Helicobacter pylori (Hp), imodzi mwa matenda opatsirana kwambiri mwa anthu. Ndi chinthu chomwe chimayambitsa matenda ambiri, monga zilonda zam'mimba, gastritis yosatha, gastric adenocarcinoma, komanso mucosa-associated lymphoid tissue (MALT) lymphoma. Kafukufuku wasonyeza kuti kuthetseratu Hp kungachepetse chiopsezo cha khansa ya m'mimba, kuonjezera kuchuluka kwa machiritso a zilonda, ndipo pakadali pano kuyenera kuphatikizidwa ndi mankhwala kungathetseretu Hp mwachindunji. Pali njira zosiyanasiyana zochotsera matenda: chithandizo choyamba cha matenda chimaphatikizapo chithandizo cha katatu, expectorant quadruple therapy, chithandizo chotsatira, komanso chithandizo chofanana. Mu 2007, American College of Gastroenterology inaphatikiza chithandizo cha katatu ndi clarithromycin ngati chithandizo choyamba chochotseratu anthu omwe sanalandire clarithromycin ndipo analibe vuto la penicillin. Komabe, m'zaka zaposachedwa, kuchuluka kwa kuthetseratu kwa chithandizo cha katatu kwakhala ≤80% m'maiko ambiri. Ku Canada, kuchuluka kwa kukana kwa clarithromycin kwawonjezeka kuchoka pa 1% mu 1990 kufika pa 11% mu 2003. Pakati pa anthu omwe adalandira chithandizo, kuchuluka kwa kukana mankhwala kunanenedwa kuti kwapitirira 60%. Kukana kwa Clarithromycin kungakhale chifukwa chachikulu chothetsera kulephera. Lipoti la Maastricht IV m'madera omwe ali ndi kukana kwakukulu kwa clarithromycin (kukana kopitilira 15% mpaka 20%), m'malo mwa chithandizo cha katatu chokhazikika ndi chithandizo chachinayi kapena chotsatizana ndi expectorant ndi/kapena chopanda sputum, pomwe chithandizo cha carat Quadruple chingagwiritsidwenso ntchito ngati chithandizo choyamba m'madera omwe ali ndi kukana kochepa kwa mycin. Kuphatikiza pa njira zomwe zili pamwambapa, kuchuluka kwa PPI kuphatikiza amoxicillin kapena maantibayotiki ena monga rifampicin, furazolidone, levofloxacin kwanenedwanso ngati njira ina yothandizira yoyamba.

Kupititsa patsogolo chithandizo chamankhwala atatu

1.1 Chithandizo cha anai

Pamene kuchuluka kwa kuchotsedwa kwa mankhwala ochiritsira katatu kumatsika, monga mankhwala, mankhwala anayi ali ndi kuchuluka kwakukulu kwa kuchotsedwa. Shaikh ndi anzake adachiza odwala 175 omwe ali ndi matenda a Hp, pogwiritsa ntchito kusanthula kwa protocol (PP) ndi cholinga. Zotsatira za kusanthula kwa cholinga chochiza (ITT) zidayesa kuchuluka kwa kuchotsedwa kwa mankhwala ochiritsira katatu: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); mankhwala anayi ali ndi kuchuluka kwakukulu kwa kuchotsedwa: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Ngakhale kuti kuchuluka kwa kuchotsedwa kwa Hp kunachepa pambuyo pa chithandizo chilichonse cholephera, chithandizo cha tincture kanayi chinapezeka kuti chinali ndi kuchuluka kwakukulu kwa kuchotsedwa (95%) ngati mankhwala pambuyo pa kulephera kwa mankhwala ochiritsira katatu. Kafukufuku wina adafikanso pamlingo wofanana: pambuyo poti chithandizo cha katatu chokhazikika ndi chithandizo cha levofloxacin katatu sichinagwire ntchito, kuchuluka kwa mankhwala a barium quadruple kunali 67% ndi 65%, motsatana, kwa iwo omwe anali ndi vuto la penicillin kapena omwe adalandira mankhwala akuluakulu. Kwa odwala omwe ali ndi mankhwala ophera tizilombo toyambitsa matenda a lactone, chithandizo cha expectorant quadruple chimakondedwanso. Zachidziwikire, kugwiritsa ntchito tincture quadruple therapy kuli ndi mwayi waukulu wa zochitika zoyipa, monga nseru, kutsegula m'mimba, kupweteka m'mimba, melena, chizungulire, mutu, kukoma kwachitsulo, ndi zina zotero, koma chifukwa expectorant imagwiritsidwa ntchito kwambiri ku China, ndi yosavuta kupeza, ndipo ili ndi kuchuluka kwa kuchotsedwa kwa mankhwala komwe kungagwiritsidwe ntchito ngati chithandizo chochiritsira. Ndikoyenera kutsatsa kuchipatala.

