ulcer. Rev Hosp Clin Fac Med Sao Paulo , 2001, 56(1): 11-16.
13. Koivisto TT, Rautelin HI, Voutilainen ME, et al . First-line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance:results of three eradication regimens. Aliment Pharmacol Ther , 2005, 21(6): 773-782.
14. Fischbach L, Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Aliment Pharmacol Ther , 2007, 26(3): 343-357.
15. Wheeldon TU, Granstrom M, Hoang TT, et al . The importance of the level of metronidazole resistance for the success of Helicobacter pylori eradication. Aliment Pharmacol Ther , 2004, 19(12): 1315-1321.
16. Shirai N, Sugimoto M, Kodaira C, et al . Dual therapy with high doses of rabeprazole and amoxicillin versus triple therapy with rabeprazole,amoxicillin,and metronidazole as a rescue regimen for Helicobacter pylori infection after the standard triple therapy. Eur J Clin Pharmacol , 2007, 63(8): 743-749.
17. Nagahara A, Miwa H, Ohkura R, et al . Strategy for retreatment of therapeutic failure of eradication of Helicobacter pylori infection. J Gastroenterol Hepatol , 2001, 16(6): 613-618.
18. Gisbert JP, Gisbert JL, Marcos S, et al . Seven-day ”rescue” therapy after Helicobacter pylori treatment failure: omeprazole, bismuth, tetracycline and metronidazole vs. ranitidine bismuth citrate, tetracycline and metronidazole. Aliment Pharmacol Ther , 1999, 13(10): 1311-1316.
19. Ferri F, Festa V, Merla A, et al . Randomized study of different ‘second-line’ therapies for Helicobacter pylori infection after failure of the standard Maastricht triple therapy. Aliment Pharmacol Ther , 2003, 18(8): 815-820.
20. Rinaldi V, Zullo A, De Francesco V, et al . Helicobacter pylori eradication with proton pump inhibitor-based triple therapies and re-treatment with ranitidine bismuth citrate-based triple therapy. Aliment Pharmacol Ther , 1999, 13(2): 163-168.
21. Zullo A, Hassan C, Campo SM, et al . A triple therapy regimen after failed Helicobacter pylori treatments. Aliment Pharmacol Ther , 2001, 15(8): 1193-1197.
22. Wong MW, Gu Q, Lam SK, et al . Randomized controlled study of rabeprazole, levofloxacin and rifabutin triple therapy vs. quadruple therapy as second-line treatment for Helicobacter pylori infection. Aliment Pharmacol Ther , 2003, 17(4): 553-560.
23. Isakov V, Domareva I, Koudryavtseva L, et al . Furazolidone-based triple ”rescue therapy” vs. quadruple ” rescueTherapy” for the eradication of Helicobacter pylori resistant to metronidazole. Aliment Pharmacol Ther , 2002, 16(7): 1277-1282.
24. Miehlke S, Hansky K, Schneider-Brachert W, et al . Randomized trial of rifabutin-based triple therapy and high-dose dual therapy for rescue treatment of Helicobacter pylori resistant to both metronidazole and clarithromycin. Aliment Pharmacol Ther , 2006, 24(2): 395-403.
25. Chao HK, Huang MH, Kuo FC, et al . Efficacy of levofloxacin-based rescue therapy for Helicobacter pylori infection after standard triple therapy: a randomized controlled trial. J Antimicrol Chemo , 2009, 63(5): 1017-1024.
26. Gisbert JP, DE LA, Morena F. Systematic review and meta-analysis:levofloxacin-based rescue regimens after Helicobacter pylori treatment failure. Aliment Pharmacol Ther , 2006, 23(8): 1283-1285.
27. Chi HC, Lin YC, Sheu BS, et al . Quadruple therapy containing amoxicillin and tetracycline is an effective regimen to rescue failed triple therapy by overcoming the antimicrobial resistance of Helicobacter pylori. Aliment Pharmacol Ther , 2003, 18(3): 347-353.
28. Farup PG, Tholfsen J, Wetternus S, et al . Comparison of three triple regimens with omeprazole or ranitidine bismuth citrate for Helicobacter pylori eradication. Scand J Gastroenterol , 2002, 37(12): 1374-1379.
29. Gisbert JP, Boixeda D, Bermejo F, et al . Re-treatment after Helicobacter pylori eradication failure. Eur J Gastroenterol Hepatol , 1999, 11(9): 1049-1054.
30. Calvet X, Ducons J, Guardiola J, et al . One-week triple vs.quadruple therapy for Helicobacter pylori infection–arandomized trial. Aliment Pharmacol Ther , 2002, 16(7): 1261-1267.
31. Katelaris PH, Forbes GM, Talley NJ, et al . A randomized comparison of quadruple and triple therapies for Helicobacter pylori eradication: The QUADRATE Study. Gastroenterology , 2002, 123(6): 1763-1769.
32. Fischbach LA, Van Zanten SV, Dickason J, et al . Meta-analysis:the efficacy,adverse events,and adherence related to first-line anti-Helicobacter pylori quadruple therapies. Aliment Pharmacol Ther , 2004, 20(10): 1071-1082.
33. Phillips PH, Whitehead MW, Doig LA, et al . Is eradication of Helicobacter pylori with colloidal bismuth subcitrate quadruple therapy safe?. Helicobacter , 2001, 6(2): 151-156.
34. Hung K, Wong M. One-week ranitidine bismuth citrate,amoxicillin and metronidazole triple therapy for the treatment of Helicobacter pylori infection in Chinese. Aliment Pharmacol Ther , 2002, 16(12): 2067-2072.
35. Alarcon T, Domingo D, Lopez-Brea M. Antibiotic resistance problems with Helicobacter pylori. Int J Antimicrob Agents , 1999, 12(1): 19-26.
36. Peitz U, Hackelsberger A, Malfertheiner PA. Practical approach to patients with refractory Helicobacter pylori infection, or who are re-infected after standard therapy. Drugs , 1999, 57(6): 905-920.
37. Deltenre M, Ntounda R, Jonas C, et al . Eradication of Helicobacter pylori: why does it fail?. Ital J Gastroenterol Hepatol , 1998, 30(Suppl.3): S326-328.
38. Gomollón F, Valdeperez J. Cost-effectiveness analysis of 2 strategies of Helicobacter pylori eradication: results of a prospective and randomized study in primary care. Med Clin , 2000, 115(1): 1-6.
39. Huang JQ, Hunt RH. Treatment after failure: the problem of ’non-responders’. Gut , 1999, 45(Suppl. 1): 140-144.
40. Graham DY, Lew GM, Malaty HM, et al . Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology , 1992, 102(2): 493-496.
41. Wermeille J, Dederding JP, Cunningham M, et al . Failure of Helicobacter pylori eradication in an ambulatory population:Is poor compliance the main cause?. Digestion , 1998, 59(Suppl.3): 437.
42. Battaglia G, Di Mario F, Vigneri S, et al . Strategy for the retreatment of failed Helicobacter pylori eradication therapy:a case series. Ital J Gastroenterol Hepatol , 1998, 30(4): 370-374.

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《中國循證醫學雜志》

幽門螺旋桿菌陽性患者首次根除治療失敗后二線治療方案的循證醫學證據

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《中國循證醫學雜志》

幽門螺旋桿菌陽性患者首次根除治療失敗后二線治療方案的循證醫學證據

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