Helicobacter pylori (Hp), oo ka mid ah cudurrada ugu badan ee faafa ee ku dhaca aadanaha. Waa arrin khatar u ah cuduro badan, sida boogaha caloosha, gastritis-ka daba-dheeraada, adenocarcinoma-ka caloosha, iyo xitaa lymphoma-ka unugyada lymphoid-ka ee la xiriira xuubka xabka. Daraasaduhu waxay muujiyeen in ciribtirka Hp uu yareyn karo khatarta kansarka caloosha, kordhin karo heerka daaweynta boogaha, oo hadda loo baahan yahay in lagu daro dawooyinku ay si toos ah u baabi'in karaan Hp. Waxaa jira noocyo kala duwan oo ikhtiyaarro daaweyn caafimaad ah oo la heli karo: daaweynta safka hore ee caabuqa waxaa ka mid ah daaweynta saddex-geesoodka ah ee caadiga ah, daaweynta afar-jibbaaranaha ee expectorant, daaweynta isku xigxiga, iyo daaweynta isku xigta. Sannadkii 2007, Kulliyadda Gastroenterology ee Mareykanka waxay isku dartay daaweynta saddex-jibbaaran iyo clarithromycin iyadoo ah daaweyn safka hore ah si loo ciribtiro dadka aan qaadan clarithromycin oo aan lahayn xasaasiyad penicillin ah. Si kastaba ha ahaatee, tobanaan sano ee la soo dhaafay, heerka ciribtirka daaweynta saddex-jibbaaran ee caadiga ah wuxuu ahaa ≤80% inta badan waddamada. Kanada, heerka iska caabbinta ee clarithromycin wuxuu ka kordhay 1% sannadkii 1990 ilaa 11% sannadkii 2003. Dadka la daaweeyay, heerka iska caabbinta daawada xitaa waxaa la soo sheegay inuu ka badan yahay 60%. Iska caabbinta Clarithromycin waxay noqon kartaa sababta ugu weyn ee keentay fashilka ciribtirka. Warbixinta isku-dhafka ah ee Maastricht IV ee meelaha leh iska caabbinta sare ee clarithromycin (heerka iska caabbinta oo ka badan 15% ilaa 20%), iyadoo lagu beddelayo daaweynta saddex-geesoodka ah ee caadiga ah afar-jibbaar ama daaweyn isku xigxigta oo leh dheecaan-qaadis iyo/ama aan lahayn xaako, halka daaweynta quadruple ee carat sidoo kale loo isticmaali karo daaweyn safka hore ah meelaha leh iska caabbinta yar ee mycin. Marka lagu daro hababka kor ku xusan, qiyaaso badan oo PPI ah oo lagu daray amoxicillin ama antibiyootiko kale sida rifampicin, furazolidone, levofloxacin ayaa sidoo kale la soo jeediyay inay yihiin daaweyn safka hore ah oo kale.

Hagaajinta daaweynta saddex-geesoodka ah ee caadiga ah

1.1 Daaweynta Afar-jibbaaran

Maadaama heerka ciribtirka ee daaweynta saddex-geesoodka ah ee caadiga ah uu hoos u dhacayo, daaweyn ahaan, daaweynta afar-geesoodka ah waxay leedahay heer ciribtir sare. Shaikh et al. waxay daweeyeen 175 bukaan oo qaba caabuqa Hp, iyagoo adeegsanaya falanqaynta iyo ujeeddada hab-raaca (PP). Natiijooyinka falanqaynta ujeeddada lagu daaweynayo (ITT) waxay qiimeeyeen heerka ciribtirka ee daaweynta saddex-geesoodka ah ee caadiga ah: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); daaweynta afar-geesoodka ah waxay leedahay heer tirtirid sare: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Inkasta oo heerka guusha ee ciribtirka Hp la dhimay ka dib daaweyn kasta oo guuldareysatay, daaweynta afar-geesoodka ah ee tincture waxay xaqiijisay inay leedahay heer tirtirid sare (95%) daawo ahaan ka dib markii lagu guuldareystay daaweynta saddex-geesoodka ah ee caadiga ah. Daraasad kale ayaa sidoo kale gaartay gabagabo la mid ah: ka dib markii lagu guuldareystay daaweynta saddex-geesoodka ah ee caadiga ah iyo daaweynta saddex-geesoodka ah ee levofloxacin, heerka ciribtirka daaweynta afar-geesoodka ah ee barium wuxuu ahaa 67% iyo 65%, siday u kala horreeyaan, kuwa xasaasiyadda ku lahaa penicillin ama qaatay daawooyin badan Bukaannada qaba antibiyootiga lactone ee wareegga ah, daaweynta afar-geesoodka ah ee expectorant ayaa sidoo kale la door bidaa. Dabcan, isticmaalka daaweynta afar-geesoodka ah ee tincture waxay leedahay fursad sare oo ah dhacdooyin xun, sida lallabbo, shuban, xanuun caloosha ah, melena, wareer, madax-xanuun, dhadhanka birta, iwm., laakiin maadaama expectorant-ka si weyn loogu isticmaalo Shiinaha, way fududahay in la helo, waxayna leedahay Heerka ciribtirka oo sarreeya ayaa loo isticmaali karaa daaweyn daaweyn ah. Waa mudan tahay in lagu dhiirrigeliyo rugta caafimaadka.

