I-Helicobacter pylori (Hp), enye yezona zifo zixhaphakileyo ebantwini. Yinto ebangela umngcipheko kwizifo ezininzi, ezifana nesilonda esiswini, i-gastritis engapheliyo, i-gastric adenocarcinoma, kwane-mucosa-associated lymphoid tissue (MALT) lymphoma. Izifundo zibonise ukuba ukususwa kwe-Hp kunokunciphisa umngcipheko womhlaza wesisu, kwandise izinga lokunyanga izilonda, kwaye okwangoku kufuneka kudityaniswe namayeza kunokuphelisa ngokuthe ngqo i-Hp. Kukho iindlela ezahlukeneyo zokuphelisa izifo ezikhoyo: unyango lokuqala losulelo luquka unyango oluqhelekileyo lwe-triple, unyango olune-expectorant, unyango olulandelelanayo, kunye nonyango oluhambelanayo. Ngo-2007, i-American College of Gastroenterology yadibanisa unyango oluphindwe kathathu ne-clarithromycin njengonyango lokuqala lokuphelisa abantu abangazange bafumane i-clarithromycin kwaye babengenayo i-penicillin allergy. Nangona kunjalo, kwiminyaka yakutshanje, izinga lokuphelisa unyango oluqhelekileyo lwe-triple therapy libe yi-≤80% kumazwe amaninzi. EKhanada, izinga lokuxhathisa le-clarithromycin linyuke ukusuka kwi-1% ngo-1990 ukuya kwi-11% ngo-2003. Phakathi kwabantu abanyangiweyo, izinga lokuxhathisa amayeza labikwa ukuba lidlula i-60%. Ukuxhathisa kwe-Clarithromycin kusenokuba yeyona nto iphambili yokungaphumeleli kokuphelisa. Ingxelo yesivumelwano seMaastricht IV kwiindawo ezinokumelana okuphezulu ne-clarithromycin (izinga lokuxhathisa elingaphezulu kwe-15% ukuya kwi-20%), ithatha indawo yonyango oluqhelekileyo lwe-triple ngonyango oluphindwe kane okanye olulandelelanayo nge-expectorant kunye/okanye olungena-sputum, ngelixa unyango lwe-carat Quadruple lungasetyenziswa njengonyango lokuqala kwiindawo ezinokumelana okuphantsi ne-mycin. Ukongeza kwiindlela ezingentla, iidosi eziphezulu ze-PPI kunye ne-amoxicillin okanye ezinye ii-antibiotics ezifana ne-rifampicin, i-furazolidone, i-levofloxacin nazo zicetyisiwe njengonyango oluhlukileyo lodidi lokuqala.

Ukuphuculwa konyango oluqhelekileyo oluphindwe kathathu

1.1 Unyango oluphindwe kane

Njengoko izinga lokuphelisa unyango oluqhelekileyo oluphindwe kathathu lisihla, njengeyeza, unyango oluphindwe kane lunezinga eliphezulu lokuphelisa. UShaikh nabanye banyanga izigulane ezili-175 ezine-Hp infection, besebenzisa uhlalutyo lwe-protocol (PP) kunye nenjongo. Iziphumo zohlalutyo lwe-intention to treat (ITT) zivavanyile izinga lokuphelisa unyango oluqhelekileyo oluphindwe kathathu: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); unyango oluphindwe kane lunezinga eliphezulu lokuphelisa: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Nangona izinga lempumelelo lokuphelisa unyango oluphindwe kathathu linciphile emva konyango ngalunye olungaphumelelanga, unyango oluphindwe kane lwe-tincture lubonakalise ukuba nezinga eliphezulu lokuphelisa (95%) njengeyeza emva kokungaphumeleli konyango oluqhelekileyo oluphindwe kathathu. Olunye uphando lufikelele kwisigqibo esifanayo: emva kokungaphumeleli konyango oluqhelekileyo lwe-triple therapy kunye nonyango oluphindwe kathathu lwe-levofloxacin, izinga lokuphelisa unyango lwe-barium quadruple therapy lalingama-67% kunye nama-65%, ngokwahlukeneyo, kwabo babene-allergy kwi-penicillin okanye abafumene i-big. Kwizigulane ezine-cyclic lactone antibiotics, unyango lwe-expectorant quadruple nalo luyathandwa. Kakade ke, ukusetyenziswa konyango lwe-tincture quadruple therapy kunamathuba aphezulu eziganeko ezimbi, ezifana nokucaphuka, urhudo, iintlungu zesisu, i-melena, isiyezi, intloko ebuhlungu, incasa yesinyithi, njl.njl., kodwa ngenxa yokuba i-expectorant isetyenziswa kakhulu eTshayina, kulula ukuyifumana, kwaye inezinga eliphezulu lokuphelisa elingasetyenziswa njengonyango lokulungisa. Kufanelekile ukukhuthazwa eklinikhi.

