含米诺环素的铋剂四联方案联合复合乳酸菌用于幽门螺杆菌感染根除治疗的回顾性研究

Retrospective Study of Minocycline-Containing Bismuth Quadruple Therapy with Addition of Compound Lactobacillus for Helicobacter Pylori Eradication

摘要: 目的：评价含米诺环素的铋剂四联方案联合复合乳酸菌在幽门螺杆菌(Helicobacter pylori, H.pylori)感染初治患者中的根除疗效、不良反应等情况。方法：回顾性分析2023年1月至2025年4月于青岛大学附属医院就诊的H.pylori感染患者的临床资料，按照纳排标准将患者分为四组，其中EACB组(211例)：艾司奥美拉唑 + 阿莫西林 + 克拉霉素 + 枸橼酸铋钾 × 14天；EACBL组(191例)：艾司奥美拉唑 + 阿莫西林 + 克拉霉素 + 枸橼酸铋钾 + 复合乳酸菌 × 14天；EAMB组(206例)：艾司奥美拉唑 + 阿莫西林 + 米诺环素 + 枸橼酸铋钾 × 14天；EAMBL组(197例)：艾司奥美拉唑 + 阿莫西林 + 米诺环素 + 枸橼酸铋钾 + 复合乳酸菌 × 14天。随访患者的H.pylori根除情况、不良反应、服药依从性等情况。结果：本研究共纳入805名患者，EACB组211名患者，根除率为84.8% (179/211)；EACBL组191名患者，根除率为90.6% (173/191)；EAMB组206名患者，根除率为97.6% (201/206)；EAMBL组197名患者，根除率为95.9% (189/197)，入组患者中有171人出现不同程度的不良反应，包括口苦、恶心、呕吐、腹胀、腹痛、胃部不适、大便次数增多、腹泻、便秘、头晕、头痛、皮疹等。其中EACB组不良反应发生率为32.2% (68/211)；EACBL组不良反应发生率为13.1% (25/191)；EAMB组不良反应发生率为23.8% (49/206)；EAMBL组不良反应发生率为14.7% (29/197)。结论：1) 本回顾性研究中观察到含米诺环素方案的根除率与更高的根除率相关。2) 加用复合乳酸菌与较低的药物不良反应发生率相关。

Abstract: Objective: This paper aims to evaluate the eradication efficacy, adverse reactions, and adherence of minocycline-containing bismuth quadruple therapy combined with compound lactobacillus in Helicobacter pylori–naive patients. Methods: A retrospective analysis was conducted on the clinical data of patients with Helicobacter pylori infection who attended the Affiliated Hospital of Qingdao University from January 2023 to April 2025. According to the inclusion and exclusion criteria, the patients were divided into four groups: EACB group (211 cases) received a regimen of esomeprazole, amoxicillin, clarithromycin, and bismuth potassium citrate; EACBL group (191 cases) received a regimen of esomeprazole, amoxicillin, clarithromycin, bismuth potassium citrate and compound lactobacillus; EAMB group (206 cases) was treated with esomeprazole, amoxicillin, minocycline, and bismuth potassium citrate; EAMBL group (197 cases) received esomeprazole, amoxicillin, minocycline, bismuth potassium citrate and compound lactobacillus. All medications were administered for 14 days. The patients were followed up to assess outcomes including Helicobacter pylori eradication status, adverse reactions, and medication adherence. Result: A total of 805 patients participated in this study; the eradication rates of the EACB, EACBL, EAMB and EAMBL groups were 84.8% (179/211); 90.6% (173/191); 97.6% (201/206); and 95.9% (189/197). Among the follow-up patients, 171 experienced adverse reactions of varying degrees, including bitter taste, nausea, vomiting, abdominal distension, abdominal pain, gastric discomfort, increased frequency of defecation, diarrhea, constipation, dizziness, headache, and rash. The incidence of adverse reactions was 32.2% (68/211) in the EACB group; 13.1% (25/191) in the EACBL group; 23.8% (49/206) in the EAMB group; and 14.7% (29/197) in the EAMBL group. Conclusion: 1) In this retrospective study, the eradication rate of the minocycline-containing regimen was associated with a higher H.pylori eradication rate. 2) The addition of compound lactobacillus was associated with a lower incidence of drug-related adverse reactions.