ʻO Helicobacter pylori (Hp), kekahi o nā maʻi lele maʻamau i loko o ke kanaka. He mea ia e pilikia ai no nā maʻi he nui, e like me ka ʻōpū ʻōpū, ka gastritis mau, ka adenocarcinoma gastric, a me ka mucosa-associated lymphoid tissue (MALT) lymphoma. Ua hōʻike ʻia nā haʻawina e hiki i ka hoʻopau ʻana iā Hp ke hōʻemi i ka pilikia o ka maʻi ʻōpū, hoʻonui i ka helu ho'ōla o nā ʻōpū, a i kēia manawa pono e hui pū ʻia me nā lāʻau lapaʻau hiki ke hoʻopau pololei iā Hp. Aia kekahi mau koho hoʻopau lapaʻau like ʻole: ʻo ka lāʻau lapaʻau mua no ka maʻi e komo pū ana me ka lāʻau lapaʻau triple maʻamau, ka lāʻau lapaʻau expectorant quadruple, ka lāʻau lapaʻau sequential, a me ka lāʻau lapaʻau concomitant. I ka makahiki 2007, ua hui pū ka American College of Gastroenterology i ka lāʻau lapaʻau triple me ka clarithromycin ma ke ʻano he lāʻau lapaʻau mua no ka hoʻopau ʻana i ka poʻe i loaʻa ʻole ka clarithromycin a ʻaʻohe maʻi penicillin. Eia nō naʻe, i nā makahiki i hala iho nei, ʻo ka helu hoʻopau ʻana o ka lāʻau lapaʻau triple maʻamau he ≤80% ma ka hapa nui o nā ʻāina. Ma Kanada, ua piʻi ka nui o ke kūʻē ʻana o ka clarithromycin mai 1% i ka makahiki 1990 a i 11% i ka makahiki 2003. Ma waena o nā kānaka i mālama ʻia, ua hōʻike ʻia ka nui o ke kūʻē ʻana i ka lāʻau lapaʻau ma mua o 60%. ʻO ke kūʻē ʻana o Clarithromycin paha ke kumu nui o ka hāʻule ʻana o ka hoʻopau ʻana. Hōʻike kuʻikahi Maastricht IV ma nā wahi me ke kūʻē kiʻekiʻe i ka clarithromycin (ka nui o ke kūʻē ma luna o 15% a 20%), e pani ana i ka lāʻau lapaʻau triple maʻamau me ka lāʻau lapaʻau quadruple a i ʻole ka sequential me ka expectorant a/a i ʻole ka sputum ʻole, ʻoiai hiki ke hoʻohana ʻia ka carat Quadruple therapy ma ke ʻano he lāʻau lapaʻau laina mua ma nā wahi me ke kūʻē haʻahaʻa i ka mycin. Ma waho aʻe o nā ʻano hana i luna, ua manaʻo ʻia nā dosis kiʻekiʻe o ka PPI me amoxicillin a i ʻole nā ​​​​​​antibiotics ʻē aʻe e like me rifampicin, furazolidone, levofloxacin ma ke ʻano he lāʻau lapaʻau laina mua ʻē aʻe.

Ka hoʻomaikaʻi ʻana i ka lāʻau lapaʻau triple maʻamau

1.1 Lapaʻau ʻehā

I ka hāʻule ʻana o ka helu hoʻopau ʻana o ka lāʻau lapaʻau ʻekolu maʻamau, ma ke ʻano he lāʻau lapaʻau, he kiʻekiʻe ka helu hoʻopau ʻana o ka lāʻau lapaʻau ʻehā. Ua mālama ʻo Shaikh et al. i 175 mau maʻi me ka maʻi Hp, me ka hoʻohana ʻana i ka nānā ʻana o kēlā me kēia protocol (PP) a me ka manaʻo. Ua loiloi nā hopena o ka nānā ʻana o ka manaʻo e mālama (ITT) i ka helu hoʻopau ʻana o ka lāʻau lapaʻau ʻekolu maʻamau: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); ʻoi aku ka kiʻekiʻe o ka helu hoʻopau ʻana o ka lāʻau lapaʻau ʻehā: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). ʻOiai ua emi ka helu holomua o ka hoʻopau ʻana o ka Hp ma hope o kēlā me kēia lāʻau lapaʻau i hāʻule ʻole, ua hōʻoia ka lāʻau lapaʻau ʻehā o ka tincture he kiʻekiʻe ka helu hoʻopau ʻana (95%) ma ke ʻano he lāʻau lapaʻau ma hope o ka hāʻule ʻole o ka lāʻau lapaʻau ʻekolu maʻamau. Ua hōʻea kekahi noiʻi ʻē aʻe i kahi hopena like: ma hope o ka hāʻule ʻana o ka triple therapy maʻamau a me ka levofloxacin triple therapy, ʻo ka helu eradication o ka barium quadruple therapy he 67% a me 65%, kēlā me kēia, no ka poʻe i maʻi i ka penicillin a i loaʻa paha i ka nui. I nā maʻi me nā antibiotics cyclic lactone, makemake ʻia ka expectorant quadruple therapy. ʻOiaʻiʻo, ʻoi aku ka kiʻekiʻe o ka hoʻohana ʻana i ka tincture quadruple therapy i nā hanana maikaʻi ʻole, e like me ka nausea, ka maʻi diarrhea, ka ʻeha ʻōpū, melena, dizziness, headache, metallic different, etc., akā no ka mea ua hoʻohana nui ʻia ka expectorant ma Kina, he maʻalahi ke loaʻa, a he kiʻekiʻe aʻe ka helu eradication hiki ke hoʻohana ʻia ma ke ʻano he lāʻau lapaʻau. He mea kūpono ke hoʻolaha ʻia ma ke keʻena.