1.2 SQT

I-SQT yanyangwa nge-PPI + amoxicillin iintsuku ezi-5, yaza yanyangwa nge-PPI + clarithromycin + metronidazole iintsuku ezi-5. I-SQT okwangoku iyacetyiswa njengonyango lokuqala lokuphelisa i-Hp. Uhlalutyo lwe-meta-analysis lwezilingo ezintandathu ezilawulwa ngokungacwangciswanga (ii-RCT) eKorea ezisekelwe kwi-SQT yi-79.4% (ITT) kunye ne-86.4% (PP), kunye nokupheliswa kwe-HQ ye-SQT Izinga liphezulu kune-standard triple therapy, i-95% CI: 1.403 ~ 2.209), indlela yokusebenza isenokuba kukuba i-5d yokuqala (okanye i-7d) isebenzisa i-amoxicillin ukutshabalalisa itshaneli ye-clarithromycin efflux eludongeni lweseli, okwenza isiphumo se-clarithromycin sisebenze ngakumbi. I-SQT idla ngokusetyenziswa njengeyeza lokungaphumeleli konyango oluqhelekileyo lwe-triple therapy kwamanye amazwe. Nangona kunjalo, izifundo zibonise ukuba izinga lokuphelisa unyango oluphindwe kathathu (82.8%) kwixesha elide (14d) liphezulu kunelo lonyango olulandelelanayo lweklasikhi (76.5%). Olunye uphando lufumanise ukuba akukho mahluko mkhulu kwizinga lokuphelisa i-Hp phakathi kwe-SQT kunye nonyango oluqhelekileyo lwe-triple, olunokuthi lunxulunyaniswe nezinga eliphezulu lokuxhathisa i-clarithromycin. I-SQT inonyango olude, olunokunciphisa ukuthobela kwesigulane kwaye alufanelekanga kwiindawo ezinokumelana okuphezulu ne-clarithromycin, ngoko ke i-SQT inokuqwalaselwa xa kukho ukungangqinelani nokusetyenziswa kwe-tincture.

1.3 Unyango oluhambisanayo

Unyango oluhambayo yi-PPI edityaniswe ne-amoxicillin, i-metronidazole kunye ne-clarithromycin. Uhlalutyo lwe-meta lubonise ukuba izinga lokuphelisa liphezulu kune-triple therapy eqhelekileyo. Olunye uhlalutyo lwe-meta lukwafumanise ukuba izinga lokuphelisa (90%) liphezulu kakhulu kunelo lonyango oluqhelekileyo lwe-triple therapy (78%). I-Maastricht IV Consensus icebisa ukuba i-SQT okanye unyango oluhamba kunye lungasetyenziswa xa kungekho zi-expectorants, kwaye amazinga okuphelisa amayeza amabini afana. Nangona kunjalo, kwiindawo apho i-clarithromycin ingamelani ne-metronidazole, iluncedo ngakumbi ngonyango oluhamba kunye. Nangona kunjalo, kuba unyango oluhamba kunye luneentlobo ezintathu zee-antibiotics, ukhetho lwee-antibiotics luya kuncitshiswa emva kokungaphumeleli konyango, ngoko ke alukhuthazwa njengesicwangciso sokuqala sonyango ngaphandle kweendawo apho i-clarithromycin kunye ne-metronidazole zingamelaniyo. Isetyenziswa kakhulu kwiindawo ezinokumelana okuphantsi kwe-clarithromycin kunye ne-metronidazole.

