目的 观察奥美拉唑+克拉霉素+阿莫西林对幽门螺旋杆菌(Hp)阳性十二指肠溃疡患者血清HMGB1、NF-κB和TNF-α的影响.方法 选择2014年2月-2016年1月大连市第五人民医院消化科诊治的Hp阳性十二指肠溃疡患者90例作为研究对象,按随机数字表法分为观察组与对照组各45例,对照组患者口服奥美拉唑治疗,观察组患者在对照组的基础上加用克拉霉素、阿莫西林进行三联治疗,疗程均为4周.治疗前后记录并观察2组患者血清HMGB1、NF-κB和TNF-α水平变化,治疗结束4周后胃镜复查溃疡愈合情况,观察临床疗效及不良反应发生率.结果 治疗后,观察组总有效率为91.1%,显著高于对照组的64.4%(χ2=7.516,P=0.006);2组血清HMGB1、NF-κB和TNF-α水平均明显下降(对照组:t=14.188、24.420、3.925;观察组:t=26.885、38.865、7.715,P均<0.01),且观察组下降优于对照组(t=14.807、12.903、4.078,P<0.01);2组胃泌素与BAO水平均降低(t=4.965、7.041,P<0.01;t=12.002、13.126,P<0.01),且观察组下降幅度优于对照组(t=9.049、7.307,P<0.01);观察组总不良反应发生率为8.89%,显著低于对照组的26.67%(χ2=4.865,P<0.05).结论 奥美拉唑+克拉霉素+阿莫西林治疗Hp阳性十二指肠溃疡患者可降低患者血清中炎性因子水平,且不良反应发生率低.%Objective To investigate the effects of omeprazole, clarithromycin and amoxicillin on HMGB1, NF-κB and TNF-αin patients with duodenal ulcer.Methods Ninty patients with Hp positive duodenal ulcer diagnosed and treated in our hospital from February 2014 to January 2016 were divided into observation group and control group according to random number method.The patients in the control group were given oral omeprazole for treatment, the observation group based on the treatment in the control group, also added with clarithromycin, amoxicillin for triple therapy, treated for 1 week.The levels of serum HMGB1, NF-κB and TNF-α were recorded and observed before and after treatment.After 4 weeks of treatment, ulcer healing, clinical curative effect and adverse reaction rate were reviewed.Results After treatment, the total effective rate was 91.1% in the observation group, which was higher than that in the control group of 64.4% (χ2=7.516,P=0.006).The levels of serum HMGB1, NF-κB and TNF-α were significantly decreased in the two groups (t=14.188,24.420,3.925,P<0.05;t=26.885,38.865,7.715,P<0.01).The decrease of gastrin and BAO in the observation group was better than that in the control group (t=4.965,7.041,P<0.01;t=12.002,13.126,P<0.01).The incidence of total adverse reactions was 8.89%, which was lower than that of the control group (26.67%)(χ2=4.865,P<0.05).Conclusion The triple therapy of omeprazole, clarithromycin and amoxicillin can significantly decrease the levels of HMGB1, NF-κB and TNF-α in patients with Hp positive duodenal ulcer.The clinical curative effect is significant and the adverse reaction rate is low, which is worthy of clinical use.
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