Helicobacter pylori (Hp), ɗaya daga cikin cututtukan da suka fi yaɗuwa a cikin mutane. Yana da haɗari ga cututtuka da yawa, kamar gyambon ciki, gastritis na yau da kullun, adenocarcinoma na ciki, har ma da lymphoma na lymphoid tissue (MALT) da ke da alaƙa da mucosa. Bincike ya nuna cewa kawar da Hp na iya rage haɗarin kamuwa da cutar kansar ciki, ƙara yawan maganin ulcers, kuma a halin yanzu ana buƙatar a haɗa shi da magunguna zai iya kawar da Hp kai tsaye. Akwai zaɓuɓɓukan kawar da cutar a asibiti iri-iri: maganin farko-farko don kamuwa da cuta ya haɗa da maganin sau uku na yau da kullun, maganin sau huɗu na expectorant, maganin jere-jere, da maganin tare. A cikin 2007, Kwalejin Gastroenterology ta Amurka ta haɗa maganin sau uku tare da clarithromycin a matsayin maganin farko don kawar da mutanen da ba su karɓi clarithromycin ba kuma ba su da rashin lafiyar penicillin. Duk da haka, a cikin 'yan shekarun nan, ƙimar kawar da maganin sau uku na yau da kullun ya kasance ≤80% a yawancin ƙasashe. A Kanada, ƙimar juriyar clarithromycin ta ƙaru daga 1% a shekarar 1990 zuwa 11% a shekarar 2003. Daga cikin mutanen da aka yi wa magani, an ruwaito cewa ƙimar juriyar magani ta wuce 60%. Rashin juriyar Clarithromycin na iya zama babban dalilin gazawar kawar da ita. Rahoton yarjejeniya ta Maastricht IV a yankunan da ke da juriyar clarithromycin mai yawa (ƙimar juriya sama da 15% zuwa 20%), wanda ya maye gurbin maganin sau uku na yau da kullun da sau huɗu ko kuma maganin da ke biye da shi tare da maganin expectorant da/ko babu maniyyi, yayin da maganin carat Quadruple kuma ana iya amfani da shi azaman maganin farko a yankunan da ke da ƙarancin juriya ga mycin. Baya ga hanyoyin da ke sama, an kuma ba da shawarar yawan allurai na PPI tare da amoxicillin ko magungunan rigakafi na madadin kamar rifampicin, furazolidone, levofloxacin a matsayin madadin maganin farko.

Inganta maganin sau uku na yau da kullun

1.1 Maganin sau huɗu

Yayin da yawan kawar da cutar Hp na yau da kullun ke raguwa, a matsayin magani, maganin sau huɗu yana da babban adadin kawar da cutar. Shaikh da abokan aikinsa sun yi wa marasa lafiya 175 magani da ke fama da cutar Hp, ta amfani da nazarin da kuma niyya na kowace yarjejeniya (PP). Sakamakon binciken niyyar magance cutar (ITT) ya kimanta yawan kawar da cutar Hp na yau da kullun: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); maganin sau huɗu yana da mafi girman adadin kawar da cutar: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Duk da cewa an rage yawan nasarar kawar da cutar Hp bayan kowace magani da ta gaza, maganin tincture na sau huɗu ya tabbatar da cewa yana da babban adadin kawar da cutar (95%) a matsayin magani bayan gazawar maganin sau uku na yau da kullun. Wani bincike kuma ya kai ga irin wannan ƙarshe: bayan gazawar maganin sau uku da kuma maganin levofloxacin sau uku, yawan kawar da maganin barium sau huɗu ya kasance kashi 67% da 65%, bi da bi, ga waɗanda ke da rashin lafiyar penicillin ko kuma waɗanda suka sha magani mai yawa. A cikin marasa lafiya da ke shan maganin rigakafi na cyclic lactone, ana fifita maganin sau huɗu na expectorant. Tabbas, amfani da maganin tincture sau huɗu yana da yuwuwar samun mummunan sakamako, kamar tashin zuciya, gudawa, ciwon ciki, melena, jiri, ciwon kai, ɗanɗanon ƙarfe, da sauransu, amma saboda ana amfani da maganin expectorant sosai a China, yana da sauƙin samu, kuma yana da. Ana iya amfani da mafi girman ƙimar kawarwa azaman maganin gyara. Ya cancanci a tallata shi a asibiti.

