摘要目的 观察抗生素应用对十二指肠球部溃疡并出血者胃内酸化14C-尿素呼气试验(14C-.UBT)的影响.方法 以上消化道出血为首发表现,经急诊胃镜检查证实的十二指肠球部溃疡并出血的住院患者156例.急诊胃镜检查见溃疡面有裸露血管出血者于胃镜检查时立即于内镜下行钛夹止血,所有患者均予以奥美拉唑静脉应用,治疗3～5 d出血停止,病情稳定后给予酸化14C-UBT.阳性者予以埃索美拉唑、阿莫两林和克拉霉素口服治疗1周后,改用口服埃索美拉唑加瑞巴派特片4周.阴性者即予以口服埃索美拉唑加瑞巴派特片4周.两组均于停药1个月后复查14C-UBT.结果 156例十二指肠球部溃疡并急性出血的初治住院患者,PPI抑酸治疗35～d后,予酸化14C-UBT,结果Hp阳性123例(123/156;78.8%).其中近2周内应用过抗生素者,Hp阳性率为40.0%,而未曾应用抗生素者Hp阳性率为92.2%,两组相比差异具有统计学意义(P<0.01).停药1个月后对所有原33例Hp阴性者复查14C-UBT发现,近2周内未应用抗生素者,复查时9例中仅1例阳性(11.1%),而曾应用抗生素24例中16例转为阳性(66.7%),两者相比差异有统计学意义(P<0.01).2周内应用左氧氟沙星,可明显影响酸化14C-UBT的结果.结论 近期内应用过抗生素者既使行胃内酸化14C-UBT仍不能消除其影响,仍有较高的假阴性率.且不同种类的抗生素对胃内酸化14C-UBT有着不同的影响.

abstractsObjective To observe the effect of a antibiotics on the intragastri cacidification 14C-ureabreathtest(14C-UBT) in duodenal bulb ulcers complications of bleeding. Methods 156 patients with duodenal bulb ulcers eomplieations of bleeding diagnosis in emergency gastroseopy were enrolled in this study. All patients then received therapy with Omeprazole 40 nag each given 2 times daily in transfusion replacement for 3-5 days, then on the intragastri cacidifieation 14C-ureabreathtest(14C-UBT) after vital signs was steady. All the patients showing a positive "breath test" ( 123/156 ;78. 8% ) were treated with elarithromyein 500 mg,Amoxicillin 1000 rag and Esomeprazole 20 rng each given 2 times daily for one week, a further treatment was given with Esomeprazole 40 mg/d and Rebamipide 100 mg/d for four weeks additional oral. Among then ,33 patients showed the Hp-negafive patients oral Esomeprazole and Rebamipide were gave for 4 weeks alone. Results A 78.8% incidence of positive "intragastri cacidification 14C-UBT" among 156 patients. Hp-negative patients 33 cases (33/ 156 ;21.2%). Those of 33 patients who had been taking antihiotics in the preceding 2 week, Hp-positive was 16 cases ( 16/40 ;40. 0% ), and that of had not been taking antibiotics in the preceding 2 week, Hp-positive 107 cases ( 107/116 ;92. 2% ), There was a significant difference among two groups( P < 0. 01 ). 14C-UBT were repeated at one month after stopping treatment on 33 eases Hp-negative :1 case was Hp-pesitive ( 1/9 ; 11.1% ) in whom had not been taking antibiotics in the preceding 2 week; however 16 cases Hp-positive ( 16/24; 66. 7% ) in whom had been taking antibiotics in the preceding 2 week ( P < 0. 01 ). The results of intragastri cacidification 14 C-UBT were effected by Levofloxacin. Conclusion Effect of application of antibiotics have not been eliminated by intragastri cacidification 14C-UBT,false positive results of 14C-UBT was higher. The results of intragastri cacidification 14C-UBT score remained difference according to varies antibiotics.