Bước đầu đánh giá hiệu quả diệt helicobacter pylori của phác đồ tuần tiến (sequential therapy) trong điều trị nhiễm helicobacter pylori ở trẻ em

DUdc DAU DANH GIA HIEU QUA DIET HELICOBACTERPYLORIZm PHAC DO TUAN TIEN

(SEQUENTIAL THERAPY) TRONG DIEU TRj NHII M HELICOBACTER PYLORI im EM

NGUYI N TH ! UT, LE THANH HAI

B§nh vi§n Nhi Trung Wo'ng

TOM TAT

Helicobacter Pylori la nguyen chinh gay viem loet da

day ta trang a tre em, viec tim ra mgt phac do cd hieu

qua de diet HP rit cd y nghJa trong diiu tri lam sang.

Phac di tuan tiin dwoc nghien ciru tren tre em nhiim

HP d Italia rat cd hieu qua, tuy nhien a Viet Nam chwa

cd nghien ciru nao dwac tiin hanh. IVIuc tieu: Danh gia

hieu qua diet HP cua phac dd tuin tiin d benh nhi

nhiem HP.

Phwong phap: 42 benh nhi din kham tai Vien Nhi tir

thing 1- 4/2010 (tuoi trung binh 6,4 ± 2,24 tuoi Tir 3-10

tuoi) nhiim HP dwgc diiu tri phac do tuin tiin

(Omeprazole* Amoxicillin trong 5 ngay, sau dd dung

Omeprazole + Clarithromycin + TInidazole trong 5 ngay

tiip theo).

Nhiem HP dwa vao: benh nhan ndi soi da day ta

trang cd ton thwang va cd kit qua test nhanh Urease

dwong tinh. Danh gia sach vi khuin sau diiu trj 6 tuin,

benh nhan ngi soi lai cd kit qua test nhanh Urease am

tinh va kit qua md benh hgc HP am tinh. Ket qua:42

benh nhan dwgc diiu trj phac do tuan tiin cd ti le sach vi

khuan la 50%o.

Ket luan: Hieu qua diet HP cua phic do tuin tiin

tren tre em nhiem HP bwac diu danh gia cd hieu qua

khong cao, can tiin hanh nghien ciru lan han ngau

nhien cd doi chirng de danh gia chinh xac han.

Tir khda: Helicobacter Pylori, viem loet da day ta

trang a tre em, Phac dd tuan tiin

SUMMARY:

Helicobacter pylori (H.pylori)is a major cause of

gastritis and peptic ulcer diseases In children a novel 10-

day sequential regimen has achieved an eradication

rate of 97.3%, in Italia, but in Vietnam We do not know

how it success.

Object: to assess the HP eradication rate of

sequential therapy in children (pilot study).

Materials and Methods: 42 children HP infection

were intervention new protocol between Jan.-Apr./2010

in National Hospital of Pediatrics. Sequential treatment

(omeprazole plus amoxicillin for 5 days, followed by

omeprazole plus clarithromycin plus tinidazole for

another 5days. H pylori infection was based on rapid

urease test positive. Eradication was assessed by

urease test negative and histological analysis HP

negative 6 weeks after therapy. Results: eradication

was achieved in 42 children receiving sequential

treatment 50%,.

Conclusions: Our study shows, for the first time in

Vietnamese children, the sequential regimen achieves a

low rate eradication. It is better to study randomize

control trial to confirm the effect of this regimen.

Keywords: Helicobacter pylori, gastritis and peptic

ulcer diseases in children

DAT VAN D ^

Helicobacter pylori (HP) Id nguyen nhdn chinh gdy

viem loet dg ddy td trdng d tre em (tren 70 % bpnh nhdn

viem da ddy, 90 % loet hdnh td trdng) [1]. Nghien euu

cua Nguyen Thi Viet Hd, nam 2006, tren tre em viem

loet da ddy td trdng ti le khdng thudc tien phdt cua HP

vdi Clarithromycin, Metronidazole vd Amoxiline lan lupt

Id 50,9%, 65,3 % va 0,5 %; ti Ip saeh vi khuan HP cua

phde dd chuan vdi Clarithromyxin vd Metronidazole Id

62,1% vd 54,7% [4].

Da cd 10 thir nghiem Idm sdng tiln hdnh tren tre em

vd ngudi Idn sir dung phde dd tuan tiln vdi 5 ngdy

diing Amoxillin + Omeprazole sau dd tilp tgc vdi 5 ngdy

diing Clarithromycin + Tinidazole + Omeprazole cho

thdy phde dd ndy cd hieu qua diet HP cao 93,5% (82,5-

98%) vd dung nap tdt. Thir nghiem Idm sang dupe

nghien cuu tren tre em Italia chi ra hieu qua cao trong

diet HP (97,3 % ) [8].

Viee tim ra mpt phde dd mdi cd kha ndng diet HP

cao Id yeu td quan trpng nhat trong dilu tri viem loet da

ddy man tinh d tre em dae bipt khi hieu qua diet HP eua

nhu'ng phac dd chuan hien nay rat thap .

0 Viet Nam chua cd nghien ciru ndo ddnh gid hieu

qua eua phde do tudn tien, xuat phdt tU tinh hinh thuc t l

dd, chiing tdi tiln hdnh d l tdi d l budc ddu ddnh gid hieu

qua cua phde dd ndy tren tre em nhiim HP Id nhu thi

ndo?

Muc tieu nghien cu'u:

Ddnh gid hipu qua diet HP eua phde dd tudn tiln d

benh nhi nhiem HP.

DOI TU'O'NG VA PHU'ONG PHAP

1.Dja diem va thd'i gian nghien CLHU

Nghien euu dupc tiln hdnh tai phdng khdm Tieu

hda, phdng Ndi soi da ddy, khoa Tieu hda, khoa Giai

phdu bpnh cua Vien Nhi Trung U'ong tir thdng 1/2010

tdi thang 4/2010.

2.Thilt k l nghien ciru

Nghien cuu can thiep theo ddi trude vd sau dilu tri.

3. odi tugng nghien ciru: Tong sd bpnh nhdn

nghien euu Id 42

Tieu chuan chgn:

Tdt ca benh nhdn tu 2 den 15 tudi din khdm tgi

phdng khdm Vien Nhi trong thdi gian nghien euu, vdi

tieu chuan:

- Cd trieu chung hudng tdi benh ly da ddy td trdng, cd

chi djnh ndi soi tieu hda: dau bgng tdi diin, ndn, budn ndn,

chudng bgng, khd tieu, ndng rdt vung thugng vj hode xuat

huylt tieu hda, thieu mdu chua rd nguyen nhdn.

- Dupe lam npi soi vd test nhanh Urease ed duong

tinh vdi HP.

- Gia dinh ddng y tham gia vdo nghien euu, benh

nhdn tudn thu dilu tri ddy du, din khdm kilm tra dung

hen.

Y HOC THUC HANH (727) - SO 7/2010 39