Patient Factors Affecting Helicobacter Pylori Eradication Therapy

許多幽門螺旋桿菌治療藥物組合已被報告具有相當療效，卻很難有百分之百的療效。為瞭解影響此治療的病人因子，我們蒐集111例接受5種除菌藥物組合治療並順從性優良的消化性潰瘍合併幽門桿菌感染患者，利用電話訪視及病歷查閱得到病患基本人口學資料，吸菸、飲酒等生活習慣，慢性病史，消化性潰瘍既往史，內視鏡檢潰瘍位置，同時期用藥記錄等。患者治療前幽門桿菌感染狀態以內視鏡檢在幽門及胃體部所得之切片利用快速尿素酶試驗及modified Giemsa's組織染色判定；治療結果判定則在治療後4-6週的內視鏡檢進行同樣的切片檢查，兩者皆陰性的患者並加作碳-13尿素呼氣試驗。當所有檢查皆呈陰性時判定治療成功。本研究利用單變項分析以及多變項羅締斯迴歸模式(multiple logistic regression model)試圖找出預測治療結果之獨立變項。本分析有效樣本共104例，單變項分析中，除治療組別外並未發現在治療成功與失敗者間有顯著不同的因子。多變項分析中，控制治療組別因子後，也沒有統計學顯著之獨立變項存在。本分析中Metronidazole抗藥性的角色因無細菌培養資料，未加探討。治療組的差異意味選擇有效藥物組合的重要。排除順從性之外，本研究並未發現顯著影響幽門螺旋桿菌治療的病人因子。

關鍵字

消化性潰瘍；幽門螺旋桿菌；清除治療；危險因子

並列摘要

Various regimes effectively eradicate Helicobacter pylori (H. pylori) in infected peptic ulcer patients. Few of them reveal perfect outcomes. Several factors are reported to be associated with the success of the eradication therapy. In order to elucidate potential influencing patient factors of H. pylori eradication therapy in Taiwan, 111 H. pylori-associated peptic ulcer patients with excellent compliance (drugs consumption greater than 95%) were recruited. Potential factors were collected by telephone interview and medical record review. Variables analyzed included age, gender, past history of peptic ulcer disease, ulcer location, habits of cigarette smoking, alcohol drinking, pretreatment with proton-pump inhibitors or histamine-2 receptor antagonists and history of diabetes or hypertension. H. pylori status was determined by rapid urease test and modified Giemsa’s staining histology in endoscopically biospsied specimen while (superscript 13)C-urea breath test was further added in post-treatment determination. 104 patients responded and were included in this analysis; 70% of them were treated with ranitidine-based regimes. Regardless of ranitidine-based or omeprozole-based regimes, no significantly affecting factors could be found except for different treatment groups in univariate analysis; in addition, no significant variables were selected in multiple logistic regression model controlling treatment groups. Ranitidine plus amoxicillin dual therapy eradicated H. pylori less effectively (P＜0.001). 52.9% of the patients were treated with metronidazole-containing regimes with 8 failure cases. Metronidazole-resistance was not assessed due to no culture data available in this series. This analysis suggests the importance of selecting efficient regimes and that, excluding compliance, no patient factors significantly affected the outcomes of H. pylori eradication therapy.

並列關鍵字

peptic ulcer ； Helicobacter pylori ； eradication ； risk factor

國際替代計量

Patient Factors Affecting Helicobacter Pylori Eradication Therapy

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