Article(id=1239201875107574234, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1239201870791627164, articleNumber=null, orderNo=null, doi=10.14109/j.cnki.xyylc.2024.03.10, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1653580800000, receivedDateStr=2022-05-27, revisedDate=null, revisedDateStr=null, acceptedDate=1688659200000, acceptedDateStr=2023-07-07, onlineDate=1773378350282, onlineDateStr=2026-03-13, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773378350282, onlineIssueDateStr=2026-03-13, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773378350282, creator=13701087609, updateTime=1773378350282, updator=13701087609, issue=Issue{id=1239201870791627164, tenantId=1146029695717560320, journalId=1205117082300743687, year='2024', volume='43', issue='3', pageStart='161', pageEnd='240', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773378349254, creator=13701087609, updateTime=1773378470498, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1239202379392938830, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1239201870791627164, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1239202379397133135, tenantId=1146029695717560320, journalId=1205117082300743687, issueId=1239201870791627164, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=213, endPage=216, ext={EN=ArticleExt(id=1239201876730769897, articleId=1239201875107574234, tenantId=1146029695717560320, journalId=1205117082300743687, language=EN, title=Effect of quadruple therapy with vonoprazan on eradication of Helicobacter pylori infection, columnId=1207314218647392369, journalTitle=Chinese Journal of New Drugs and Clinical Remedies, columnName=Original Article, runingTitle=null, highlight=null, articleAbstract=
AIM

To observe the effect of vonoprazan quadruple 14-day therapy on Helicobacter pyloriHp) infection.

METHODS

A total of 120 Hp positive patients were included and divided into treatment group and control group, 60 cases in each group. The treatment group was given vonoprazan 20 mg + bismuth potassium citrate 220 mg + amoxicillin 1 000 mg+ furazoldone 100 mg, and the control group was given omeprazole 20 mg+ amoxicillin 1 000 mg+ bismuth potassium citrate 220 mg+ furazoldone 100 mg, twice a day for 14 days. The 14C-urea breath test was performed in all patients 4 to 6 weeks after the course of treatment, and the eradication rate of Hp and the occurrence of adverse reactions in the two groups were observed respectively.

RESULTS

Among the 120 patients included, there were 57 males and 63 females, aged from 20 to 69 years old, with an average age of (37.9±5.4) years. The Hp eradication rate in the treatment group was higher than that in the control group (97% vs. 80%, P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).

CONCLUSION

Quadruple 14-day therapy with vonoprazan is a safe and highly effective treatment for Hp eradication and can be used as a first- and second-line treatment.

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目的

观察含伏诺拉生的四联14 d疗法治疗幽门螺杆菌(Hp)感染的效果。

方法

回顾性分析120例Hp阳性患者,将其按治疗方案分为治疗组和对照组,各60例。治疗组口服伏诺拉生20 mg+枸橼酸铋钾220 mg+阿莫西林1 000 mg+呋喃唑酮100 mg;对照组口服奥美拉唑20 mg+阿莫西林1 000 mg+枸橼酸铋钾220 mg+呋喃唑酮100 mg,均每日2次,共14 d。患者均在疗程结束后4~6周内行14C-尿素呼气试验,分别观察2组Hp根除情况及不良反应的发生情况。

结果

纳入的120例患者中,男性57例,女性63例,年龄20~69岁,平均(37.9±5.4)岁,Hp根除率治疗组高于对照组(97% vs. 80%,P < 0.05)。2组不良反应发生率无显著差异(P > 0.05)。

结论

含伏诺拉生的四联14 d疗法治疗Hp感染是一种安全高效的根除Hp治疗方法,可作为一线及二线治疗方案。

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钟万锷,男,副主任医师,硕士,主要从事胃肠道疾病与幽门螺杆菌感染的研究,E-mail:

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钟万锷,男,副主任医师,硕士,主要从事胃肠道疾病与幽门螺杆菌感染的研究,E-mail:

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不良反应对照组治疗组
头晕1(2)1(2)
发热2(3)1(2)
恶心2(3)2(3)
皮疹1(2)1(2)
口苦1(2)0(0)
腹痛3(5)4(7)
肝肾功能异常0(0)1(2)
食欲减退2(3)3(5)
合计12(20)13(22)
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2组患者不良反应发生率比较

