Helicobacter pylori (Hp), chimwe chezvirwere zvinotapukira zvakanyanya muvanhu. Ndiyo njodzi yezvirwere zvakawanda, zvakaita semaronda emudumbu, gastritis isingaperi, gastric adenocarcinoma, uye kunyange mucosa-associated lymphoid tissue (MALT) lymphoma. Zvidzidzo zvakaratidza kuti kubviswa kweHp kunogona kuderedza njodzi yekenza yemudumbu, kuwedzera mwero wekurapa maronda, uye parizvino kunofanirwa kusanganiswa nemishonga kunogona kubvisa Hp zvakananga. Kune nzira dzakasiyana-siyana dzekurapa dziripo: kurapwa kwekutanga kwehutachiona kunosanganisira standard triple therapy, expectorant quadruple therapy, sequential therapy, uye concomitant therapy. Muna 2007, American College of Gastroenterology yakabatanidza triple therapy neclarithromycin senzira yekutanga yekurapa vanhu vasina kugamuchira clarithromycin uye vasina penicillin allergy. Zvisinei, mumakumi emakore achangopfuura, mwero wekubvisa standard triple therapy wave uri ≤80% munyika zhinji. MuCanada, mwero wekusagona kurapwa kwe clarithromycin wakawedzera kubva pa1% muna 1990 kusvika pa11% muna 2003. Pakati pevanhu vakarapwa, mwero wekusagona kurapwa kwemishonga wakatotaurwa kuti waipfuura 60%. Kusagona kurapwa kweClarithromycin kungave kuri iko kunokonzera kukundikana kwekubvisa mishonga. Mushumo weMaastricht IV wakabvumiranwa munzvimbo dzine kusagona kurapwa zvakanyanya ne clarithromycin (mwero wekusagona kurapwa unopfuura 15% kusvika 20%), uchitsiva kurapwa katatu kwakajairika nekurapa kwakapetwa kana kwakapetwa kaviri ne expectorant uye/kana kusina sputum, nepo carat Quadruple therapy inogonawo kushandiswa sekurapa kwekutanga munzvimbo dzine kusagona kurapwa zvakanyanya ne mycin. Kuwedzera kune nzira dziri pamusoro apa, maPPI akawanda pamwe ne amoxicillin kana mamwe ma antibiotic akadai se rifampicin, furazolidone, levofloxacin akakurudzirwawo seimwe nzira yekurapa kwekutanga.

Kuvandudzwa kwekurapa kwakajairwa katatu

1.1 Kurapa kwakapetwa kane

Sezvo mwero wekubviswa kwemishonga yakajairwa katatu uchidzikira, semushonga, kurapwa kwemana kune mwero wekubviswa kwakanyanya. Shaikh nevamwe vake vakarapa varwere 175 vane Hp infection, vachishandisa per protocol (PP) analysis uye chinangwa. Mhedzisiro ye intention to treat (ITT) analysis yakaongorora mwero wekubviswa kwemishonga yakajairwa katatu: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); kurapwa kwemana kune mwero wekubviswa kwakanyanya: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Kunyangwe mwero wekubudirira kwekubviswa kwemishonga yakajairwa katatu wakaderedzwa mushure mekukundikana kwekurapwa kwega kwega, kurapwa kwemana kwetincture kwakaratidza kuti kwaive ne mwero wekubviswa kwakanyanya (95%) semushonga mushure mekukundikana kwemishonga yakajairwa katatu. Imwe ongororo yakasvikawo pamhedziso yakafanana: mushure mekukundikana kwekurapa katatu uye levofloxacin katatu, mwero wekubviswa kwekurapwa kwebarium quadruple waive 67% uye 65%, zvichiteerana, kune avo vaive neallergies kupenicillin kana kuti vaive vagamuchira yakakura. Mune varwere vane cyclic lactone antibiotics, expectorant quadruple therapy inofarirwawo. Ehe, kushandiswa kwetincture quadruple therapy kune mukana wakakura wezviitiko zvakaipa, zvakaita sekusvotwa, manyoka, kurwadziwa mudumbu, melena, dzungu, musoro, kuravira kwesimbi, nezvimwewo, asi nekuti expectorant inoshandiswa zvakanyanya muChina, iri nyore kuwana, uye ine mwero wepamusoro wekubviswa kwekurapwa unogona kushandiswa sekurapa. Zvakakosha kukurudzira mukiriniki.

