内科

目的比较高剂量二联疗法与含铋剂四联疗法根除幽门螺杆菌的临床疗效及安全性。方法选取2019年2月至2020年10月甘肃省酒泉市人民医院收治的100例幽门螺杆菌感染患者作为研究对象，采用随机数字表法将其分为二联组（50例）和四联组（50例）。二联组采用高剂量二联疗法（奥美拉唑+阿莫西林），四联组采用含铋剂四联疗法（奥美拉唑+枸橼酸铋钾+克拉霉素+阿莫西林）。比较两组的幽门螺杆菌根除率、用药依从性、药物不良反应总发生率及药物耐受程度。结果高剂量二联疗法与含铋剂四联疗法的幽门螺杆菌根除率差异无统计学意义：意向性治疗分析显示，二联组与四联组根除率分别为86.00%（43/50）和82.00%（41/50）（χ²=0.298，P=0.585）；符合方案分析显示，根除率分别为93.48%（43/46）和91.11%（41/45）（经Fisher确切概率法检验，P=1.000）。治疗14 d后，二联组中文版4条目Morisky用药依从性问卷得分高于四联组（P<0.05）。治疗期间，二联组药物不良反应总发生率低于四联组，药物耐受程度优于四联组（均P<0.05）。结论高剂量二联疗法根除幽门螺杆菌的疗效与含铋剂四联疗法相比，差异无统计学意义，且患者用药依从性更高、药物不良反应更少、药物耐受程度更优。

Objective To compare the clinical efficacy and safety of high-dose dual therapy and bismuth-containing quadruple therapy for Helicobacter pylori (H. pylori) eradication. Methods A total of 100 patients with H. pylori infection admitted to Jiuquan People's Hospital of Gansu Province from February 2019 to October 2020 were selected as the research objects, and they were divided into a dual therapy group (n=50) or a quadruple therapy group (n=50) using the random number table method. The dual therapy group received high-dose dual therapy (omeprazole + amoxicillin), while the quadruple therapy group received bismuth-containing quadruple therapy (omeprazole + bismuth potassium citrate + clarithromycin + amoxicillin). The H. pylori eradication rate, medication adherence, total incidence of adverse drug reactions, and drug tolerance were compared between the two groups. Results There was no statistically significant difference in the H. pylori eradication rate between high-dose dual therapy and bismuth-containing quadruple therapy: intention to treat analysis showed that the eradication rates of the dual therapy group and the quadruple therapy group were 86.00% (43/50) and 82.00% (41/50), respectively (χ²=0.298, P=0.585); per protocol analysis showed that the eradication rates were 93.48% (43/46) and 91.11% (41/45), respectively (tested by Fisher's exact probability method, P=1.000). After 14 days of treatment, the score of the Chinese version of the 4-item Morisky Medication Adherence Scale in the dual therapy group was higher than that in the quadruple therapy group (P<0.05). During the treatment period, the total incidence of adverse drug reactions in the dual therapy group was lower than that in the quadruple therapy group, and the drug tolerance was better than that in the quadruple therapy group (all P<0.05). Conclusion There is no statistically significant difference in the efficacy for H. pylori eradication between the high-dose dual therapy and the bismuth-containing quadruple therapy, while the former has higher medication adherence, fewer adverse drug reactions, and better drug tolerance in patients.