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不良反应对照组治疗组
头晕1(2)1(2)
发热2(3)1(2)
恶心2(3)2(3)
皮疹1(2)1(2)
口苦1(2)0(0)
腹痛3(5)4(7)
肝肾功能异常0(0)1(2)
食欲减退2(3)3(5)
合计12(20)13(22)
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含伏诺拉生四联疗法根除幽门螺杆菌感染的疗效
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钟万锷 , 曹萍
中国新药与临床杂志 | 论著 2024,43(3): 213-216
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中国新药与临床杂志 | 论著 2024, 43(3): 213-216
含伏诺拉生四联疗法根除幽门螺杆菌感染的疗效
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钟万锷 , 曹萍
作者信息
  • 宁波市第六医院 消化内科,浙江 宁波 315040
  • 钟万锷,男,副主任医师,硕士,主要从事胃肠道疾病与幽门螺杆菌感染的研究,E-mail:

Effect of quadruple therapy with vonoprazan on eradication of Helicobacter pylori infection
Wan-e ZHONG , Ping CAO
Affiliations
  • Department of Gastroenterology, Ningbo No 6 Hospital, Ningbo ZHEJIANG 315040, China
出版时间: 2024-03-25 doi: 10.14109/j.cnki.xyylc.2024.03.10
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目的

观察含伏诺拉生的四联14 d疗法治疗幽门螺杆菌(Hp)感染的效果。

方法

回顾性分析120例Hp阳性患者,将其按治疗方案分为治疗组和对照组,各60例。治疗组口服伏诺拉生20 mg+枸橼酸铋钾220 mg+阿莫西林1 000 mg+呋喃唑酮100 mg;对照组口服奥美拉唑20 mg+阿莫西林1 000 mg+枸橼酸铋钾220 mg+呋喃唑酮100 mg,均每日2次,共14 d。患者均在疗程结束后4~6周内行14C-尿素呼气试验,分别观察2组Hp根除情况及不良反应的发生情况。

结果

纳入的120例患者中,男性57例,女性63例,年龄20~69岁,平均(37.9±5.4)岁,Hp根除率治疗组高于对照组(97% vs. 80%,P < 0.05)。2组不良反应发生率无显著差异(P > 0.05)。

结论

含伏诺拉生的四联14 d疗法治疗Hp感染是一种安全高效的根除Hp治疗方法,可作为一线及二线治疗方案。

伏诺拉生  /  四联疗法  /  幽门螺杆菌
AIM

To observe the effect of vonoprazan quadruple 14-day therapy on Helicobacter pyloriHp) infection.

METHODS

A total of 120 Hp positive patients were included and divided into treatment group and control group, 60 cases in each group. The treatment group was given vonoprazan 20 mg + bismuth potassium citrate 220 mg + amoxicillin 1 000 mg+ furazoldone 100 mg, and the control group was given omeprazole 20 mg+ amoxicillin 1 000 mg+ bismuth potassium citrate 220 mg+ furazoldone 100 mg, twice a day for 14 days. The 14C-urea breath test was performed in all patients 4 to 6 weeks after the course of treatment, and the eradication rate of Hp and the occurrence of adverse reactions in the two groups were observed respectively.

RESULTS

Among the 120 patients included, there were 57 males and 63 females, aged from 20 to 69 years old, with an average age of (37.9±5.4) years. The Hp eradication rate in the treatment group was higher than that in the control group (97% vs. 80%, P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).

CONCLUSION

Quadruple 14-day therapy with vonoprazan is a safe and highly effective treatment for Hp eradication and can be used as a first- and second-line treatment.