1.2 SQT

SQT yakarapwa nePPI + amoxicillin kwemazuva mashanu, ndokuzorapwa nePPI + clarithromycin + metronidazole kwemazuva mashanu. SQT parizvino inokurudzirwa senzira yekutanga yekurapa Hp. Kuongororwa kwemeta-ongororo yemiedzo mitanhatu yakadzorwa isina kurongeka (RCTs) muKorea zvichibva paSQT ndeye 79.4% (ITT) uye 86.4% (PP), uye HQ yekubvisa SQT. Mwero wacho wakakwira kupfuura wekurapa katatu, 95% CI: 1.403 ~ 2.209), nzira yacho ingave yekuti 5d yekutanga (kana 7d) inoshandisa amoxicillin kuparadza clarithromycin efflux channel pamadziro esero, zvichiita kuti mhedzisiro yeclarithromycin ishande zvakanyanya. SQT inowanzo shandiswa semushonga wekukundikana kwekurapa katatu kwakajairwa kunze kwenyika. Zvisinei, zvidzidzo zvakaratidza kuti mwero wekubvisa katatu (82.8%) kwenguva yakareba (14d) wakakwira kupfuura wekurapa kwakatevedzana (76.5%). Imwe ongororo yakawanawo kuti pakanga pasina musiyano wakakosha muhuwandu hwekubvisa Hp pakati peSQT nekurapa kwakajairwa katatu, izvo zvingave zvine chekuita nehuwandu hwakakwira hwekusagona kurapwa neclarithromycin. SQT ine nzira refu yekurapwa, izvo zvinogona kuderedza kutevedzera kwemurwere uye hazvina kukodzera kunzvimbo dzine kuramba kwakanyanya kurwara neclarithromycin, saka SQT inogona kufungwa nezvayo kana paine zvinopesana nekushandiswa kwetincture.

1.3 Kurapa kweshamwari

Kurapa kunoperekedza iPPI yakasanganiswa neamoxicillin, metronidazole uye clarithromycin. Kuongorora kwakaratidza kuti mwero wekupedza wakakwira kupfuura wekurapa katatu. Imwe ongororo yakaratidzawo kuti mwero wekupedza (90%) wakakwira zvakanyanya kupfuura wekurapa katatu (78%). Maastricht IV Consensus inoratidza kuti SQT kana kurapwa kwakabatana kunogona kushandiswa pasina mishonga inobvisa masero emudumbu, uye mwero wekupedza mishonga miviri yakafanana. Zvisinei, munzvimbo dzine clarithromycin isingapindi metronidazole, inobatsira zvikuru nekurapa kwakabatana. Zvisinei, nekuti kurapwa kwakabatana kunosanganisira marudzi matatu emishonga inorwisa mabhakitiriya, sarudzo yemishonga inorwisa mabhakitiriya ichaderedzwa mushure mekukundikana kwekurapa, saka haikurudzirwi sechirongwa chekutanga chekurapa kunze kwenzvimbo dzine clarithromycin nemetronidazole dzisingapindi. Inonyanya kushandiswa munzvimbo dzine kusapindirana kwakaderera neclarithromycin nemetronidazole.

1.4 kurapwa kwemushonga wakakwira

Ongororo dzakawana kuti kuwedzera dose uye/kana kuwanda kwekutora PPI ne amoxicillin kwakakura kupfuura 90%. Mhedzisiro yekuuraya mabhakitiriya ye amoxicillin pa Hp inoonekwa seinoenderana nenguva, uye nekudaro, zvinobudirira kuwedzera kuwanda kwekutora. Chechipiri, kana pH mudumbu ikachengetwa pakati pe3 ne6, kudzokororwa kwemushonga kunogona kudziviswa zvinobudirira. Kana pH mudumbu ikadarika 6, Hp haizodzokorori uye inonzwa amoxicillin. Ren nevamwe vakaita miedzo yakarongwa isina kurongeka muvarwere 117 vane Hp-positive. Boka re high dose rakapihwa amoxicillin 1g, tid uye rabeprazole 20mg, bid, uye boka re control rakapihwa amoxicillin 1g, tid uye rabeprazole. 10mg, bid, mushure memavhiki maviri ekurapwa, huwandu hwekubvisa Hp hweboka remushonga wakakwira hwaive 89.8% (ITT), 93.0% (PP), hwakakwira zvakanyanya kupfuura boka rekutonga: 75.9% (ITT), 80.0% (PP), P <0.05. Chidzidzo chakabva kuUnited States chakaratidza kuti kushandisa esomeprazole 40 mg, ld + amoxicillin 750 mg, mazuva matatu, ITT = 72.2% mushure memazuva gumi nemana ekurapwa, PP = 74.2%. Franceschi nevamwe vake vakaongorora kurapwa kutatu: 1 standard triple therapy: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 kurapwa kwemushonga wepamusoro: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, nzira yekurapa ndeye 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, bid kurapwa kwe5d, lansoprazole 30mg bid, carat. 500mg bid uye tinidazole 500mg bid zvakarapwa kwemazuva mashanu. Kubviswa kwemishonga mitatu yekurapa kwaive: 55%, 75%, uye 73%. Musiyano uripo pakati pekurapa kwemushonga wepamusoro nekurapa katatu kwakajairika waive wakakosha, uye musiyano wacho wakaenzaniswa neSQT. Hazvina kukosha. Ehe, zvidzidzo zvakaratidza kuti kurapwa kwemushonga wepamusoro weomeprazole neamoxicillin hakuna kuvandudza zvakanyanya mwero wekubvisa mishonga, zvichida nekuda kweCYP2C19 genotype. Mazhinji maPPI anogadziriswa neCYP2C19 enzyme, saka simba reCYP2C19 gene metabolite rinogona kukanganisa metabolism yePPI. Esomeprazole inonyanya kugadziriswa necytochrome P450 3 A4 enzyme, iyo inogona kuderedza simba reCYP2C19 gene kusvika pamwero wakati. Pamusoro pezvo, pamusoro pePPI, amoxicillin, rifampicin, furazolidone, levofloxacin, inokurudzirwawo seimwe nzira yekurapa ine mwero wepamusoro.

