目的 探究瑞巴派特联合铋剂四联疗法治疗幽门螺杆菌（Hp）阳性胃溃疡的临床效果。方法 选取2020年7月—2022年7月广西壮族自治区胸科医院收治的112例Hp阳性胃溃疡患者，随机分为对照组和治疗组，每组各56例。对照组给予铋剂四联疗法，泮托拉唑钠肠溶片40 mg/次，2次/d；阿莫西林克拉维酸钾片1 g/次，2次/d；克拉霉素片500 mg/次，2次/d；枸橼酸铋钾胶囊0.3 g/次，3次/d。治疗组在对照组基础上口服瑞巴派特片，0.1 g/次，3次/d。两组均在治疗2周后停用抗生素，治疗时间均为4周。观察两组患者临床疗效，比较治疗前后两组患者Hp根除率，胃黏膜形态学指标，及血清干扰素-γ（IFN-γ）、白细胞介素-2（IL-2）、IL-4和IL-5水平。结果 治疗后，治疗组临床有效率（98.22%）和Hp根除率（98.22%）均分别显著高于对照组（87.50%，85.71%，P<0.05）。治疗后，两组患者胃黏膜形态学指标评分均较治疗前降低（P<0.05），且治疗组慢性炎症细胞、腺体密度及黏膜后厚度评分均低于对照组（P<0.05）。治疗后，两组患者血清IFN-γ、IL-2水平均较治疗前降低，而血清IL-4、IL-5水平均较治疗前升高（P<0.05），且治疗组明显好于对照组（P<0.05）。结论 瑞巴派特联合四联疗法是Hp阳性胃溃疡有效且安全的治疗方案，能减轻患者胃黏膜损害程度，纠正Th1/Th2免疫失衡。

Objective To explore the clinical effect of rebamipide combined with bismuth quadruple therapy in treatment of Hp positive gastric ulcer. Methods Patients (112 cases) with Hp positive gastric ulcer in Guangxi Zhuang Autonomous Region Chest Hospital from July 2020 to July 2022 were randomly divided into control and treatment group, and each group had 56 cases. Patients in the control group were given bismuth quadruple therapy, including Pantoprazole Sodium Enteric-Coated Tablets 40 mg/time, twice daily, Amoxicillin and Clavulanate Potassium Tablets 1 g/time, twice daily, Clarithromycin Tablets 500 mg/time, twice daily, Bismuth Potassium Citrate Capsules 0.3 g/time, three times daily. Patients in the treatment group were po administered with Rebamipide Tablets on the basis of the control group, 0.1 g/time, three times daily. Patients in two groups stopped using antibiotics after 2 weeks of treatment, and the treatment time was 4 weeks. After treatment, the clinical evaluation was evaluated, and the eradication rate of Hp, morphological indexes of gastric mucosa, and the levels of serum IFN-γ, IL-2, IL-4 and IL-5 in two groups before and after treatment were compared. Results After treatment, the clinical effective rate (98.22%) and Hp eradication rate (98.22%) in the treatment group were significantly higher than those in the control group (87.50%, 85.71%, P < 0.05). After treatment, the morphological indexes of gastric mucosa in two groups were lower than those before treatment (P < 0.05), and the scores of chronic inflammatory cells, gland density and retromucosal thickness in the treatment group were lower than those in the control group (P < 0.05). After treatment, the levels of serum IFN-γ and IL-2 were significantly decreased, while the levels of serum IL-4 and IL-5 were significantly increased in two groups (P< 0.05), and which in the treatment group were significantly better than those the control group (P < 0.05). Conclusion Rebamipide combined with bismuth quadruple therapy is an effective and safe treatment for Hp positive gastric ulcer, which can reduce the degree of gastric mucosal damage and correct the immune imbalance of Th1/Th2.

R975

广西壮族自治区卫生健康委员会科研项目（Z20200892）