vonoprazan  /  quadruple therapy  /  Helicobacter pylori
钟万锷, 曹萍. 含伏诺拉生四联疗法根除幽门螺杆菌感染的疗效. 中国新药与临床杂志, 2024 , 43 (3) : 213 -216 . DOI: 10.14109/j.cnki.xyylc.2024.03.10
Wan-e ZHONG, Ping CAO. Effect of quadruple therapy with vonoprazan on eradication of Helicobacter pylori infection[J]. Chinese Journal of New Drugs and Clinical Remedies, 2024 , 43 (3) : 213 -216 . DOI: 10.14109/j.cnki.xyylc.2024.03.10
幽门螺杆菌(Helicobacter pylori, Hp)感染是导致胃炎、消化性溃疡、消化道肿瘤等疾病的重要原因,根除Hp具有重要意义。质子泵抑制剂(proton pump inhibitor,PPI)联合两种抗生素的三联疗法曾经是公认的Hp根除治疗方案,但由于抑酸效果不理想,且抗生素耐药等问题,含PPI三联疗法的Hp根除率已从20世纪90年代的90%降至日前的70%左右[1]。如何提高Hp根除率仍是目前研究的热点和难点,其中含PPI四联疗法已成为目前的主要治疗方案。由于Hp的生存与胃内酸碱度(pH)相关,充分的酸抑制对于根除Hp具有非常重要的作用[2]。伏诺拉生(vonoprazan)是一种新型钾竞争型酸阻滞剂(potassium-competitive acid blocker,P-CAB),其主要是以钾离子竞争性方式可逆性抑制H+/K+-ATP酶活性,能长时间停留于胃壁细胞部位而抑制胃酸的生产[3]。伏诺拉生主要通过肝脏药物代谢酶CYP3A4代谢,其代谢受CYP2C19基因多态性的影响小[4]。这些特点使得伏诺拉生对H+/K+-ATP酶具有更快、更强、更稳定的抑制作用。本研究回顾性分析采用含伏诺拉生四联疗法治疗Hp感染患者,观察其疗效和安全性,以期为Hp感染治疗提供更好的方案。
本研究是一项回顾性研究。选择2020年4月—2022年2月在本院门诊确诊为Hp阳性的患者。纳入标准:经胃镜病理检测或14C-尿素呼气试验(14C-UBT)阳性确诊为Hp感染患者。排除标准:年龄< 18岁或> 70岁;孕妇及哺乳期妇女;有严重心、肺、肝、肾等疾病,对青霉素及所用方案药物过敏者。共纳入120例,男57例,女63例,年龄20~69岁,平均(37.9±5.4)岁,将其按治疗方案分为对照组和治疗组,各60例。对照组男性28例,女性32例,包含胃溃疡9例,十二指肠溃疡13例,慢性非萎缩性胃炎伴糜烂17例,慢性萎缩性胃炎6例,体检14C-UBT阳性15例;初治患者46例,与本次治疗方案不同的含PPI方案治疗失败者14例。治疗组男性29例,女性31例,包含胃溃疡11例,十二指肠溃疡19例,慢性非萎缩性胃炎伴糜烂12例,慢性萎缩性胃炎4例,体检14C-UBT阳性14例;初治患者47例,含PPI方案治疗失败者13例。2组患者的性别、年龄、疾病类型差异无显著差异(P > 0.05)。本研究经本院伦理委员会审查通过(L2022106)。
治疗组给予富马酸伏诺拉生片(Takeda Pharmaceutical Company Limited,规格为20 mg,注册证号H20200011)20 mg,枸橼酸铋钾胶囊[丽珠集团丽珠制药厂,规格为0.3 g(含铋110 mg),批准文号为国药准字H10920098]220 mg,阿莫西林胶囊[石药集团中诺药业(石家庄)有限公司,规格为按C16H19N3O5S计0.25 g,批准文号为国药准字H13023964]1 000 mg,呋喃唑酮片(天津力生制药股份有限公司,规格为100 mg,批准文号为国药准字H12020160)100 mg,每日2次,共14 d。对照组口服阿莫西林胶囊1 000 mg+奥美拉唑胶囊(海南海灵化学制药有限公司,规格为20 mg,批准文号为国药准字H10920092)20 mg+枸橼酸铋钾220 mg+呋喃唑酮片100 mg,每日2次,共14 d。奥美拉唑、枸橼酸铋钾于餐前或空腹服用,阿莫西林及呋喃唑酮于餐后半小时服用,伏诺拉生不受进食影响,建议饭前服用。
疗程结束后第7日和第14日进行随访,观察并记录2组患者不良反应发生情况,疗程结束后4~6周内行14C-UBT,结果阴性者认为Hp成功根除。终止治疗指征:治疗期间出现严重不良反应或者出现其他疾病情况需要终止治疗者。
采用SPSS 22.0统计软件进行统计分析。计数资料用百分率表示,组间比较采用χ2检验。以P < 0.05为有显著差异。
治疗组有58例成功根除HpHp根除率为97%(58/60)。其中初治患者47例全部成功根除,根除率100%;基于PPI方案治疗失败的13例中,1例未及时复查C14-UBT失访,1例失败,11例根除,根除率85%。对照组有48例成功根除HpHp根除率为80%(48/60)。其中初治患者46例中,1例未及时复查C14-UBT失访,6例失败,39例成功根除,根除率85%;基于PPI其他方案治疗失败者14例中,2例未及时复查C14-UBT失访,3例失败,9例根除,根除率64%。2组均无中止治疗病例。2组Hp根除率比较具有显著差异(P<0.05)。
