【摘要】 目的 探討含鉍劑的四聯療法作為一線方案對幽門螺桿菌感染的有效性和安全性。 方法 選擇2008年9月-2010年9月間137例確診幽門螺桿菌感染的初治患者，隨機分為RAC組（雷貝拉唑、阿莫西林和克拉霉素）和RBAC組（雷貝拉唑、阿莫西林、克拉霉素和枸櫞酸鉍鉀）。經治療7 d后比較兩組根除率和不良反應發生率。 結果 RAC組和RBAC組的按方案分析根除率分別為77.6%和90.3%，意向性治療分析根除率分別為72.6%和86.7%。RBAC組的按方案分析和意向性治療分析根除率均高于RAC組（Plt;0.05）。不良反應發生率分別為1.6%和1.3%（Pgt;0.05）。 結論 以雷貝拉唑、阿莫西林、克拉霉素和枸櫞酸鉍鉀為組合的四聯療法能顯著提高幽門螺桿菌感染的初治成功率，不良反應少，安全有效。【Abstract】 Objective To investigate the effectiveness and safety of the quadruple therapy containing a bismuth compound for first-line Helicobacter pylori eradication treatment. Methods A total of 137 patients diagnosed to be Helicobacter pylori-positive between September 2008 and September 2010 were randomized into two groups to receive the combination of rabeprazole, amoxicillin and clarithromycin (RAC group) and the combination of rabeprazole, amoxicillin, clarithromycin and bismuth potassinm citrate (RBAC group) respectively. The efficacy and tolerance were observed after the treatment for 7 days. Results The per protocol (PP) eradication rates of Helicobacter pylori were 86.7% for RAC group and 90.3% for RBAC group (Plt;0.05), respectively. The intention-to-treat protocol (ITT) eradication rates of Helicobacter pylori were 72.6% for RAC group and 86.7% for RBAC group (Plt;0.05), respectively. The was no significant difference in the incidence of side effects between the two groups (1.6% vs. 1.3%, Pgt;0.05). Conclusion The quadruple therapy containing rabeprazole, amoxicillin, clarithromycin and bismuth potassinm citrate provides a good eradication rate of Helicobacter pylori with a good compliance when compared with the standard triple therapy schemes.