1.2 SQT

SQT inalandira chithandizo cha PPI + amoxicillin kwa masiku 5, kenako inalandira chithandizo cha PPI + clarithromycin + metronidazole kwa masiku 5. Pakadali pano SQT ikulangizidwa ngati chithandizo choyamba chochotsera Hp. Kusanthula kwa meta kwa mayeso asanu ndi limodzi olamulidwa mwachisawawa (RCTs) ku Korea kutengera SQT ndi 79.4% (ITT) ndi 86.4% (PP), ndi HQ kuchotsa SQT. Chiŵerengerocho ndi chapamwamba kuposa chithandizo chachizolowezi cha katatu, 95% CI: 1.403 ~ 2.209), njira yake ikhoza kukhala yakuti 5d yoyamba (kapena 7d) imagwiritsa ntchito amoxicillin kuwononga njira ya clarithromycin efflux pakhoma la selo, zomwe zimapangitsa kuti clarithromycin ikhale yogwira mtima kwambiri. SQT nthawi zambiri imagwiritsidwa ntchito ngati njira yothetsera kulephera kwa chithandizo chachizolowezi cha katatu kunja. Komabe, kafukufuku wasonyeza kuti chiŵerengero chochotsera chithandizo cha katatu (82.8%) kwa nthawi yayitali (14d) ndi chapamwamba kuposa cha chithandizo chachikhalidwe (76.5%). Kafukufuku wina adapezanso kuti panalibe kusiyana kwakukulu pa kuchuluka kwa kuchotsedwa kwa Hp pakati pa SQT ndi chithandizo chachizolowezi cha katatu, chomwe chingagwirizane ndi kuchuluka kwa kukana kwa clarithromycin. SQT ili ndi chithandizo cha nthawi yayitali, chomwe chingachepetse kutsata kwa wodwala ndipo sichiyenera madera omwe clarithromycin imakana kwambiri, kotero SQT ikhoza kuganiziridwa ngati pali zotsutsana pakugwiritsa ntchito tincture.

1.3 Chithandizo chogwirizana

Chithandizo chogwirizana ndi PPI chophatikizidwa ndi amoxicillin, metronidazole ndi clarithromycin. Kusanthula kwa meta kunawonetsa kuti kuchuluka kwa kuchotsedwa kwa mankhwala kunali kokwera kuposa chithandizo cha katatu. Kusanthula kwina kwa meta kunapezanso kuti kuchuluka kwa kuchotsedwa kwa mankhwala (90%) kunali kokwera kwambiri kuposa chithandizo cha katatu (78%). Maastricht IV Consensus ikuwonetsa kuti SQT kapena chithandizo chogwirizana chingagwiritsidwe ntchito popanda mankhwala otulutsa ma expectorant, ndipo kuchuluka kwa kuchotsedwa kwa mankhwala awiriwa ndi kofanana. Komabe, m'madera omwe clarithromycin imakana ndi metronidazole, ndi bwino kwambiri ndi chithandizo chogwirizana. Komabe, chifukwa chithandizo chogwirizana nacho chimakhala ndi mitundu itatu ya maantibayotiki, kusankha maantibayotiki kudzachepetsedwa chithandizo chikalephera, kotero sichikulimbikitsidwa ngati njira yoyamba yothandizira kupatula madera omwe clarithromycin ndi metronidazole zimakana. Amagwiritsidwa ntchito kwambiri m'madera omwe ali ndi kukana kochepa kwa clarithromycin ndi metronidazole.

