每日一题_2023.08.21

A 46-year-old man presents with a three-week history of burning substernal and epigastric pain that improves after meals. Medical history is significant for hypertension, which is controlled with exercise and diet. Medications include a daily vitamin supplement. He has no other complaints. Social history reveals that the patient was born in Cambodia, and lived there until five years ago when he moved to the United States. A urease breath test per- formed in the office is positive. What is the recommended treatment for the patient?

一名46岁男性因胸骨后和上腹部灼烧痛3周就诊，餐后好转。病史对高血压有重要意义，可通过运动和饮食控制。药物治疗包括每日补充维生素。他没有别的主诉。其他病史显示患者出生在柬埔寨，并一直生活在那里，直到五年前搬到美国。在办公室进行的尿素呼气试验呈阳性。该患者的推荐治疗方案是什么?

(A)  Ampicillin, clindamycin, and bismuth氨苄西林、克林霉素和铋

(B)  Bismuth, metronidazole, tetracycline, and omeprazole铋、甲硝唑、四环素和奥美拉唑

(C)  Imipenem and cilastatin亚胺培南和西司他丁

(D)  Ranitidine, omeprazole, and bismuth雷尼替丁、奥美拉唑和铋

(E)  Vancomycin, gentamicin, and aztreonam万古霉素、庆大霉素和氨曲南

答案解析：

该患者极有可能患有幽门螺杆菌引起的消化性溃疡病，幽门螺杆菌引起70%的胃溃疡和高达90%的十二指肠溃疡。来自某些民族的人通常有更高的幽门螺杆菌感染率，特别是如果他们在卫生条件差的地区长大。消化性溃疡病的典型表现是胸骨后上腹痛。在胃溃疡的情况下，饭后疼痛加重;对于十二指肠溃疡，进食后疼痛会减轻。幽门螺杆菌感染可通过脲酶呼气试验(幽门螺杆菌含有可将尿素裂解为氨的脲酶)或活检(银染色显示有一螺旋形鞭毛状生物体附着在黏膜上皮上)进行诊断。幽门螺杆菌的治疗包括铋剂、甲硝唑、奥美拉唑、四环素或阿莫西林;或甲硝唑与奥美拉唑、克拉霉素联用。

正确答案：B