1.2 SQT

Ua mālama ʻia ʻo SQT me PPI + amoxicillin no 5 mau lā, a laila mālama ʻia me PPI + clarithromycin + metronidazole no 5 mau lā. Manaʻo ʻia ʻo SQT i kēia manawa ma ke ʻano he lāʻau lapaʻau hoʻopau mua no Hp. ʻO kahi meta-analysis o ʻeono mau hoʻokolohua i hoʻomalu ʻia i ka randomized (RCTs) ma Korea e pili ana iā SQT he 79.4% (ITT) a me 86.4% (PP), a me ka hoʻopau ʻana o HQ o SQT ʻOi aku ka kiʻekiʻe o ka helu ma mua o ka lāʻau lapaʻau triple maʻamau, 95% CI: 1.403 ~ 2.209), ʻo ke ʻano hana paha ʻo ka 5d mua (a i ʻole 7d) e hoʻohana i ka amoxicillin e luku i ke kahawai efflux clarithromycin ma ka paia cell, e ʻoi aku ka maikaʻi o ka hopena o clarithromycin. Hoʻohana pinepine ʻia ʻo SQT ma ke ʻano he lāʻau lapaʻau no ka hāʻule ʻana o ka lāʻau lapaʻau triple maʻamau ma waho. Eia nō naʻe, ua hōʻike nā haʻawina ua ʻoi aku ka kiʻekiʻe o ka helu hoʻopau ʻana o ka lāʻau lapaʻau triple (82.8%) i ka manawa lōʻihi (14d) ma mua o ka lāʻau lapaʻau sequential maʻamau (76.5%). Ua ʻike pū kekahi noiʻi ʻaʻohe ʻokoʻa koʻikoʻi ma nā helu hoʻopau Hp ma waena o SQT a me ka lāʻau lapaʻau triple maʻamau, kahi e pili ana paha i ka nui o ke kūʻē ʻana o ka clarithromycin. Loaʻa i ka SQT kahi papa hana lōʻihi, kahi e hōʻemi ai i ka hoʻokō ʻana o ka mea maʻi a ʻaʻole kūpono no nā wahi me ke kūʻē kiʻekiʻe i ka clarithromycin, no laila hiki ke noʻonoʻo ʻia ka SQT i ka wā e kūʻē ai i ka hoʻohana ʻana i ka tincture.

1.3 Hoʻōla hoa

ʻO ka lāʻau lapaʻau e hele pū ana me ka PPI i hui pū ʻia me amoxicillin, metronidazole a me clarithromycin. Ua hōʻike ʻia kahi meta-analysis ua ʻoi aku ka kiʻekiʻe o ka helu hoʻopau ma mua o ka lāʻau lapaʻau triple maʻamau. Ua ʻike pū kekahi meta-analysis ʻoi aku ka kiʻekiʻe o ka helu hoʻopau (90%) ma mua o ka lāʻau lapaʻau triple maʻamau (78%). Manaʻo ka Maastricht IV Consensus hiki ke hoʻohana ʻia ka SQT a i ʻole ka lāʻau lapaʻau concomitant i ka loaʻa ʻole o nā expectorants, a ua like nā helu hoʻopau o nā lāʻau lapaʻau ʻelua. Eia nō naʻe, ma nā wahi i kūʻē ai ka clarithromycin i ka metronidazole, ʻoi aku ka maikaʻi me ka lāʻau lapaʻau concomitant. Eia nō naʻe, no ka mea, ʻo ka lāʻau lapaʻau e hele pū ana me ʻekolu ʻano antibiotics, e hoʻemi ʻia ke koho ʻana o nā antibiotics ma hope o ka hāʻule ʻana o ka lāʻau lapaʻau, no laila ʻaʻole ia e ʻōlelo ʻia ʻo ia ka hoʻolālā lapaʻau mua koe wale nō nā wahi i kūʻē ai ka clarithromycin a me ka metronidazole. Hoʻohana nui ʻia ma nā wahi me ka pale haʻahaʻa i ka clarithromycin a me ka metronidazole.

