Helicobacter pylori (Hp), imwe mu ndwara zandura zikunze kugaragara mu bantu. Ni ikintu gitera indwara nyinshi, nk'ibisebe byo mu gifu, indwara y'igifu idakira, adenocarcinoma yo mu gifu, ndetse na lymphoma ya mucosa-associated lymphoid tissue (MALT). Ubushakashatsi bwagaragaje ko kurandura Hp bishobora kugabanya ibyago byo kurwara kanseri yo mu gifu, kongera igipimo cyo gukira ibisebe, kandi ubu bigomba guhuzwa n'imiti bishobora kurandura Hp mu buryo butaziguye. Hari uburyo butandukanye bwo kurandura indwara: uburyo bwa mbere bwo kuvura ubwandu burimo uburyo busanzwe bwo kuvura inshuro eshatu, uburyo bwo kuvura indwara ya expectorant quadruple, uburyo bwo kuvura bukurikiranye, no kuvura hamwe. Mu 2007, Ishuri Rikuru ry'Abanyamerika ryita ku ndwara ya Gastroenterology ryahuje uburyo bwo kuvura inshuro eshatu na clarithromycin nk'uburyo bwa mbere bwo kuvura abantu batari barahawe clarithromycin kandi badafite allergie ya penisiline. Ariko, mu myaka ya vuba aha, igipimo cyo kurandura uburyo busanzwe bwo kuvura inshuro eshatu cyari ≤80% mu bihugu byinshi. Muri Kanada, igipimo cyo kudakira kwa clarithromycin cyariyongereye kuva kuri 1% mu 1990 kigera kuri 11% mu 2003. Mu bantu bavuwe, igipimo cyo kudakira kwa clarithromycin cyavuzwe ko kirenga 60%. Ubudakira bwa Clarithromycin bushobora kuba intandaro nyamukuru yo kunanirwa kurandura burundu. Raporo y’ubwumvikane bwa Maastricht IV mu duce dufite ubudakira bwa clarithromycin bwinshi (igipimo cyo kudakira kiri hejuru ya 15% kugeza kuri 20%), gisimbuza uburyo busanzwe bwo kuvura inshuro eshatu hakoreshejwe uburyo bwa kane cyangwa bukurikiranye hamwe n’umuti ugabanya ubukana bw’imiti cyangwa amatembabuzi, mu gihe uburyo bwa karat Quadruple bushobora no gukoreshwa nk’uburyo bwa mbere bwo kuvura mu duce dufite ubudakira bwa clarithromycin buke. Uretse uburyo bwavuzwe haruguru, PPI nyinshi hamwe na amoxicillin cyangwa imiti yindi nka rifampicin, furazolidone, levofloxacin nabyo byavuzwe nk’ubundi buryo bwo kuvura bwa mbere.

Kunoza uburyo bwo kuvura indwara eshatu (triple therapy) busanzwe

1.1 Ubuvuzi bugizwe na bane

Uko igipimo cyo kurandura indwara ya triple therapy isanzwe kigabanuka, nk'umuti, 4th therapy ifite igipimo cyo kurandura indwara. Shaikh n'abandi bavuriye abarwayi 175 banduye Hp, bakoresheje isesengura rya protocole (PP) n'intego. Ibisubizo by'isesengura rya intention to treat (ITT) byasuzumye igipimo cyo kurandura indwara ya triple therapy isanzwe: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); 4th therapy ifite igipimo cyo kurandura indwara: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Nubwo igipimo cyo kurandura indwara ya Hp cyagabanutse nyuma ya buri muti wananiranye, 4th treatment yagaragaye ko ifite igipimo cyo kurandura indwara ya triple therapy isanzwe (95%) nk'umuti nyuma yo kurandura indwara ya triple therapy isanzwe. Ubundi bushakashatsi nabwo bwageze ku mwanzuro nk'uwo: nyuma y'uko uburyo busanzwe bwo kuvura inshuro eshatu na levofloxacin triple therapy bunaniwe, igipimo cyo kurandura barium quadruple therapy cyari 67% na 65%, ku bantu bari bafite ubwivumbure kuri penisiline cyangwa bari barahawe imiti myinshi. Ku barwayi bafite imiti igabanya ubukana bwa lactone, uburyo bwo kuvura indwara ya expectorant quadruple therapy nabwo ni bwiza. Birumvikana ko gukoresha tincture quadruple therapy bifite amahirwe menshi yo kugira ingaruka mbi, nko kugira isesemi, impiswi, ububabare bwo mu nda, melena, isereri, kuribwa umutwe, uburyohe bw'icyuma, nibindi, ariko kubera ko expectorant ikoreshwa cyane mu Bushinwa, biroroshye kuyibona, kandi ifite igipimo cyo kurandura indwara gishobora gukoreshwa nk'ubuvuzi buvura. Birakwiye ko ivurirwa kwa muganga.

