Clinical Study On The Treatment Of H.pylori With The Optimized Combination Of Chinese And Western Medicine Based On Drug Resistance Test

Objective:Under the guidance of drug sensitivity test or drug-resistant gene detection,select the precise quadruple scheme and combine with syndrome differentiation Chinese medicine to give patients individualized precise treatment.To observe the efficacy and safety of the optimized program of Chinese and Western medicine in the treatment of H.pylori,and to provide new ideas and methods for the treatment of H.pylori.Methods:From January 2018 to September 2019,90 H.pylori-positive patients in the outpatient department of spleen and stomach diseases of Hubei Hospital of traditional Chinese medicine were collected and divided into Control group,Test group A and Test group B,30 cases in each group.The Control group was given standard doses of bismuth for 14 days,the Test group A was given precise bismuth for 14 days under the guidance of drug sensitivity test or drug resistance gene detection,the Test group B was given dialectical Chinese medicine for 28 days on the basis of Test group A,and reexamined4 weeks after stopping the drug.H.pylori eradication rate,clinical effective rate and adverse reactions were observed.Results:(1)There was no significant difference in gender,age,gastritis type and the number of previous treatment between the Control group,the Test group A and the Test group B beforetreatment;(2)In this study,H.pylori was used to isolate and culture the gastric mucosa of 60 patients.43 cases were successful,17 cases failed,and the success rate was 71.7%.The drug resistance rates of amoxicillin,furazolidone and metronidazole were 8.5%,6.0% and 88.3%,which were higher than the domestic average.The drug resistance rate of levofloxacin was 11.4%,which was lower than the domestic average.The drug resistance rates of clarithromycin and tetracycline were similar to the domestic average;(3)Spleen stomach damp heat syndrome has the highest proportion(42.2%),liver stomach disharmony syndrome is the second(38.9%),spleen stomach weakness syndrome is the lowest(18.9%);(4)The eradication rates of Control group,Test group A and Test group B were 73.3%,93.3% and 96.7%,respectively.Before and after treatment,P value of single group is less than 0.05,and H.pylori can be effectively eradicated in all three groups through x-squared test;after x-squared test,P value of Test group A and Control group B is 0.038 and 0.011,respectively,which are less than0.05,with statistical difference;after x-squared test,P =0.554 > 0.05,there is no statistical difference,so it can be recognized The eradication rate of Test group A and B was significantly higher than that of Control group,but there was no significant difference between the two groups;(5)The total clinical effective rates of Control group,Test group A and Test group B were 70.0%,73.3% and 90.0%,respectively.There was no statistical difference between the Control group and the Test group A in the clinical effective rate by Wilcoxon rank sum test(P = 0899 > 0.05);there was statistical difference between the Control group and the Test group B,the trial TestA and the Test group B in the clinical effective rate by Wilcoxon rank sum test(P = 0.006,0.005,both less than 0.05)It was better than Control group and Test group A,but there was no significant difference between Control group and Test group A;(6)The adverse reactions of Control group,Test group A and Test group B were 6.7%,10.0% and 3.3% respectively.The incidence of adverse reactions in the Control group and the Test group A,the Control group and the Test group B,The test group A and the Test group B were respectively 1.000,1.000 and 0.605,P values were greater than 0.05,and there was no statistical difference in the incidence of adverse reactions in the three groups.Conclusion:1.Drug sensitivity test or drug resistance gene detection before treatment can effectively improve the eradication rate of Helicobacter pylori,which is more than 90%,but can not significantly improve the clinical efficiency;2.The drug resistance of H.pylori in this study is not optimistic.The drug resistance rate of amoxicillin and furazolidone is higher than the average level in China;3.The syndrome differentiation of H.pylori infection related gastritis is spleen stomach dampness heat syndrome,the pathogenesis of which is mainly based on deficiency with excess and mixed with deficiency with excess;4.Dialectical Chinese medicine can improve the eradication rate of H.pylori,improve the clinical efficiency and reduce the adverse reactions;5.Under the guidance of drug resistance test,the eradication rate and clinical efficiency of the combination oftraditional Chinese medicine and Western medicine are significantly better than the traditional standard four combination scheme,and the adverse reaction rate is low,which is worthy of clinical application.