Kugadzirwa kwehutachiona hwakasanganiswa

Kuwedzera mishonga inorwisa utachiona (MEA) mukurapa kwakajairwa kunogona kuderedza maitiro asina kunaka, asi zvichiri kukakavadzana kana huwandu hwemishonga inorwisa utachiona hweHp huchigona kuwedzerwa. Kuongorora kwakaratidza kuti kurapwa katatu kweB. sphaerodes pamwe chete nekurapa katatu chete kwakawedzera huwandu hwemishonga inorwisa utachiona hweHp (miedzo mina yakadzorwa isina kurongeka, n=915, RR=l.13, 95% CI: 1.05) ~1.21), kunoderedzawo maitiro asina kunaka anosanganisira manyoka. Zhao Baomin nevamwe vake vakaratidzawo kuti kusanganiswa kwemishonga inorwisa utachiona kunogona kuvandudza zvakanyanya huwandu hwemishonga inorwisa utachiona, kunyangwe mushure mekupfupisa nzira yekurapa, kuchine huwandu hwakanyanya hwemishonga inorwisa utachiona. Chidzidzo chevarwere 85 vane Hp-positive chakarongwa kuita mapoka mana eLactobacillus 20 mg bid, clarithromycin 500 mg bid, uye tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus pamwe chete nebifidobacteria, placebo kwevhiki imwe chete, zadza mibvunzo pamusoro pekutsvagisa zviratidzo vhiki rega rega kwemavhiki mana, mavhiki mashanu kusvika manomwe gare gare kuti utarise hutachiona, chidzidzo chakawana: boka remaprobiotic uye kunyaradzwa Kwakanga kusina musiyano wakakura muhuwandu hwekubviswa kwemasero pakati pemapoka, asi mapoka ese emaprobiotic aive nekubatsira kwakanyanya mukudzivirira mhedzisiro yakaipa kupfuura boka rekutonga, uye pakanga pasina musiyano wakakura mukuitika kwemhedzisiro yakaipa pakati pemapoka emaprobiotic. Maitiro ayo maprobiotic anobvisa Hp achiri kujeka, uye anogona kudzivirira kana kumisa nemakwikwi ekunamatira nzvimbo uye zvinhu zvakasiyana-siyana zvakaita se organic acids uye bacteriopeptides. Zvisinei, zvimwe zvidzidzo zvakawana kuti kusanganiswa kwemaprobiotics hakuwedzere mwero wekubviswa kwemasero, izvo zvingave zvine chekuita nemhedzisiro yekuwedzera yemaprobiotics chete kana maantibiotics asingashande zvakanyanya. Kuchine nzvimbo yakakura yekutsvagisa mumajoini eprobiotics, uye kumwe kutsvagisa kunodiwa pamhando, makosi ekurapa, zviratidzo uye nguva yekugadzirira maprobiotic.

Zvinhu zvinokanganisa huwandu hwekubvisa Hp

Zvinhu zvakawanda zvinokanganisa kubviswa kweHp zvinosanganisira kuramba mishonga inorwisa mabhakitiriya, nzvimbo yenzvimbo, zera remurwere, mamiriro ekusvuta, kutevedzera mitemo, nguva yekurapwa, kuwanda kwemabhakitiriya, gastritis isingaperi, kuwanda kweasidhi yemudumbu, mhinduro yemunhu kuPPI, uye CYP2C19 gene polymorphism. Kuvapo. Zvidzidzo zvakashuma kuti mukuongorora kwakasiyana-siyana, zera, nzvimbo yekugara, mishonga, chirwere chemudumbu, zvirwere zvinosangana nazvo, nhoroondo yekubviswa kwemishonga, PPI, nzira yekurapwa, uye kutevedzera kurapwa zvinosanganiswa nehuwandu hwekubviswa kwemishonga. Pamusoro pezvo, zvimwe zvirwere zvisingaperi, zvakaita seshuga, BP, chirwere cheitsvo chisingaperi, chirwere chechiropa chisingaperi, uye chirwere chemapapu chisingaperi zvinogonawo kunge zvine chekuita nehuwandu hwekubviswa kweHp. Zvisinei, mhedzisiro yechidzidzo chazvino haina kufanana, uye zvimwe zvidzidzo zvakakura zvinodiwa.