- 期刊
醇提大黃對消化性潰瘍合併幽門螺旋桿菌感染之作用探討
The Effect of Alcohol Extracted Dahuang (Rhubarb) on Peptic Ulcer Disease with ＂Helicobacter pylori＂ Infection
摘要
幽門螺旋桿菌（＂Helicobacter pylori＂, Hp）已被認為是消化性潰瘍復發的主要因子，臨床上根除Hp可有效降低潰瘍的復發率。動物實驗及臨床研究報告皆曾證實大黃除了可作為治療潰瘍的藥物外，亦能對抗Hp。本研究的目的是要探討醇提大黃對消化性潰瘍的療效、對Hp的根除率及副作用，並與另一具Hp抑制力的潰瘍藥物－鉍製劑及三合療法作比較。自民國86年1月至87年6月在本院接受上消化道內視鏡檢查證實有活動性消化性潰瘍合併Hp感染者以隨機分組方式分為三組，各給予不同的治療。大黃組只給予醇堤大黃膠囊（500毫克）1天3次，每次2粒，8週。De-Nol組只給予De-Nol（120毫克）1天4次，1次1粒，8週；三合組則接受三合療法，包括De-Nol加metronidazole（250毫克）及tetracycline（500毫克），1天4次，每次各1粒，治療2週後再給予De-Nol治療6週。於治療完成後1個月追蹤上消化道內視鏡及Hp之測試。共有98位患者納入研究（男性71名，女性27名，平均年齡41.7歲），三組之人數依次為32，26，及40人。三組之年齡、性別、抽菸人數比例，皆無差別。上腹痛之緩解以三合組效果最好，一週內即有顯著緩解者佔75.0%，其次為大黃組（56.2%），最差的是De-Nol組（34.6%）。潰瘍癒合率三組依次為40.6%，53.8%及82.5%（p＜0.05）；Hp之根除率三組依次為6.2%，15.4%及80.0%（p＜0.05），而大黃組與De-Nol組無論在潰瘍癒合及Hp根除皆無差別。藥物的副作用輕微，發生率依次為21.9%，30.8%，及27.5%（p＜0.05）。本研究結果顯示單獨使用大黃對消化性潰瘍的療效不佳，且無明顯抑制Hp之效果。目前對於Hp陽性之消化性潰瘍患者，三合療法仍是最佳選擇。
並列摘要
＂Helicobacter pylori＂ (Hp) has been reported as an important factor of recurrence in peptic ulcer disease. Clinically, the ulcer recurrence rate will be much reduced when the Hp has been eradicated. In the literature, Dahuang has been reported to have the efficacy to cure peptic ulcer and also has anti-Hp effect. The aim of this study was to evaluate the efficacy of alcohol extracted Dahuang in the treatment of peptic ulcer disease, eradication rate of Hp and the side effects of the drugs. Ninety-eight consecutive cases were randomized to three groups according to the date of endoscopic examination in China Medical College Hospital from January 1997 to Jun 1998. Group I (n=32), Dahuang (500 mg) 2 tablets tid for 8 weeks. Group II (n=26), De-Nol (120 mg) 1 tablet qid for 8 weeks. Group III (n=40), De-Nol 120 mg qid, metronidazole 250 mg qid and tetracycline 500 mg qid for 2 weeks then De-Nol 120 mg qid for another 6 weeks. Follow-up endoscopic examination was performed 1 month later. The results of this study showed that triple therapy provided the best effect of symptom relief. After treatment for 1 week, 56.2% of patients in Group I, 34.6% in Group II and 75.0% in Group III had complete symptom relief (p＜0.01). The ulcer healing rates are 40.6% in Group I, 53.8% in Group II and 82.5% in Group III (p＜0.05). Hp eradication rates are 6.2% (Group I), 15.4% (Group II ) and 80.0% (Group III), respectively (p＜0.01). No significant difference in ulcer healing rate and Hp eradication rate between Group I and Group II was observed. Side effects of these drugs were mild and there was no significant difference in side effects among these three groups. We concluded that the efficacy of alcohol extracted Dahuang alone to treat peptic ulcer is poor and no obvious effect to inhibit the growth of Hp in patients with peptic ulcer disease. Triple therapy is still the best choice for Hp-associated peptic ulcer disease.