1.4 mankhwala amphamvu kwambiri

Kafukufuku wapeza kuti kuwonjezera mlingo ndi/kapena kuchuluka kwa ma PPI ndi amoxicillin kumaposa 90%. Mphamvu ya amoxicillin yopha mabakiteriya pa Hp imaonedwa kuti imadalira nthawi, motero, ndi bwino kuwonjezera kuchuluka kwa ma ARV. Kachiwiri, pamene pH m'mimba ikusungidwa pakati pa 3 ndi 6, kubwerezabwereza kumatha kuletsedwa bwino. Pamene pH m'mimba ikupitirira 6, Hp sidzabwerezanso ndipo imakhala yogwirizana ndi amoxicillin. Ren et al adachita mayeso olamulidwa mwachisawawa mwa odwala 117 omwe ali ndi Hp-positive. Gulu la odwala omwe ali ndi mlingo waukulu linapatsidwa amoxicillin 1g, tid ndi rabeprazole 20mg, bid, ndipo gulu lowongolera linapatsidwa amoxicillin 1g, tid ndi rabeprazole. 10mg, bid, patatha milungu iwiri ya chithandizo, kuchuluka kwa Hp kuchotsa kwa gulu la mlingo waukulu kunali 89.8% (ITT), 93.0% (PP), kokwera kwambiri kuposa gulu lolamulira: 75.9% (ITT), 80.0% (PP), P <0.05. Kafukufuku wochokera ku United States adawonetsa kuti kugwiritsa ntchito esomeprazole 40 mg, ld + amoxicillin 750 mg, masiku atatu, ITT = 72.2% patatha masiku 14 a chithandizo, PP = 74.2%. Franceschi et al. adasanthula mobwerezabwereza mankhwala atatu: 1 standard triple therapy: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; Mankhwala awiri a mlingo waukulu: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, njira ya chithandizo ndi 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, chithandizo cha bid cha 5d, lansoprazole 30mg bid, carat. 500mg bid ndi tinidazole 500mg bid zinachiritsidwa kwa masiku 5. Kuchuluka kwa kuchotsedwa kwa njira zitatu zochizira kunali: 55%, 75%, ndi 73%. Kusiyana pakati pa chithandizo cha mlingo waukulu ndi chithandizo cha katatu kunali kofunikira kwambiri, ndipo kusiyanako kunayerekezeredwa ndi SQT. Sikofunikira kwambiri pa ziwerengero. Zachidziwikire, kafukufuku wasonyeza kuti chithandizo cha omeprazole ndi amoxicillin cha mlingo waukulu sichinawongolere bwino kuchuluka kwa kuchotsedwa, mwina chifukwa cha mtundu wa CYP2C19. Ma PPI ambiri amasinthidwa ndi enzyme ya CYP2C19, kotero mphamvu ya metabolite ya jini ya CYP2C19 ingakhudze kagayidwe ka PPI. Esomeprazole imasinthidwa makamaka ndi enzyme ya cytochrome P450 3 A4, yomwe ingachepetse mphamvu ya jini ya CYP2C19 pamlingo wina. Kuphatikiza apo, kuwonjezera pa PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, imalimbikitsidwanso ngati njira ina yochizira matenda ambiri.