1.4 lāʻau lapaʻau kiʻekiʻe

Ua ʻike ʻia nā haʻawina ʻoi aku ka nui o ka hoʻonui ʻana i ka nui a/a i ʻole ke alapine o ka lawelawe ʻana o PPI a me amoxicillin ma mua o 90%. Ua manaʻo ʻia ka hopena bactericidal o amoxicillin ma Hp e pili ana i ka manawa, a no laila, ʻoi aku ka maikaʻi o ka hoʻonui ʻana i ke alapine o ka lawelawe ʻana. ʻO ka lua, ke mālama ʻia ka pH i loko o ka ʻōpū ma waena o 3 a me 6, hiki ke kāohi pono ʻia ka hana hou ʻana. Ke ʻoi aku ka pH i loko o ka ʻōpū ma mua o 6, ʻaʻole e hana hou ʻo Hp a he naʻau koʻikoʻi i ka amoxicillin. Ua hana ʻo Ren et al i nā hoʻokolohua i hoʻomalu ʻia ma 117 mau maʻi me nā maʻi Hp-positive. Ua hāʻawi ʻia ka hui kiʻekiʻe i ka amoxicillin 1g, tid a me rabeprazole 20mg, bid, a ua hāʻawi ʻia ka hui kaohi iā amoxicillin 1g, tid a me rabeprazole. 10mg, bid, ma hope o 2 mau pule o ka mālama ʻana, ʻo ka helu hoʻopau Hp o ka hui mahele kiʻekiʻe he 89.8% (ITT), 93.0% (PP), ʻoi aku ka kiʻekiʻe ma mua o ka hui kaohi: 75.9% (ITT), 80.0% (PP), P <0.05. Ua hōʻike ʻia kahi noiʻi mai ʻAmelika Hui Pū ʻIa e hoʻohana ana i ka esomeprazole 40 mg, ld + amoxicillin 750 mg, 3 mau lā, ITT = 72.2% ma hope o 14 mau lā o ka mālama ʻana, PP = 74.2%. Ua kālailai ʻo Franceschi et al. i ʻekolu mau lāʻau lapaʻau: 1 maʻamau triple therapy: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 kiʻekiʻe-dose therapy: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, ʻo ka papa o ka mālama ʻana he 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, lāʻau lapaʻau bid no 5d, lansoprazole 30mg bid, carat Ua mālama ʻia ka bid 500mg a me ka tinidazole 500mg bid no 5 mau lā. ʻO nā helu hoʻopau o nā ʻano lāʻau lapaʻau ʻekolu: 55%, 75%, a me 73%. ʻO ka ʻokoʻa ma waena o ka lāʻau lapaʻau kiʻekiʻe a me ka lāʻau lapaʻau triple maʻamau he koʻikoʻi ka helu helu, a ua hoʻohālikelike ʻia ka ʻokoʻa me SQT. ʻAʻole koʻikoʻi ka helu helu. ʻOiaʻiʻo, ua hōʻike nā haʻawina ʻaʻole i hoʻomaikaʻi maikaʻi ka omeprazole kiʻekiʻe a me ka lāʻau amoxicillin i nā helu hoʻopau, ma muli paha o ka genotype CYP2C19. Hoʻopili ʻia ka hapa nui o nā PPI e ka enzyme CYP2C19, no laila hiki i ka ikaika o ka metabolite gene CYP2C19 ke hoʻopilikia i ka metabolism o PPI. Hoʻopili nui ʻia ʻo Esomeprazole e ka enzyme cytochrome P450 3 A4, hiki ke hōʻemi i ka mana o ka gene CYP2C19 i kekahi ʻano. Eia kekahi, ma waho aʻe o ka PPI, ʻo amoxicillin, rifampicin, furazolidone, levofloxacin, ua ʻōlelo ʻia hoʻi ma ke ʻano he koho lapaʻau kiʻekiʻe.