1.2 SQT

An yi wa SQT magani da PPI + amoxicillin na tsawon kwanaki 5, sannan aka yi wa PPI + clarithromycin + metronidazole na tsawon kwanaki 5. A halin yanzu ana ba da shawarar SQT a matsayin maganin kawar da cutar Hp. Nazarin gwaji guda shida da aka sarrafa bazuwar (RCTs) a Koriya bisa ga SQT shine 79.4% (ITT) da 86.4% (PP), da kuma kawar da SQT a HQ. Yawan ya fi na yau da kullun, 95% CI: 1.403 ~ 2.209), hanyar na iya zama cewa na farko na 5d (ko 7d) suna amfani da amoxicillin don lalata tashar clarithromycin efflux akan bangon tantanin halitta, wanda hakan ke sa tasirin clarithromycin ya fi tasiri. Sau da yawa ana amfani da SQT a matsayin magani don gazawar maganin sau uku na yau da kullun a ƙasashen waje. Duk da haka, bincike ya nuna cewa yawan kawar da maganin sau uku (82.8%) a tsawon lokaci (14d) ya fi na maganin sau uku na gargajiya (76.5%). Wani bincike ya kuma gano cewa babu wani bambanci mai mahimmanci a cikin yawan kawar da Hp tsakanin SQT da maganin sau uku na yau da kullun, wanda zai iya danganta da yawan juriyar clarithromycin. SQT yana da tsawon magani, wanda zai iya rage bin ƙa'idodin marasa lafiya kuma bai dace da yankunan da ke da juriyar clarithromycin sosai ba, don haka ana iya la'akari da SQT lokacin da ake amfani da tincture.

1.3 Maganin abokin tarayya

Maganin da ke tare da shi shine PPI tare da amoxicillin, metronidazole da clarithromycin. Wani bincike na meta ya nuna cewa yawan kawar da cutar ya fi na yau da kullun na maganin sau uku. Wani bincike na meta kuma ya gano cewa yawan kawar da cutar (90%) ya fi na yau da kullun na maganin sau uku (78%). Ma'aikatar Maastricht IV ta ba da shawarar cewa ana iya amfani da SQT ko maganin tare idan babu magungunan expectorant, kuma yawan kawar da cutar guda biyu iri ɗaya ne. Duk da haka, a yankunan da clarithromycin ke da juriya ga metronidazole, ya fi amfani idan aka yi amfani da maganin tare. Duk da haka, saboda maganin tare da shi ya ƙunshi nau'ikan maganin rigakafi guda uku, zaɓin maganin rigakafi zai ragu bayan gazawar maganin, don haka ba a ba da shawarar a matsayin tsarin magani na farko ba sai dai a yankunan da clarithromycin da metronidazole ke da juriya. Yawancin lokaci ana amfani da shi a yankunan da ke da ƙarancin juriya ga clarithromycin da metronidazole.

1.4 maganin yawan shan magani

Bincike ya gano cewa ƙara yawan shan PPI da amoxicillin ya fi 90%. Ana ɗaukar tasirin kashe ƙwayoyin cuta na amoxicillin akan Hp ya dogara da lokaci, saboda haka, ya fi tasiri a ƙara yawan shan magani. Na biyu, lokacin da pH a cikin ciki ya kasance tsakanin 3 da 6, ana iya hana kwafin magani yadda ya kamata. Lokacin da pH a cikin ciki ya wuce 6, Hp ba zai sake kwafi ba kuma yana da alaƙa da amoxicillin. Ren et al sun gudanar da gwaje-gwajen da aka sarrafa bazuwar a cikin marasa lafiya 117 tare da marasa lafiya masu Hp-positive. An ba wa rukunin masu yawan shan magani amoxicillin 1g, tid da rabeprazole 20mg, bid, kuma an ba wa rukunin masu shan magani amoxicillin 1g, tid da rabeprazole. 10mg, bid, bayan makonni 2 na magani, ƙimar kawar da Hp na rukunin magunguna masu yawa ya kasance 89.8% (ITT), 93.0% (PP), mafi girma fiye da rukunin kulawa: 75.9% (ITT), 80.0% (PP), P <0.05. Wani bincike daga Amurka ya nuna cewa amfani da esomeprazole 40 mg, ld + amoxicillin 750 mg, kwanaki 3, ITT = 72.2% bayan kwanaki 14 na magani, PP = 74.2%. Franceschi da abokan aikinsa sun yi nazari kan jiyya uku: 1 daidaitaccen magani sau uku: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 babban magani: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, hanyar magani shine 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, maganin bid don 5d, lansoprazole 30mg bid, carat An yi maganin bid na 500mg da tinidazole 500mg na tsawon kwanaki 5. Yawan kawar da magungunan guda uku sune: 55%, 75%, da 73%. Bambanci tsakanin maganin bid mai yawa da maganin sau uku na yau da kullun yana da mahimmanci a kididdiga, kuma an kwatanta bambancin da SQT. Ba shi da mahimmanci a kididdiga. Tabbas, bincike ya nuna cewa maganin omeprazole da amoxicillin mai yawan shan magani bai inganta yawan kawar da cutar yadda ya kamata ba, wataƙila saboda nau'in halittar CYP2C19. Yawancin PPIs ana metabolize su ta hanyar enzyme na CYP2C19, don haka ƙarfin metabolite na kwayar halittar CYP2C19 na iya shafar metabolism na PPI. Esomeprazole galibi ana metabolize shi ta hanyar cytochrome P450 3 A4 enzyme, wanda zai iya rage tasirin kwayar halittar CYP2C19 zuwa wani mataki. Bugu da ƙari, ban da PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, ana kuma ba da shawarar su a matsayin madadin magani mai yawan gaske.

