Ko te Helicobacter pylori (Hp), tētahi o ngā mate pāwera tino noa i roto i te tangata. He take mōrearea tēnei mō ngā mate maha, pērā i te mate puku, te gastritis mau tonu, te adenocarcinoma puku, tae atu ki te lymphoma kiko lymphoid e pā ana ki te mucosa (MALT). Kua whakaatuhia e ngā rangahau ka taea e te whakakorenga o te Hp te whakaiti i te mōrearea o te mate pukupuku puku, te whakanui ake i te tere whakaora o ngā mate puku, ā, me whakakotahi me ngā rongoā i tēnei wā ka taea te whakakore tika i te Hp. He maha ngā kōwhiringa whakakorenga haumanu e wātea ana: ko te maimoatanga tuatahi mō te mate ko te rongoā toru paerewa, te rongoā whā expectorant, te rongoā raupapa, me te rongoā tahi. I te tau 2007, i whakakotahi te American College of Gastroenterology i te rongoā toru me te clarithromycin hei rongoā tuatahi mō te whakakorenga o te hunga kāore i whiwhi clarithromycin, ā, kāore he mate pāwera penicillin. Heoi, i ngā tekau tau tata nei, ko te tere whakakorenga o te rongoā toru paerewa he ≤80% i te nuinga o ngā whenua. I Kanata, kua piki ake te auau ātete o te clarithromycin mai i te 1% i te tau 1990 ki te 11% i te tau 2003. I roto i ngā tāngata i rongoatia, i pūrongohia te auau ātete rongoā neke atu i te 60%. Ko te ātete ki te clarithromycin pea te tino take o te korenga o te whakakorenga. Ko te pūrongo whakaae a Maastricht IV i ngā wāhi he nui te ātete ki te clarithromycin (he nui ake te ātete i te 15% ki te 20%), hei whakakapi i te rongoā toru paerewa ki te rongoā whā, rongoā raupapa rānei me te expectorant me/ranei te kore huware, i te mea ka taea hoki te whakamahi i te rongoā carat Quadruple hei rongoā raina-tuatahi i ngā wāhi he iti te ātete ki te mycin. Haunga ngā tikanga o runga ake nei, kua whakaarohia hoki ngā horopeta teitei o te PPI me te amoxicillin, ngā paturopi rerekē rānei pērā i te rifampicin, te furazolidone, te levofloxacin hei rongoā raina-tuatahi kē.

Te whakapai ake i te rongoā toru paerewa

1.1 Whakaora whā

I te hekenga o te auau whakakorenga o te rongoā takitoru paerewa, he nui te auau whakakorenga o te rongoā whā-whā. I rongoatia e Shaikh me ētahi atu he 175 ngā tūroro i pangia e te mate Hp, mā te whakamahi i te tātaritanga ia tikanga (PP) me te whāinga. I arotakehia e ngā hua o te tātaritanga whāinga ki te rongoā (ITT) te auau whakakorenga o te rongoā takitoru paerewa: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); he nui ake te auau whakakorenga o te rongoā whā-whā: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Ahakoa i heke te auau angitu o te whakakorenga Hp i muri i ia maimoatanga kore angitu, i kitea he nui te auau whakakorenga o te maimoatanga whā-whā o te tincture (95%) hei rongoā i muri i te korenga o te rongoā takitoru paerewa. I tae atu hoki tētahi atu rangahau ki tētahi whakatau ōrite: i muri i te korenga o te rongoā toru paerewa me te rongoā toru levofloxacin, ko te tere whakakorenga o te rongoā whā-toru barium he 67% me te 65%, ia, mō te hunga i mate pāwera ki te penicillin, i whiwhi rānei i te nui o te rongoā expectorant. I roto i ngā tūroro e mau ana i ngā paturopi cyclic lactone, he pai ake te rongoā whā-toru expectorant. Ko te tikanga, he nui ake te tūponotanga o ngā pānga kino ki te whakamahinga o te tincture therapy whā-toru, pērā i te whakapairuaki, te korere, te mamae o te puku, te melena, te whanoke, te ānini, te reka konganuku, me ētahi atu, engari nā te mea he whānuitia te whakamahinga o te expectorant i Haina, he ngāwari noa te tiki, ā, he nui ake te tere whakakorenga ka taea te whakamahi hei rongoā whakaora. He mea tika kia whakatairangahia i roto i te whare hauora.