Hoʻomākaukau microbial i hui pū ʻia

ʻO ka hoʻohui ʻana i nā mea hana ecological microbial (MEA) i ka lāʻau lapaʻau maʻamau hiki ke hōʻemi i nā hopena maikaʻi ʻole, akā he mea hoʻopaʻapaʻa mau ia inā hiki ke hoʻonui ʻia ka nui o ka hoʻopau ʻana i ka Hp. Ua ʻike ʻia kahi meta-analysis ua hoʻonui ka lāʻau lapaʻau ʻekolu o B. sphaeroides i hui pū ʻia me ka lāʻau lapaʻau ʻekolu wale nō i ka nui o ka hoʻopau ʻana i ka Hp (4 mau hoʻokolohua i hoʻomalu ʻia i ka randomized, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), hōʻemi pū i nā hopena maikaʻi ʻole me ka maʻi diarrhea. Ua hōʻike pū ʻo Zhao Baomin et al. hiki i ka hui pū ʻana o nā probiotics ke hoʻomaikaʻi nui i ka nui o ka hoʻopau ʻana, ʻoiai ma hope o ka hoʻopōkole ʻana i ke kaʻina o ka lāʻau lapaʻau, aia nō ka nui o ka hoʻopau ʻana. Ua hoʻokaʻawale ʻia kahi noiʻi o 85 mau maʻi me nā maʻi Hp-positive i 4 mau hui o Lactobacillus 20 mg bid, clarithromycin 500 mg bid, a me tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus i hui pū ʻia me bifidobacteria, placebo no 1 pule, e hoʻopiha i kahi nīnau nīnau ma ka noiʻi hōʻailona i kēlā me kēia pule no 4 mau pule, 5 a 7 mau pule ma hope e nānā i ka maʻi, ua ʻike ʻia ke aʻo ʻana: ka hui probiotics a me ka hōʻoluʻolu ʻAʻohe ʻokoʻa koʻikoʻi i ka helu hoʻopau ʻana ma waena o nā hui, akā ʻoi aku ka maikaʻi o nā hui probiotic āpau i ka pale ʻana i nā hopena ʻino ma mua o ka hui kaohi, a ʻaʻohe ʻokoʻa koʻikoʻi i ka hanana o nā hopena ʻino ma waena o nā hui probiotic. ʻAʻole maopopo loa ke ʻano hana e hoʻopau ai nā probiotics iā Hp, a hiki ke kāohi a hoʻopau paha me nā wahi hoʻopili hoʻokūkū a me nā mea like ʻole e like me nā waikawa organik a me nā bacteriopeptides. Eia nō naʻe, ua ʻike kekahi mau haʻawina ʻaʻole hoʻomaikaʻi ka hui pū ʻana o nā probiotics i ka helu hoʻopau ʻana, kahi e pili ana paha i ka hopena keu o nā probiotics i ka wā ʻaʻole maikaʻi nā antibiotics. Aia nō kahi wahi noiʻi nui i nā probiotics hui, a pono ka noiʻi hou aku ma nā ʻano, nā papa hana lapaʻau, nā hōʻailona a me ka manawa o nā hoʻomākaukau probiotic.

Nā kumu e pili ana i ka wikiwiki o ka hoʻopau ʻana o Hp

ʻO kekahi mau mea e pili ana i ka hoʻopau ʻana iā Hp, ʻo ia ke kūʻē ʻana i nā antibiotic, ka ʻāina honua, ka makahiki o ka mea maʻi, ke kūlana puhipaka, ka hoʻokō ʻana, ka manawa lapaʻau, ka nui o ka bacteria, ka gastritis atrophic mau loa, ka nui o ka waikawa gastric, ka pane pilikino i ka PPI, a me ka polymorphism gene CYP2C19. ʻO ke alo. Ua hōʻike ʻia nā haʻawina i loko o ka loiloi univariate, ka makahiki, ka wahi noho, ka lāʻau lapaʻau, ka maʻi gastrointestinal, ka comorbidity, ka mōʻaukala hoʻopau, PPI, ke ʻano o ka lāʻau, a me ka hoʻokō ʻana i ka lāʻau e pili ana i nā helu hoʻopau. Eia kekahi, ʻo kekahi mau maʻi maʻi hiki ke loaʻa, e like me ka maʻi diabetes, ke koko kiʻekiʻe, ka maʻi puʻupaʻa mau loa, ka maʻi ate mau loa, a me ka maʻi māmā mau loa, hiki ke pili pū me ka helu hoʻopau o Hp. Eia naʻe, ʻaʻole like nā hopena o ke aʻo ʻana o kēia manawa, a pono nā haʻawina nui hou aʻe.