1.2 SQT

SQT yavuwe na PPI + amoxicillin mu minsi 5, hanyuma ivurwa na PPI + clarithromycin + metronidazole mu minsi 5. Ubu SQT irasabwa nk'uburyo bwa mbere bwo kuvura Hp. Isesengura rya meta-analysis ry'ibizamini bitandatu byagenzuwe mu buryo butaziguye (RCTs) muri Koreya bishingiye kuri SQT ni 79.4% (ITT) na 86.4% (PP), hamwe no kurandura SQT mu buryo bwa HQ. Igipimo kiri hejuru ugereranije n'uburyo busanzwe bwo kuvura inshuro eshatu, 95% CI: 1.403 ~ 2.209), uburyo bushobora kuba ari uko 5d ya mbere (cyangwa 7d) ikoresha amoxicillin kugira ngo isenye umuyoboro wa clarithromycin efflux ku rukuta rw'uturemangingo, bigatuma ingaruka za clarithromycin zigira akamaro kanini. SQT ikunze gukoreshwa nk'umuti wo kunanirwa kwa triple therapy isanzwe mu mahanga. Ariko, ubushakashatsi bwagaragaje ko igipimo cyo kurandura triple therapy (82.8%) mu gihe kirekire (14d) kiri hejuru ugereranyije n'uburyo busanzwe bwo kuvura (76.5%). Hari ubushakashatsi bwagaragaje ko nta tandukaniro rigaragara mu kugabanya Hp hagati ya SQT n'ubuvuzi busanzwe bwa gatatu, bishobora kuba bifitanye isano n'igipimo cyo hejuru cy'ubudahangarwa bwa clarithromycin. SQT ifite uburyo bwo kuvura burambye, bushobora kugabanya ubwumvikane bw'abarwayi kandi ntibukwiriye ahantu hafite ubudahangarwa bwinshi bwa clarithromycin, bityo SQT ishobora kwitabwaho iyo habayeho ibibujijwe mu gukoresha tincture.

1.3 Ubuvuzi bujyanye n'abandi

Ubuvuzi bujyana na PPI buvanze na amoxicillin, metronidazole na clarithromycin. Isesengura ryakozwe ryagaragaje ko igipimo cyo kurandura cyari hejuru ugereranije n’ubuvuzi busanzwe bwa gatatu. Ikindi gipimo cyagaragaje kandi ko igipimo cyo kurandura (90%) cyari hejuru cyane ugereranije n’ubuvuzi busanzwe bwa gatatu (78%). Ihuriro rya Maastricht IV Consensus rivuga ko SQT cyangwa ubuvuzi bujyana na yo bushobora gukoreshwa mu gihe nta miti igabanya ubukana bw’imiti, kandi igipimo cyo kurandura cy’imiti yombi gisa. Ariko, mu turere aho clarithromycin idakira metronidazole, ni byiza cyane iyo ubuvuzi bujyana na yo bugizwe n’ubwoko butatu bwa antibiyotike, guhitamo antibiyotike bizagabanuka nyuma yo kunanirwa k’ubuvuzi, bityo ntibyemewe nk’uburyo bwa mbere bwo kuvura keretse mu turere aho clarithromycin na metronidazole zidakira. Ikoreshwa cyane mu turere dufite ubushobozi buke bwo kurandura clarithromycin na metronidazole.

1.4 uburyo bwo kuvura hakoreshejwe dose nyinshi

Ubushakashatsi bwagaragaje ko kongera igipimo n'inshuro zo gutanga PPI na amoksilini birenga 90%. Ingaruka za amoksilini zo kwica bagiteri kuri Hp zifatwa nk'izishingiye ku gihe, bityo, ni byiza kurushaho kongera inshuro zo gutanga. Icya kabiri, iyo pH mu gifu ikomeje kuba hagati ya 3 na 6, kongera kwiyongera kwayo bishobora kugabanywa neza. Iyo pH mu gifu irenze 6, Hp ntizongera kwiyongera kandi iba ifite amoksilini. Ren n'abandi bakoze igerageza ryagenzuwe ku barwayi 117 bafite abarwayi ba Hp. Itsinda ryahawe amoksilini 1g, tid na rabeprazole 20mg, bid, naho itsinda ryagenzuwe rihabwa amoksilini 1g, tid na rabeprazole. 10mg, bid, nyuma y'ibyumweru 2 by'ubuvuzi, igipimo cyo gukuraho Hp mu itsinda ry'ibipimo byinshi cyari 89.8% (ITT), 93.0% (PP), kiri hejuru cyane ugereranije n'itsinda ryigenzurwa: 75.9% (ITT), 80.0% (PP), P <0.05. Ubushakashatsi bwakozwe muri Leta Zunze Ubumwe za Amerika bwagaragaje ko gukoresha esomeprazole 40 mg, ld + amoxicillin 750 mg, iminsi 3, ITT = 72.2% nyuma y'iminsi 14 y'ubuvuzi, PP = 74.2%. Franceschi n'abandi basesenguye uburyo butatu bwo kuvura: 1 uburyo busanzwe bwo kuvura inshuro eshatu: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; Uburyo 2 bwo kuvura hakoreshejwe dose nyinshi: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, uburyo bwo kuvura ni 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, bid treatment kuri 5d, lansoprazole 30mg bid, carat. 500mg bid na tinidazole 500mg bid byavuwe mu gihe cy'iminsi 5. Igipimo cyo kurandura ubwoko butatu bw'ubuvuzi cyari: 55%, 75%, na 73%. Itandukaniro hagati yo kuvura hakoreshejwe dose nyinshi n'ubuvuzi busanzwe bwa gatatu ryari rifite agaciro gakomeye mu mibare, kandi itandukaniro ryari rigereranyijwe na SQT. Ntabwo rifite agaciro gakomeye mu mibare. Birumvikana ko ubushakashatsi bwagaragaje ko kuvura hakoreshejwe dose nyinshi na amoxicillin bitazamuye igipimo cyo kurandura, bishoboka ko byatewe na genotype ya CYP2C19. Inyinshi muri PPI zitunganywa na enzyme ya CYP2C19, bityo imbaraga za metabolite ya CYP2C19 zishobora kugira ingaruka ku mikorere ya PPI. Esomeprazole itunganywa ahanini na enzyme ya cytochrome P450 3 A4, ishobora kugabanya ingaruka za gene ya CYP2C19 ku rugero runaka. Byongeye kandi, uretse PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, nabyo birasabwa nk'uburyo bwo kuvura butanga urugero rwo hejuru.