1.2 SQT

I rongoatia te SQT ki te PPI + amoxicillin mō ngā rā e 5, kātahi ka rongoatia ki te PPI + clarithromycin + metronidazole mō ngā rā e 5. E taunakitia ana te SQT hei rongoā tuatahi mō te whakakorenga i te Hp. Ko te tātaritanga whānui o ngā whakamātautau whakahaere matapōkere e ono (RCT) i Korea i runga i te SQT he 79.4% (ITT) me te 86.4% (PP), ā, ko te whakakorenga HQ o te SQT he teitei ake te tere i te rongoā takitoru paerewa, 95% CI: 1.403 ~ 2.209), ko te tikanga pea ko te whakamahinga o te amoxicillin e te 5d tuatahi (7d rānei) hei whakangaro i te awa e puta ai te clarithromycin ki te pakitara pūtau, kia pai ake ai te pānga o te clarithromycin. He maha ngā wā ka whakamahia te SQT hei rongoā mō te korenga o te rongoā takitoru paerewa ki tāwāhi. Heoi, kua whakaatuhia e ngā rangahau he teitei ake te tere whakakorenga rongoā takitoru (82.8%) i roto i te wā roa (14d) i te rongoā raupapa matarohia (76.5%). I kitea anō hoki i roto i tētahi rangahau kāore he rerekētanga nui i roto i ngā reiti whakakorenga Hp i waenga i te SQT me te rongoā takitoru paerewa, e pā ana pea ki te reiti teitei ake o te ātete ki te clarithromycin. He roa ake te maimoatanga o te SQT, ka whakaiti pea i te ngohengohe o te tūroro, ā, kāore e pai mō ngā wāhi he nui te ātete ki te clarithromycin, nō reira ka whakaarohia pea te SQT ina he ārai mō te whakamahinga o te tincture.

1.3 Te rongoā hoa

Ko te rongoā āpiti ko te PPI i honoa ki te amoxicillin, metronidazole me te clarithromycin. I whakaatuhia e te tātaritanga-maha he teitei ake te tere whakakore i te rongoā takitoru paerewa. I kitea anō hoki e tētahi atu tātaritanga-maha he nui ake te tere whakakore (90%) i te rongoā takitoru paerewa (78%). E kī ana te Maastricht IV Consensus ka taea te whakamahi i te SQT, i te rongoā āpiti rānei i te korenga o ngā rongoā pupuhi, ā, he rite tonu ngā tere whakakore o ngā rongoā e rua. Heoi, i ngā wāhi e ātete ana te clarithromycin ki te metronidazole, he pai ake te whakamahi i te rongoā āpiti. Heoi, nā te mea e toru ngā momo paturopi kei roto i te rongoā āpiti, ka whakaitihia te kōwhiringa o ngā paturopi i muri i te korenga o te maimoatanga, nō reira kāore i te tūtohutia hei mahere maimoatanga tuatahi engari mō ngā wāhi e ātete ana te clarithromycin me te metronidazole. Ko te nuinga o te wā ka whakamahia i ngā wāhi he iti te ātete ki te clarithromycin me te metronidazole.

1.4 te rongoā horopeta teitei

Kua kitea e ngā rangahau he nui ake i te 90% te whakanui ake i te horopeta me/ranei te auau o te whakahaerenga o te PPI me te amoxicillin. E kiia ana ko te pānga patu huakita o te amoxicillin ki te Hp he mea whakawhirinaki ki te wā, nō reira, he pai ake te whakanui ake i te auau o te whakahaerenga. Tuarua, ina mau tonu te pH i roto i te puku i waenga i te 3 me te 6, ka taea te aukati i te whakaputanga. Ina neke atu te pH i roto i te puku i te 6, kāore te Hp e whakaputanga anō, ā, he tairongo ki te amoxicillin. I whakahaerehia e Ren me ētahi atu ngā whakamātautau whakahaere matapōkere i roto i te 117 tūroro me ngā tūroro Hp-pai. I hoatu ki te rōpū horopeta teitei te amoxicillin 1g, tid me te rabeprazole 20mg, bid, ā, i hoatu ki te rōpū whakahaere te amoxicillin 1g, tid me te rabeprazole. 10mg, bid, i muri i te 2 wiki o te maimoatanga, ko te tere whakakorenga Hp o te rōpū horopeta teitei ko 89.8% (ITT), 93.0% (PP), he nui ake i te rōpū whakahaere: 75.9% (ITT), 80.0% (PP), P <0.05. I whakaatuhia e tētahi rangahau mai i te Hononga o Amerika mā te whakamahi i te esomeprazole 40 mg, ld + amoxicillin 750 mg, 3 rā, ITT = 72.2% i muri i te 14 rā o te maimoatanga, PP = 74.2%. I tātarihia whakamuri e Franceschi me ētahi atu e toru ngā maimoatanga: 1 te rongoā toru paerewa: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 te rongoā horopeta teitei: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, ko te roanga o te maimoatanga he 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, maimoatanga bid mō te 5d, lansoprazole 30mg bid, carat I rongoatia te 500mg bid me te tinidazole 500mg bid mō ngā rā e 5. Ko ngā reiti whakakorenga o ngā tikanga maimoatanga e toru ko: 55%, 75%, me te 73%. He mea nui te rerekētanga i waenga i te rongoā horopeta teitei me te rongoā toru paerewa, ā, i whakaritea te rerekētanga ki te SQT. Kāore i te nui te rerekētanga. Ko te tikanga, kua whakaatuhia e ngā rangahau kāore te rongoā omeprazole horopeta teitei me te amoxicillin i whakapai ake i ngā reiti whakakorenga, nā te momoira CYP2C19 pea. Ko te nuinga o ngā PPI ka whakapūngaohia e te whākōkī CYP2C19, nō reira ko te kaha o te matū whakaputa ira CYP2C19 ka pā ki te pākia o te PPI. Ko te nuinga o te Esomeprazole ka whakapūngaohia e te whākōkī cytochrome P450 3 A4, ka taea te whakaiti i te awe o te ira CYP2C19 ki tētahi taumata. Hei tāpiritanga ki te PPI, e taunakitia ana hoki te amoxicillin, te rifampicin, te furazolidone, te levofloxacin hei rongoā rerekē mō te horopeta nui.

