The Study On Effect Of Amoxicillin Combined With Clarithromycin On Liver Function In Helicobacter Pylori Eradication Therapy

Objective:At present,the eradication of Helicobacter pylori(H.pylori)treatment is a combination of several drugs for a short time and a large dose.Among them,antibiotics and proton pump inhibitor(PPI)can induce liver damage.The risk factors for drug-induced liver injury(DILI)are various.The purpose of this study was to observe the effect of amoxicillin combined with clarithromycin on patients' liver function in the treatment of H.pylori eradication and related factors affecting liver function,so as to provide theoretical basis for the individualized treatment of H.pylori eradication and the strengthening of adverse drug reaction(ADR)monitoring during medication.Methods:A total of 422 patients with H.pylori infection confirmed by 13C-urea breath test(13C-UTB),rapid urease test(RUT)or histopathological examination in the outpatient department of gastroenterology of Chengde center hospital from November 2018 to December 2019 due to upper digestive tract symptoms were selected as subjects.According to whether the patients agreed to eradicate H.pylori,they were divided into the eradication group and the non-eradication group,with 224 patients in the eradication group and 198 patients in the non-eradication group.The eradication group was treated with amoxicillin,clarithromycin,rabeprazole and colloidal pectin bismuth dry suspension,while the non-eradication group was treated with rabeprazole and colloidal pectin bismuth dry suspension.Before and after 2 weeks of treatment,fasting venous blood of patients was drawn to examine liver function.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),total bilirubin(TBil)and direct bilirubin(DBil)were compared between the two groups.The patients in the eradication group were divided into the normal liver function group and the abnormal liver function group according to the results of liver function reexamination,the normal liver function group with 202 cases,and the abnormal liver function group with 22 cases.The relationship between age,gender,drinking history,smoking history,body mass index(BMI),fatty liver,hypercholesterolemia,hypertriglyceridemia and liver function in the eradication group was analyzed.Pearson?2 test or Fisher exact test were used in univariate analysis.Statistically significant factors in univariate analysis were included in Logistic regression analysis for multivariate analysis.The independent factors influencing the liver function of H.pylori eradication with amoxicillin and clarithromycin were obtained through analysis.Results:1.Before treatment,the serum ALT,AST and GGT levels were not significantly different between eradication group and non-eradication group(P > 0.05).After treatment,the serum ALT,AST and GGT levels in the eradication group were significantly higher than those in the non-eradication group,and the serum ALT,AST and GGT levels in the two groups were significantly different(P < 0.05).The serum ALT,AST and GGT levels in the eradication group increased significantly after 2 weeks of treatment and were compared with the pretreatment levels,the differences were significantly different(P < 0.05).The serum ALT,AST and GGT levels in the non-eradication group after 2 weeks of treatment were compared with the pretreatment levels,the differences were no significantly different(P>0.05).2.There was no significant difference in serum ALP,TBil and DBil between eradication group and non-eradication group before and after treatment(P>0.05).There was no significant difference in serum ALP,TBil and DBil between pretreatment and posttreatment in the same group(P > 0.05).3.Univariate analysis showed that there were statistically significant differences in age,gender,drinking history,and fatty liver between the abnormal liver function group and the normal liver function group in treatment of H.pylori eradication with amoxicillin and clarithromycin(P<0.05).4.The results of multivariate analysis showed that fatty liver was an independent factor affecting the liver function in radical cure of H.pylori with amoxicillin and clarithromycin.The absence of fatty liver is a protective factor for liver function(OR: 3.634,95%ci: 1.365-9.674,P=0.010).The risk of abnormal liver function in patients with fatty liver is 3.634 times higher than in patients without fatty liver.Conclusion:Amoxicillin combined with clarithromycin in the eradication of H.pylori treatment can lead to patients with abnormal liver function,the transaminase increased obviously.Fatty liver is an independent factor affecting the liver function in the treatment of H.pylori with amoxicillin and clarithromycin.Fatty liver is a risk factor for liver function in H.pylori eradication therapy with amoxicillin and clarithromycin.