Gutegura mikorobe bivanze

Kongera imiti irwanya udukoko (MEA) ku buvuzi busanzwe bishobora kugabanya ingaruka mbi, ariko biracyari impaka niba igipimo cyo kurandura Hp gishobora kwiyongera. Isesengura ryakozwe ryagaragaje ko uburyo bwo kuvura butatu bwa B. sphaeroide buvanze n'uburyo bwo kuvura butatu bwonyine byongera igipimo cyo kurandura Hp (ibizamini 4 byagenzuwe ku buryo butaziguye, n=915, RR=l.13, 95% CI: 1.05) ~1.21), binagabanya ingaruka mbi zirimo impiswi. Zhao Baomin n'abandi bagaragaje kandi ko guhuza imiti ya probiotics bishobora kongera cyane igipimo cyo kurandura, ndetse no nyuma yo kugabanya igihe cyo kuvura, haracyari igipimo cyo kurandura cyane. Inyigo yakozwe ku barwayi 85 bafite Hp yashyizwe mu matsinda 4 ya Lactobacillus 20 mg bid, clarithromycin 500 mg bid, na tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus hamwe na bifidobacteria, placebo mu cyumweru 1, uzuza urutonde rw'ibibazo ku bushakashatsi ku bimenyetso buri cyumweru mu gihe cy'ibyumweru 4, nyuma y'ibyumweru 5 kugeza kuri 7 kugira ngo harebwe ubwandu, ubushakashatsi bwagaragaje: itsinda rya probiotics n'ihumure Nta tandukaniro rigaragara mu muvuduko wo kurandura hagati y'amatsinda, ariko amatsinda yose ya probiotics yari afite akamaro cyane mu gukumira ingaruka mbi kurusha itsinda ryagenzuwe, kandi nta tandukaniro rigaragara mu muvuduko w'ingaruka mbi mu matsinda ya probiotics. Uburyo probiotics zica Hp buracyari budasobanutse neza, kandi bushobora gukumira cyangwa guhagarika gukora hamwe n'ahantu hahanganye n'ibintu bitandukanye nka aside organic na bacteriopeptides. Ariko, hari ubushakashatsi bwagaragaje ko guhuza probiotics bidatuma igipimo cyo kurandura kiraba cyiza, bishobora kuba bifitanye isano n'ingaruka z'inyongera za probiotics gusa iyo antibiyotike zidakora neza. Haracyari ahantu hanini ho gukora ubushakashatsi muri probiotics, kandi hakenewe ubundi bushakashatsi ku bwoko, amasomo yo kuvura, ibimenyetso n'igihe cyo gutegura probiotics.

Ibintu bigira ingaruka ku gipimo cyo kurandura Hp

Ibintu byinshi bigira ingaruka ku kurandura Hp birimo ubudahangarwa bw'imiti irwanya udukoko, akarere k'ubuzima, imyaka y'umurwayi, uko anywa itabi rihagaze, igihe cyo kuvurwa, ubucucike bwa bagiteri, indwara ya gastritis idakira, ubwinshi bw'aside yo mu gifu, uburyo umuntu yitabira PPI, na CYP2C19 gene polymorphism. Ubushakashatsi bwagaragaje ko mu isesengura ryihariye, imyaka, aho umuntu atuye, imiti, indwara zo mu gifu, indwara zifata, amateka yo kurandura, PPI, uburyo bwo kuvurwa, no gukurikiza ubuvuzi bifitanye isano n'umuvuduko wo kurandura. Byongeye kandi, zimwe mu ndwara zidakira, nka diyabete, umuvuduko ukabije w'amaraso, indwara zidakira z'impyiko, indwara zidakira z'umwijima, n'indwara zidakira z'ibihaha nazo zishobora kuba zifitanye isano n'umuvuduko wo kurandura Hp. Ariko, ibisubizo by'ubushakashatsi buriho ubu ntabwo ari bimwe, kandi hakenewe izindi nyigo nini.