1.2 SQT

SQT waxaa lagu daaweeyay PPI + amoxicillin muddo 5 maalmood ah, ka dibna waxaa lagu daaweeyay PPI + clarithromycin + metronidazole muddo 5 maalmood ah. SQT hadda waxaa lagula talinayaa inay tahay daawaynta ciribtirka safka hore ee Hp. Falanqayn kooban oo lix tijaabo oo la xakameeyey oo aan kala sooc lahayn (RCTs) oo laga sameeyay Kuuriya oo ku salaysan SQT waa 79.4% (ITT) iyo 86.4% (PP), iyo ciribtirka HQ ​​ee SQT. Heerku wuxuu ka sarreeyaa daaweynta saddex-geesoodka ah ee caadiga ah, 95% CI: 1.403 ~ 2.209), farsamadu waxay noqon kartaa in 5d (ama 7d) ee ugu horreeya ay isticmaalaan amoxicillin si ay u burburiyaan kanaalka qulqulka clarithromycin ee derbiga unugyada, taasoo ka dhigaysa saameynta clarithromycin mid waxtar badan leh. SQT waxaa badanaa loo isticmaalaa sidii daawo loogu talagalay guuldarada daaweynta saddex-geesoodka ah ee caadiga ah ee dibadda. Si kastaba ha ahaatee, daraasaduhu waxay muujiyeen in heerka ciribtirka daaweynta saddex-geesoodka ah (82.8%) muddo dheer (14d) uu ka sarreeyo kan daaweynta isku xigxiga ee caadiga ah (76.5%). Daraasad ayaa sidoo kale lagu ogaaday in aysan jirin farqi weyn oo ku yimid heerarka ciribtirka Hp ee u dhexeeya SQT iyo daaweynta saddex-geesoodka ah ee caadiga ah, taas oo laga yaabo inay la xiriirto heer sare oo iska caabbinta clarithromycin ah. SQT waxay leedahay daaweyn dheer, taas oo yareyn karta u hoggaansanaanta bukaanka mana ku habboona meelaha leh iska caabbinta sare ee clarithromycin, sidaa darteed SQT waxaa laga yaabaa in la tixgeliyo marka ay ka hor imaanayso isticmaalka tincture.

1.3 Daaweynta Saaxiibka

Daaweynta la socota waa PPI oo lagu daray amoxicillin, metronidazole iyo clarithromycin. Falanqayn meta ah ayaa muujisay in heerka ciribtirka uu ka sarreeyay daaweynta saddex-geesoodka ah ee caadiga ah. Falanqayn meta ah ayaa sidoo kale lagu ogaaday in heerka ciribtirka (90%) uu si weyn uga sarreeyay kan daaweynta saddex-geesoodka ah ee caadiga ah (78%). Heshiiska Maastricht IV wuxuu soo jeedinayaa in SQT ama daaweynta isku-dhafka ah la isticmaali karo marka aysan jirin daawooyinka dheecaanka qaada, heerarka ciribtirka labada daaweynna ay isku mid yihiin. Si kastaba ha ahaatee, meelaha ay clarithromycin u adkaysato metronidazole, waxay ka faa'iido badan tahay daaweynta isku-dhafka ah. Si kastaba ha ahaatee, maadaama daaweynta la socota ay ka kooban tahay saddex nooc oo antibiyootiko ah, doorashada antibiyootikada ayaa la dhimi doonaa ka dib marka daaweyntu ku guuldareysato, sidaa darteed laguma talinayo inay noqoto qorshaha daaweynta ugu horreysa marka laga reebo meelaha ay clarithromycin iyo metronidazole u adkaystaan. Badanaa waxaa loo isticmaalaa meelaha leh iska caabin yar oo clarithromycin iyo metronidazole ah.

