Helicobacter pylori 이차 사제 병합요법의 제균율
Eradication Rates of Bismuth-based Quadruple Therapy as a Second-line Treatment for Helicobacter pylori Infection
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목적: 최근 일차 헬리코박터 제균율이 감소하는 추세로 이차 치료의 대상자는 더욱 늘어나고 있어, 2차 치료의 필요성이 커지고 있다. 저자들은 일차 제균 치료에 실패한 환자에서 사제 요법을 이용한 이차치료의 제균율을 조사하여 제균 효과를 알아보았다. 대상 및 방법: 2001년 1월부터 2007년 12월까지 서울과 경기도를 방문하여 일차 제균 치료에 실패한 환자 중 2차 제균 치료를 시행 받은 환자 215명을 대상으로 의무기록을 통하여 후향적으로 분석하였다. H.pylori 2차 제균 치료로 bismuth 포함 사제요법을 7일에서 14일까지 투여하고, 사제요법 종료 4주 후에 요소호기검사와 조직검사를 시행하여 제균 판정을 하였다. 결과: 이차 제균 치료의 제균 성공율은 ITT (intention to treat) 분석에서 64% (137/215), PP (per protocol) 분석에서 91% (137/ 151)이었다. 질환의 종류와 제균 기간, 지역, 프로톤 펌프 억제제의 종류에 따른 제균 성적의 차이는 통계적으로 유의하지 않았다. 2001년부터 2007년까지 시간에 따른 제균 성공율의 차이는 없었다. 결론: 우리나라에서 bismuth포함 사제 요법의 성공율은 90%이상으로 헬리코박터의 이차 제균 치료로 유용하다.
Abstract
Background/Aims: There has been a substantial decline in Helicobacter pylori (H. pylori) cure rates with standard triple therapy in recent years. Therefore, great emphasis has been placed on second line treatment for its successful eradication. The aim of this study was to evaluate the efficacy of bismuth based quadruple therapy as a second line treatment for H. pylori infection. Methods: From January 2001 to December 2007, the hospital records of 215 patients who failed to the standard triple therapy were reviewed retrospectively. The patients were treated with bismuth based quadruple therapy (PPI, bismuth 120 mg qid, metronidazole 500 mg tid, and tetracycline 500 mg qid). The successful eradication of H. pylori was defined as negative result from histology, CLO test or 13C-urea breath test. Results: Eradication rates by intention-to-treat (ITT) and per-protocol (PP) analyses with quadruple therapy were 64% (137/215) and, 91% (137/151) respectively. The eradication rates were not significantly different according to diseases, duration of treatment, area and proton pump inhibitors. The PP eradication rates for the years from 2001 to 2007 were not significantly different. Conclusions: The bismuth based quadruple therapy is still effective as the second line treatment for the eradication of H. pylori.
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