Kukonzekera tizilombo toyambitsa matenda pamodzi

Kuwonjezera mankhwala ophera tizilombo toyambitsa matenda (MEA) ku mankhwala wamba kungachepetse zotsatira zoyipa, koma zikukayikitsabe ngati kuchuluka kwa kuchotsedwa kwa Hp kungawonjezeke. Kusanthula kwa meta kunapeza kuti chithandizo cha katatu cha B. sphaeroides pamodzi ndi chithandizo cha katatu chokha chinawonjezera kuchuluka kwa kuchotsedwa kwa Hp (mayesero 4 olamulidwa mwachisawawa, n=915, RR=l.13, 95% CI: 1.05) ~1.21), komanso kuchepetsa zotsatira zoyipa kuphatikizapo kutsegula m'mimba. Zhao Baomin et al. adawonetsanso kuti kuphatikiza kwa ma probiotics kumatha kusintha kwambiri kuchuluka kwa kuchotsedwa, ngakhale atafupikitsa nthawi ya chithandizo, pakadalibe kuchuluka kwa kuchotsedwa. Kafukufuku wa odwala 85 omwe ali ndi Hp-positive adachitika mwachisawawa m'magulu 4 a Lactobacillus 20 mg bid, clarithromycin 500 mg bid, ndi tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus pamodzi ndi bifidobacteria, placebo kwa sabata imodzi, lembani mafunso okhudza kafukufuku wa zizindikiro sabata iliyonse kwa milungu 4, milungu 5 mpaka 7 pambuyo pake kuti muwone matenda, kafukufukuyu adapeza: gulu la ma probiotic ndi chitonthozo Panalibe kusiyana kwakukulu pa kuchuluka kwa kuchotsedwa pakati pa magulu, koma magulu onse a ma probiotic anali opindulitsa kwambiri popewa zotsatira zoyipa kuposa gulu lolamulira, ndipo panalibe kusiyana kwakukulu pa kuchuluka kwa zotsatira zoyipa pakati pa magulu a ma probiotic. Njira yomwe ma probiotic amachotsera Hp sichikudziwikabe, ndipo ikhoza kuletsa kapena kuletsa ndi malo opikisana omatira ndi zinthu zosiyanasiyana monga ma organic acid ndi ma bacteriopeptides. Komabe, maphunziro ena apeza kuti kuphatikiza ma probiotic sikukweza kuchuluka kwa kuchotsedwa, komwe kungakhale kogwirizana ndi zotsatira zowonjezera za ma probiotic pokhapokha ngati maantibayotiki sagwira ntchito bwino. Palinso malo abwino ofufuzira mu ma probiotic olumikizana, ndipo kafukufuku wowonjezereka ukufunika pa mitundu, njira zochiritsira, zizindikiro ndi nthawi ya kukonzekera ma probiotic.

Zinthu zomwe zimakhudza kuchuluka kwa kuchotsedwa kwa Hp

Zinthu zingapo zomwe zimakhudza kuchotsedwa kwa Hp ndi monga kukana maantibayotiki, dera la malo, zaka za wodwala, momwe wodwala akusuta, kutsatira malamulo, nthawi yolandira chithandizo, kuchuluka kwa mabakiteriya, gastritis yosatha, kuchuluka kwa asidi m'mimba, kuyankha kwa munthu ku PPI, ndi polymorphism ya majini a CYP2C19. Kupezeka. Kafukufuku wanena kuti mu kusanthula kwa univariate, zaka, malo okhala, mankhwala, matenda am'mimba, matenda ena ofanana, mbiri yochotsera, PPI, njira yochizira, ndi kutsatira chithandizo zimagwirizanitsidwa ndi kuchuluka kwa kuchotsedwa. Kuphatikiza apo, matenda ena osatha, monga matenda a shuga, kuthamanga kwa magazi, matenda osatha a impso, matenda osatha a chiwindi, ndi matenda osatha a m'mapapo angakhalenso okhudzana ndi kuchuluka kwa kuchotsedwa kwa Hp. Komabe, zotsatira za kafukufuku wapano sizofanana, ndipo maphunziro ena akuluakulu akufunika.