1.4 daaweyn qiyaas sare leh

Daraasado ayaa lagu ogaaday in kordhinta qiyaasta iyo/ama inta jeer ee la qaato PPI iyo amoxicillin ay ka badan tahay 90%. Saamaynta bakteeriyada disha ee amoxicillin ee Hp waxaa loo arkaa inay ku xiran tahay waqtiga, sidaas darteedna, way ka waxtar badan tahay in la kordhiyo inta jeer ee la qaato. Marka labaad, marka pH-ga caloosha la ilaaliyo inta u dhaxaysa 3 iyo 6, taranka si wax ku ool ah ayaa loo joojin karaa. Marka pH-ga caloosha uu ka bato 6, Hp ma sii tarmi doono waxayna u nugul tahay amoxicillin. Ren et al waxay sameeyeen tijaabooyin la xakameeyey oo kala sooc ah 117 bukaan oo qaba bukaanada Hp-positive. Kooxda qiyaasta sare leh waxaa la siiyay amoxicillin 1g, tid iyo rabeprazole 20mg, bid, kooxda xakamayntana waxaa la siiyay amoxicillin 1g, tid iyo rabeprazole. 10mg, bid, ka dib 2 toddobaad oo daaweyn ah, heerka ciribtirka Hp ee kooxda qiyaasta sare wuxuu ahaa 89.8% (ITT), 93.0% (PP), si weyn ayuu uga sarreeyaa kooxda xakamaynta: 75.9% (ITT), 80.0% (PP), P <0.05. Daraasad laga sameeyay Mareykanka ayaa muujisay in isticmaalka esomeprazole 40 mg, ld + amoxicillin 750 mg, 3 maalmood, ITT = 72.2% ka dib 14 maalmood oo daaweyn ah, PP = 74.2%. Franceschi et al. waxay dib u eegis ku sameeyeen saddex daaweyn: 1 daaweyn saddex-geesood ah oo caadi ah: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 daaweyn qiyaas sare leh: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, koorsada daaweyntu waa 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, daawaynta dalabka ee 5d, lansoprazole 30mg bid, karat Bid 500mg iyo tinidazole 500mg bid ayaa la daaweeyay 5 maalmood. Heerarka ciribtirka saddexda nidaam ee daawaynta waxay ahaayeen: 55%, 75%, iyo 73%. Farqiga u dhexeeya daaweynta qiyaasta sare iyo daaweynta saddex-geesoodka ah ee caadiga ah wuxuu ahaa mid tirakoob ahaan muhiim ah, farqigana waxaa la barbar dhigay SQT. Ma ahayn mid tirakoob ahaan muhiim ah. Dabcan, daraasaduhu waxay muujiyeen in daaweynta qiyaasta sare leh ee omeprazole iyo amoxicillin aysan si wax ku ool ah u wanaajin heerarka ciribtirka, laga yaabee inay sabab u tahay nooca CYP2C19. Inta badan PPI-yada waxaa metabolize ku sameeya enzyme-ka CYP2C19, sidaa darteed xoogga metabolite-ka hidda-wadaha CYP2C19 wuxuu saameyn karaa dheef-shiid kiimikaadka PPI. Esomeprazole waxaa inta badan metabolize ku sameeya enzyme-ka cytochrome P450 3 A4, kaas oo yareyn kara saameynta hidda-wadaha CYP2C19 ilaa xad. Intaa waxaa dheer, marka laga reebo PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, ayaa sidoo kale lagu talinayaa inay noqdaan beddel daaweyn oo qiyaas sare leh.

