基于质子泵抑制剂的序贯疗法对Barrett食管的疗效对比研究

Curative effects of sequential therapy based on the proton pump inhibitor on Barrett’s esophagus： a comparative study

摘要:

目的：对比分别以埃索美拉唑镁、奥美拉唑、兰索拉唑为基础的治疗方案对Barrett食管（Barrett’s esophagus，BE）的治疗效果。方法：选取87例患者，随机分为3组，分别以埃索美拉唑镁、奥美拉唑和兰索拉唑为基础进行治疗，对比患者在治疗前、治疗后1~5周以及治疗后12~24个月的长程维持治疗期内罹患BE的发展变化情况。结果：埃索美拉唑镁组幽门螺旋杆菌（helicobacter pylori，Hp）感染抑制情况和胃食管反流病（gastroesophageal reflux disease，GERD）症状缓解情况均优于奥美拉唑组和兰索拉唑组（P=0.019，P=0.007），差异有统计学意义。对BE的直接治疗作用方面，相对于奥美拉唑组和兰索拉唑组，埃索美拉唑镁组在治疗后化生长度缩减率（P=0.028 2）、化生面积减小率（P=0.022 6）、鳞状上皮检出率（P=0.001）、混杂上皮检出率（P=0.003）等评价指标上显示其疗效占优；对BE的预防作用方面，通过对比治疗后检出化生程度加剧的病例数（检出率）等指标，埃索美拉唑镁组与奥美拉唑组和兰索拉唑组相比差异无统计学意义（P=0.483）；不良反应发生的监测情况，埃索美拉唑镁组不良反应发生率低于奥美拉唑组和兰索拉唑组（P=0.013），显示其安全性较高。结论：基于埃索美拉唑镁的治疗方案更加安全、可靠，不良反应低，可以更好的控制Hp感染，抑制胃酸分泌，缓解、消除GERD对食管黏膜上皮的侵蚀，促进食管黏膜上皮细胞的增生，进而在一定程度上实现了对病变组织的修复，遏制了BE向食管腺癌的进一步发展。

Abstract:

Objective：To study and compare the different curative effects on Barrett’s esophagus（BE） by using esomeprazole magnesium，omeprazole and lansoprazole as the basic therapeutic regimen respectively. Methods：Totally 87 patients were randomly selected and divided into three groups. Esomeprazole magnesium，omeprazole and lansoprazole were given to the three groups respectively. Changes of BE before and after the treatment（1-5 weeks） and during the long-term maintenance treatment（12-24 months） were carefully observed. Results：Data indicated that there were significantly statistical differences among the three groups；esomeprazole magnesium group displayed more positive results than omeprazole group and lansoprazole group in the control of helicobacter pylori（Hp） infection and alleviation of gastroesophageal reflux disease（GERD） and BE symptoms（P=0.019，P=0.007）. Concerning the direct treatment effect on BE，evaluation indicators including metaplasia length reduction rate（P=0.028 2），metaplasia area reduction rate（P=0.022 6），squamous epithelium detection rate（P=0.001） and mixed epithelium detection rate（P=0.003） were better in esomeprazole magnesium group than in omeprazole group and lansoprazole group. Concerning the prevention of BE，there was no statistical difference among esomeprazole magnesium group，omeprazole group and lansoprazole group in number of cases with metaplasia aggravation after the treatment（P=0.483）. Adverse reaction detection showed that esomeprazole magnesium group had lower incidence rate than omeprazole group and lansoprazole group（P=0.013），indicating that the former treatment was much safer than the latter ones. Conclusion：Therapy with esomeprazole magnesium is much safer and more dependable with lower adverse effects. It is able to control the Hp infection more effectively，inhibit the secretion of gastric acid，alleviate or eliminate the erosion of GERD on the mucous membrane epithelium of esophagus，promote the esophageal epithelial cell proliferation，which，to some extent，contributes to the remedy of the pathological tissues and restrain BE from developing into esophageal adenocarcinoma.