目的 比较不同治疗方案对于幽门螺杆菌（Helicobacter pylori， Hp）感染合并小肠细菌过度生长（small intestinal bacterial overgrowth， SIBO）的治疗情况。 方法 纳入2022年4月至2023年7月在中国人民解放军总医院第六医学中心消化内科门诊及住院部就诊的Hp和SIBO共同阳性的患者。将纳入患者随机分为A、B、C 三组，A组患者给予铋剂四联方案根除Hp后使用利福昔明清除小肠细菌；B组患者使用利福昔明清除小肠细菌后行铋剂四联方案根除Hp；C组患者同时给予铋剂四联方案及利福昔明治疗Hp和SIBO。分别停药4 ~ 6周后复查¹³C尿素呼气试验与甲烷氢呼气试验。比较三组Hp和SIBO共同转阴率、腹部症状评分改善程度和腹泻、便秘、恶心等不良反应的发生情况。 结果 三组Hp转阴率差异无统计学意义（P > 0.05），B组的SIBO转阴率、共同转阴率高于A组（P < 0.05），B组与C组相比差异无统计学意义（P > 0.05）。治疗后B组GSRS评分改善程度高于A、C组（P = 0.015，P = 0.014），B组整体不良反应低于A组（P < 0.001）。B、C组整体不良反应差异无统计学意义（P > 0.05）。A组的SIBO转阴率、共同转阴率、治疗后GSRS评分改善程度与C组差异无统计学意义（P > 0.05），A组不良反应发生率高于C组（P = 0.004）。 结论 Hp感染合并SIBO患者多数伴有反酸、烧心、腹胀、便秘、腹泻等胃肠道不适，清除小肠细菌后行Hp治疗可提高Hp和SIBO共同的转阴率，并有效减轻腹部症状，减少不良反应的发生。

Objective To compare different therapeutic regimens for treatment of Helicobacter pylori （Hp） infection combined with small intestinal bacterial overgrowth （SIBO）. Methods This study was a single?center， single?blind， 16?week randomized controlled trial to evaluate the efficacy of different therapeutic regimens for patients with Hp infection combined with SIBO. Patients who were co?positive for Hp and SIBO attending the outpatient and inpatient departments of the Department of Gastroenterology of the Sixth Medical Center of the PLA General Hospital from April 2022 to July 2023 were enrolled. The enrolled patients were randomly divided into 3 groups， A， B， and C. Different treatment regimens were applied to the three groups. The 13C?urea breath test and methane hydrogen breath test were reviewed respectively after 4 ~ 6 weeks of drug discontinuation， to compare the rate of co?conversion of Hp and SIBO， the degree of improvement of abdominal symptom scores， and the incidence of adverse reactions， such as diarrhea， constipation， and nausea in the three groups. Results There was no statistically significant difference in the Hp conversion rate among the three groups（P > 0.05）， and the SIBO conversion rate and co?conversion rate of group B were higher than that of group A（P < 0.05）， and the difference was not statistically significant compared with that of group C（P > 0.05）. The degree of improvement in GSRS score after treatment was higher in group B than in groups A and C （P = 0.015，P = 0.014）， and the overall adverse reactions in group B were lower than those in group A （P < 0.001）. The difference in overall adverse reactions between groups B and C was not statistically significant（P > 0.05）. The rate of SIBO conversion， the rate of co?conversion， and the degree of improvement in GSRS score after treatment were not statistically significant between group A and C（P > 0.05）， and the adverse reaction incidence was higher than that of group C （P = 0.004）. Conclusion Most patients with Hp infection combined with SIBO are accompanied by gastrointestinal discomforts such as acid reflux， heartburn， abdominal distension， constipation， and diarrhea， etc. HP treatment after removal of small intestinal bacteria can improve the rate of Hp and SIBO co?conversion， and effectively alleviate the abdominal symptoms and reduce the incidence of adverse reactions.