2组患者均无严重不良反应,未发生因药物反应而中断治疗者。2组不良反应主要为头晕、发热、恶心、皮疹、口苦、腹痛、肝肾功能异常、食欲减退等。2组不良反应发生率无显著差异(P > 0.05),见表1
Hp是一种主要定值于胃黏膜的革兰阴性微需氧菌,是引起许多消化道疾病及胃肠外疾病的重要原因,如慢性胃炎、消化性溃疡、胃黏膜相关性淋巴组织淋巴瘤、慢性荨麻疹等。根除Hp可减轻胃黏膜炎症,促进消化性溃疡愈合,减少消化性溃疡的发病率和复发率[5],并使胃黏膜相关淋巴组织淋巴瘤消退[6]。根除Hp对部分顽固性荨麻疹患者有效[7]。2021年12月一项关于中国人群Hp和胃癌关系的研究[8]表明,无论是非贲门胃癌还是贲门癌,Hp感染均为其强关联因素,78.5%的非贲门胃癌和62.1%的贲门癌病例可归因于Hp感染。近年研究[9]发现,Hp感染与结直肠腺瘤有关,及早发现Hp感染并治疗,对预防胃癌及肠道肿瘤有重大意义。
伏诺拉生抑酸机制与PPI不同,其代谢稳定,具有更好的抑酸效果。KAGAMI等[10]研究发现,口服伏诺拉生20 mg每日1次,全天胃内pH值≥4的时间达95%,给于PPI中抑酸效果最强的艾司奥美拉唑20 mg每日1次,全天胃内pH值≥4时间只能达68%。一项研究[11]发现,健康男性每日1次服用10~40 mg不同剂量伏诺拉生,连续用药7 d,均能快速持久地抑制胃酸分泌,耐受性良好,且抑酸效果与剂量有相关性,随着剂量增加,抑酸效果越强,服用伏诺拉生40 mg连续7 d后pH值> 5的时间几乎为100%。抑酸效果直接影响Hp的根除率,胃内的高pH值环境,可以增加抗生素抗菌活性和稳定性,并促进Hp进入繁殖期,处于生长繁殖期的Hp对抗生素更敏感,因而更容易被清除[12]。近年已有研究显示伏诺拉生为基础的不同方案用于Hp根除,其效果优于PPI为基础的治疗方案。日本的一项研究[13]发现,以伏诺拉生为基础的三联疗法(伏诺拉生、阿莫西林和克拉霉素)的Hp根除率约为90%,不良事件的发生率与含PPI方案类似。其结论与本研究结果一致。与含伏诺拉生的三联疗法比较,含伏诺拉生的二联疗法因减少克拉霉素的使用,还有助于减少抗生素耐药[14]。一项多中心、开放、随机对照临床试验[15]中,335例Hp感染者按1:1的分配比例随机使用含伏诺拉生的二联方案(伏诺拉生+低剂量阿莫西林)和含伏诺拉生的三联方案(伏诺拉生+低剂量阿莫西林+克拉霉素)7 d疗法根除Hp,ITT分析和PP分析显示Hp根除率分别为85.5% vs. 89.2%和87.1% vs. 90.2%,两种方案Hp根除率无显著差异(均P > 0.05),含伏诺拉生的二联方案耐克拉霉素菌株根除率高于含伏诺拉生的三联方案(92.3% vs. 76.2%,P < 0.05)。以伏诺拉生为基础的二联及三联疗法,其Hp根除率高于以PPI为基础的治疗方案,但根除率仍不够理想,含伏诺拉生三联方案存在克拉霉素耐药率高的问题。本研究为了避免抗生素耐药,不选用耐药率高的克拉霉素。GUNARATNE等[16]用伏诺拉生联合2~5种不同的抗生素组成不同的方案治疗Hp感染,抗生素主要是阿莫西林、利福普丁、左氧氟沙星、呋喃唑酮、硝唑胺和四环素。通过两年的临床观察发现,伏诺拉生联合2种以上的抗生素10 d疗法在初治患者疗效达100%,二线治疗疗效为91%,说明抑制胃酸的效果对Hp根除率有重要影响。
本研究表明,含伏诺拉生的四联14 d疗法,Hp根除率显著高于含PPI四联14 d疗法。无论作为Hp感染的初治用药还是作为含PPI方案治疗失败患者的二线用药,含伏诺拉生的四联14 d疗法都能获得较好的Hp根除效果。2组均无严重不良反应发生。可推荐含伏诺拉生四联疗法用于Hp感染的一线及二线治疗。但作为常规方案,对照组方案也有较高的根除率,也值得临床使用。
综上所述,伏诺拉生作为新型抑酸药物,能更快、更强、更持久地抑制胃酸分泌,使胃内pH值持续升高,从而让抗生素更好地治疗Hp。含伏诺拉生根除Hp的四联疗法是一种安全高效的治疗方案,值得临床推广。但由于伏诺拉生上市时间短,临床病例有限,还需要更长时间对伏诺拉生根除Hp的效果及不良反应进行观察。
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doi: 10.14109/j.cnki.xyylc.2024.03.10
  • 接收时间:2022-05-27
  • 首发时间:2026-03-13
  • 出版时间:2024-03-25
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  • 收稿日期:2022-05-27
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    宁波市第六医院 消化内科,浙江 宁波 315040
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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