Te whakarite i ngā moroiti whakakotahi

Mā te tāpiri i ngā kaihoko rauropi moroiti (MEA) ki te rongoā paerewa ka taea te whakaiti i ngā tauhohenga kino, engari kei te tautohetia tonutia mēnā ka taea te whakanui ake i te tere whakakorenga Hp. I kitea i roto i tētahi tātaritanga-maha ko te rongoā takitoru o te B. sphaeroides me te rongoā takitoru anake i whakanui ake i te tere whakakorenga Hp (4 ngā whakamātautau whakahaere matapōkere, n=915, RR=l.13, 95% CI: 1.05) ~1.21), ka whakaitihia hoki ngā tauhohenga kino tae atu ki te mate korere. I whakaatuhia hoki e Zhao Baomin me ētahi atu ka taea e te whakakotahitanga o ngā probiotics te whakapai ake i te tere whakakorenga, ahakoa i muri i te whakapoto i te roanga o te maimoatanga, he nui tonu te tere whakakorenga. I wehea matapōkeretia tētahi rangahau o ngā tūroro 85 me ngā tūroro Hp-pai ki roto i ngā rōpū e 4 o Lactobacillus 20 mg bid, clarithromycin 500 mg bid, me tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus i honoa ki te bifidobacteria, placebo mō te 1 wiki, whakakīia he pātai mō te rangahau tohu i ia wiki mō te 4 wiki, 5 ki te 7 wiki i muri mai hei tirotiro i te mate, i kitea e te rangahau: rōpū probiotics me te whakamarie Kāore he rerekētanga nui i roto i te tere whakakore i waenga i ngā rōpū, engari he pai ake ngā rōpū probiotics katoa ki te aukati i ngā tauhohenga kino i te rōpū whakahaere, ā, kāore he rerekētanga nui i roto i te auau o ngā tauhohenga kino i waenga i ngā rōpū probiotics. Kāore anō kia mārama te tikanga e whakakorea ai e ngā probiotics te Hp, ā, ka ārai, ka whakakore rānei i ngā pae piri whakataetae me ngā momo matū pēnei i ngā waikawa waro me ngā bacteriopeptides. Heoi, kua kitea e ētahi rangahau kāore te whakakotahitanga o ngā probiotics e whakapai ake i te tere whakakore, e pā ana pea ki te pānga tāpiri o ngā probiotics ina kore e tino whai hua ngā paturopi. He nui tonu te wāhi rangahau i roto i ngā probiotics tahi, ā, me rangahau anō mō ​​ngā momo, ngā akoranga maimoatanga, ngā tohu me te wā o ngā whakaritenga probiotic.

Ngā āhuatanga e pā ana ki te tere whakakorenga o te Hp

He maha ngā āhuatanga e pā ana ki te whakakorenga o te Hp ko te ātete ki ngā paturopi, te rohe whenua, te tau o te tūroro, te tūnga momi hikareti, te tutuki i te whakaritenga, te wā maimoatanga, te kiato o te huakita, te gastritis atrophic mau tonu, te kukū o te waikawa puku, te urupare takitahi ki te PPI, me te polymorphism ira CYP2C19. Te aroaro. Kua pūrongohia e ngā rangahau i roto i te tātaritanga univariate, te tau, te rohe noho, te rongoā, te mate puku, te mate tāpiri, te hītori whakakorenga, te PPI, te akoranga maimoatanga, me te tutuki i te whakaritenga maimoatanga e pā ana ki ngā reiti whakakorenga. Hei tāpiri, ko ētahi mate mau tonu pea, pērā i te mate huka, te toto toto tiketike, te mate tākihi mau tonu, te mate ate mau tonu, me te mate pūkahukahu mau tonu, tera pea e pā ana ki te reiti whakakorenga o te Hp. Heoi, kāore ngā hua o te rangahau o nāianei i te ōrite, ā, me whai atu i ngā rangahau nui.