Diyaarinta bakteeriyada isku dhafan

Ku darista wakiilada deegaanka ee microbial (MEA) daaweynta caadiga ah waxay yareyn kartaa falcelinta xun, laakiin wali waa muran ka taagan yahay in heerka ciribtirka Hp la kordhin karo. Falanqayn kooban ayaa lagu ogaaday in daaweynta saddex-geesoodka ah ee B. sphaeroides oo lagu daray daaweynta saddex-geesoodka ah ay kordhisay heerka ciribtirka Hp (4 tijaabo oo la kala soocay, n=915, RR=l.13, 95% CI: 1.05) ~1.21), sidoo kale waxay yareysaa falcelinta xun oo ay ku jiraan shubanka. Zhao Baomin et al. waxay sidoo kale muujiyeen in isku-darka probiotics-ku uu si weyn u hagaajin karo heerka ciribtirka, xitaa ka dib marka la soo gaabiyo koorsada daaweynta, weli waxaa jira heer ciribtir oo sarreeya. Daraasad lagu sameeyay 85 bukaan oo qaba bukaannada Hp-positive ah ayaa lagu kala soocay 4 kooxood oo ah Lactobacillus 20 mg bid, clarithromycin 500 mg bid, iyo tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus oo lagu daray bifidobacteria, placebo muddo 1 toddobaad ah, buuxi su'aalo ku saabsan cilmi-baarista calaamadaha toddobaad kasta muddo 4 toddobaad ah, 5 ilaa 7 toddobaad ka dib si loo hubiyo caabuqa, daraasaddu waxay ogaatay: kooxda probiotics iyo raaxada Ma jirin farqi weyn oo ku yimid heerka ciribtirka ee u dhexeeya kooxaha, laakiin dhammaan kooxaha probiotics waxay ka faa'iideysteen ka hortagga falcelinta xun marka loo eego kooxda xakamaynta, mana jirin farqi weyn oo ku yimid dhacdooyinka falcelinta xun ee kooxaha probiotics. Habka ay probiotics u tirtiraan Hp weli ma cadda, waxayna joojin kartaa ama joojin kartaa goobaha isku dhejinta tartanka iyo walxaha kala duwan sida asiidhyada dabiiciga ah iyo bacteriopeptides. Si kastaba ha ahaatee, daraasado qaar ayaa ogaaday in isku-darka probiotics uusan hagaajin heerka ciribtirka, kaas oo laga yaabo inuu la xiriiro saameynta dheeraadka ah ee probiotics kaliya marka antibiyootikadu aysan waxtar lahayn. Wali waxaa jira meel cilmi baaris oo weyn oo ku jirta probiotics-ka isku dhafan, waxaana loo baahan yahay cilmi-baaris dheeraad ah oo ku saabsan noocyada, koorsooyinka daaweynta, tilmaamaha iyo waqtiga diyaarinta probiotic.

Arrimaha saameeya heerka ciribtirka Hp

Dhowr arrimood oo saameeya ciribtirka Hp waxaa ka mid ah iska caabbinta antibiyootiga, gobolka juqraafiyeed, da'da bukaanka, xaaladda sigaarka, u hoggaansanaanta, waqtiga daaweynta, cufnaanta bakteeriyada, gastritis-ka daba-dheeraada ee atrophic, fiirsashada aashitada caloosha, jawaabta shaqsiyeed ee PPI, iyo isbeddelka hidda-wadaha CYP2C19. Joogitaanka. Daraasaduhu waxay soo sheegeen in falanqaynta hal-nooc, da'da, aagga la deggan yahay, daawada, cudurka caloosha iyo mindhicirka, cudurrada faafa, taariikhda ciribtirka, PPI, koorsada daaweynta, iyo u hoggaansanaanta daaweynta ay la xiriiraan heerarka ciribtirka. Intaa waxaa dheer, qaar ka mid ah cudurrada daba-dheeraada ee suurtagalka ah, sida sonkorowga, dhiigkarka, cudurka kelyaha ee daba-dheeraada, cudurka beerka ee daba-dheeraada, iyo cudurka sambabada ee daba-dheeraada ayaa sidoo kale lala xiriirin karaa heerka ciribtirka Hp. Si kastaba ha ahaatee, natiijooyinka daraasadda hadda jirta isku mid ma aha, waxaana loo baahan yahay daraasado ballaaran oo dheeraad ah.