据近日在线发表在《柳叶刀》杂志上的一研究文章介绍，我国**幽门螺杆菌联盟公布的一项多中心、开放标签、随机研究显示，与标准三联抗幽门螺杆菌（Hp）治疗相比，序贯治疗的Hp根除率更高。因此，研究者认为，序贯疗法应成为Hp感染的标准一线治疗方案。

　　该研究从**6个医疗中心纳入900例Hp感染患者，随机分入序贯疗法10 d（S-10，头5 d应用兰索拉唑30 mg、阿莫西林1 g；后5 d应用兰索拉唑30 mg、克拉霉素500 mg和甲硝唑500 mg；按照2次/d给药）组、序贯疗法14 d（S-14，头7 d应用兰索拉唑30 mg、阿莫西林1 g；后7 d应用兰索拉唑30 mg、克拉霉素500 mg和甲硝唑500 mg；按照2次/d给药）组以及三联疗法14 d（T-14，全程应用兰索拉唑30 mg、阿莫西林1 g和克拉霉素500 mg，所有药物2次/d）组。

　　结果显示，S-14组、S-10组和T-14组的Hp根除率依次为90.7%、87.0%和82.3%。在意向治疗（ITT）分析（需治疗例数12.0，P=0.003）和实际完成治疗（PP）分析（需治疗例数13.7，P=0.003）中，S-14组的疗效均优于T-14组。三组的不良反应或并发症发生率无显著差异。

　　研究者指出，在研究涉及的地区，克拉霉素耐药率和甲硝唑耐药率分别为10%和24%。克拉霉素耐药可降低所有Hp根除方案疗效，而甲硝唑耐药仅影响序贯疗法疗效。在该研究中，不论10 d还是14 d序贯疗法，疗效均优于三联疗法。此外，在序贯疗法和三联疗法治疗失败的患者中，包含左氧氟沙星的改良序贯疗法也有效。因此，序贯疗法可取代三联疗法，成为Hp感染的一线标准治疗方案。研究者强调，最佳Hp根除方案应根据当地Hp的抗生素耐药情况来选择。

　　Sequential versus t**le therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial.

　　Lancet 2012 Nov 15;[Epub ahead of print] PMID:23158886

　　Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

　　BACKGROUND: Whether sequential treatment can replace t**le therapy as the standard treatment for Helicobacter pylori infection is unknown. We compared the efficacy of sequential treatment for 10 days and 14 days with t**le therapy for 14 days in first-line treatment. METHODS: For this multicentre, open-label, randomised trial, we recruited patients (≥20 years of age) with H pylori infection from six centres in Taiwan. Using a computer-generated randomisation sequence, we randomly allocated patients (1:1:1; block sizes of six) to either sequential treatment (lansoprazole 30 mg and amoxicillin 1 g for the first 7 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg for another 7 days; with all drugs given twice daily) for either 10 days (S-10) or 14 days (S-14), of 14 days of t**le therapy (T-14; lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg for 14 days; with all drugs given twice daily). Investigators were masked to treatment allocation. Our primary outcome was the eradication rate in first-line treatment by intention-to-treat (ITT) and per-protocol (PP) analyses. This trial is registered with ClinicalTrials.gov, number NCT01042184. FINDINGS: Between Dec 28, 2009, and Sept 24, 2011, we enrolled 900 patients: 300 to each group. The eradication rate was 90·7% (95% CI 87·4-94·0; 272 of 300 patients) in the S-14 group, 87·0% (83·2-90·8; 261 of 300 patients) in the S-10 group, and 82·3% (78·0-86·6; 247 of 300 patients) in the T-14 group. Treatment efficacy was better in the S-14 group than it was in the T-14 group in both the ITT analysis (number needed to treat of 12·0 [95% CI 7·2-34·5]; p=0·003) and PP analyses (13·7 [8·3-40], p=0·003). We recorded no significant difference in the occurrence of adverse effects or in compliance between the three groups. INTERPRETATION: Our findings lend support to the use of sequential treatment as the standard first-line treatment for H pylori infection. FUNDING: National Taiwan University Hospital and National Science Council.