Shirye-shiryen ƙwayoyin cuta masu haɗaka

Ƙara magungunan ƙwayoyin cuta na muhalli (MEA) zuwa maganin da aka saba amfani da shi na iya rage halayen da ba su da kyau, amma har yanzu ana jayayya ko za a iya ƙara yawan kawar da Hp. Wani bincike na meta ya gano cewa maganin B. sphaeroides sau uku tare da maganin sau uku kawai ya ƙara yawan kawar da Hp (gwaji 4 da aka sarrafa bazuwar, n=915, RR=l.13, 95% CI: 1.05) ~1.21), kuma yana rage halayen da ba su da kyau ciki har da gudawa. Zhao Baomin et al. sun kuma nuna cewa haɗin probiotics na iya inganta yawan kawar da cutar sosai, koda bayan rage lokacin magani, har yanzu akwai babban adadin kawar da cutar. An yi wani bincike na marasa lafiya 85 da ke da Hp-positive a cikin ƙungiyoyi 4 na Lactobacillus 20 mg bid, clarithromycin 500 mg bid, da tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus tare da bifidobacteria, placebo na tsawon mako 1, cike tambayoyi kan binciken alamun kowace mako na tsawon makonni 4, makonni 5 zuwa 7 bayan haka don duba kamuwa da cuta, binciken ya gano: ƙungiyar probiotics da kwanciyar hankali Babu wani bambanci mai mahimmanci a cikin ƙimar kawarwa tsakanin ƙungiyoyin, amma duk ƙungiyoyin probiotic sun fi amfani wajen hana halayen da ba su da kyau fiye da ƙungiyar kulawa, kuma babu wani bambanci mai mahimmanci a cikin yawan halayen da ba su da kyau a tsakanin ƙungiyoyin probiotic. Hanyar da probiotics ke amfani da ita wajen kawar da Hp har yanzu ba a fayyace ba, kuma yana iya hana ko dakatar da aiki tare da wuraren mannewa masu gasa da abubuwa daban-daban kamar acid na halitta da bacteriopeptides. Duk da haka, wasu bincike sun gano cewa haɗin probiotics ba ya inganta ƙimar kawarwa, wanda zai iya danganta da ƙarin tasirin probiotics kawai lokacin da maganin rigakafi ba su da tasiri sosai. Har yanzu akwai babban sararin bincike a cikin probiotics na haɗin gwiwa, kuma ana buƙatar ƙarin bincike kan nau'ikan, darussan magani, alamu da lokacin shirye-shiryen probiotic.

Abubuwan da ke shafar ƙimar kawar da Hp

Abubuwa da dama da ke shafar kawar da Hp sun haɗa da juriya ga maganin rigakafi, yankin ƙasa, shekarun majiyyaci, yanayin shan taba, bin ƙa'ida, lokacin magani, yawan ƙwayoyin cuta, gastritis mai tsanani, yawan acid na ciki, martanin mutum ga PPI, da kuma yawan kwayoyin halittar CYP2C19. Kasancewar. Bincike ya ba da rahoton cewa a cikin nazarin univariate, shekaru, yankin zama, magani, cututtukan ciki, kamuwa da cuta, tarihin kawar da cutar, PPI, hanyar magani, da bin magani suna da alaƙa da yawan kawar da cutar. Bugu da ƙari, wasu cututtuka masu yuwuwar kamuwa da cutar, kamar su ciwon suga, hauhawar jini, cututtukan koda na yau da kullun, cututtukan hanta na yau da kullun, da cututtukan huhu na yau da kullun suma suna iya alaƙa da yawan kawar da Hp. Duk da haka, sakamakon binciken na yanzu ba iri ɗaya bane, kuma ana buƙatar ƙarin manyan bincike.