Unyango lwedosi ephezulu ye-1.4

Izifundo zifumanise ukuba ukwandisa idosi kunye/okanye ukuphindaphindwa kokunikwa kwe-PPI kunye ne-amoxicillin kungaphezulu kwe-90%. Isiphumo sokubulala iintsholongwane se-amoxicillin kwi-Hp sithathwa njengesixhomekeke kwixesha, kwaye ke ngoko, kusebenza ngakumbi ukwandisa ukuphindaphindwa kokunikwa. Okwesibini, xa i-pH esiswini igcinwa phakathi kwe-3 kunye ne-6, ukuphindaphinda kunokuthintelwa ngempumelelo. Xa i-pH esiswini idlula i-6, i-Hp ayisayi kuphinda iphindaphindwe kwaye inovelwano kwi-amoxicillin. URen nabanye benze uvavanyo olulawulwa ngokungacwangciswanga kwizigulana ezili-117 ezinezigulane ezine-Hp-positive. Iqela leedosi eziphezulu linikwe i-amoxicillin 1g, tid kunye ne-rabeprazole 20mg, bid, kwaye iqela lolawulo linikwe i-amoxicillin 1g, tid kunye ne-rabeprazole. I-10mg, ibhidi, emva kweeveki ezi-2 zonyango, izinga lokuphelisa i-Hp yeqela ledosi ephezulu yayiyi-89.8% (ITT), 93.0% (PP), iphezulu kakhulu kuneqela lolawulo: 75.9% (ITT), 80.0% (PP), P <0.05. Uphononongo oluvela eMelika lubonise ukuba ukusebenzisa i-esomeprazole 40 mg, ld + amoxicillin 750 mg, iintsuku ezi-3, ITT = 72.2% emva kweentsuku ezili-14 zonyango, PP = 74.2%. UFranceschi et al. bahlalutye ngokuphindaphindiweyo unyango oluthathu: 1 unyango oluqhelekileyo oluphindwe kathathu: i-lansoola 30mg, ibhidi, i-clarithromycin 500mg, ibhidi, i-amoxicillin 1000mg, ibhidi, 7d; Unyango olunedosi ephezulu ezi-2: I-Lansuo Carbazole 30mg, i-bid, i-clarithromycin 500mg, i-bid, i-amoxicillin 1000mg, i-tid, ikhosi yonyango yi-7d; 3SQT: i-lansoprazole 30mg, i-bid + i-amoxicillin 1000mg, unyango lwe-bid lwe-5d, i-lansoprazole 30mg bid, i-carat I-bid ye-500mg kunye ne-tinidazole 500mg bid zanyangwa iintsuku ezi-5. Amazinga okuphelisa amayeza amathathu aye: 55%, 75%, kunye ne-73%. Umahluko phakathi konyango olunedosi ephezulu kunye nonyango oluqhelekileyo lwe-triple wawubalulekile ngokwezibalo, kwaye umahluko wawuthelekiswa ne-SQT. Ayibalulekanga ngokwezibalo. Kakade ke, izifundo zibonise ukuba unyango olunedosi ephezulu lwe-omeprazole kunye ne-amoxicillin aluzange luphucule ngempumelelo amazinga okuphelisa, mhlawumbi ngenxa ye-CYP2C19 genotype. Uninzi lwee-PPIs lusetyenziswa yi-enzyme ye-CYP2C19, ngoko ke amandla e-metabolite ye-CYP2C19 gene anokuchaphazela i-metabolism ye-PPI. I-Esomeprazole isetyenziswa kakhulu yi-enzyme ye-cytochrome P450 3 A4, enokunciphisa impembelelo ye-CYP2C19 gene ukuya kwinqanaba elithile. Ukongeza, ukongeza kwi-PPI, i-amoxicillin, i-rifampicin, i-furazolidone, i-levofloxacin, nayo iyacetyiswa njengendlela yonyango enedosi ephezulu.

Ukulungiswa kweentsholongwane ezidibeneyo

Ukongeza ii-microbial ecosystem agents (MEA) kunyango oluqhelekileyo kunokunciphisa iziphumo ezingalunganga, kodwa kusaphikiswana ngokuba izinga lokuphelisa i-Hp linganyuswa na. Uhlalutyo lwe-meta lufumanise ukuba unyango oluphindwe kathathu lwe-B. sphaeroides oludityaniswe nonyango oluphindwe kathathu lodwa lunyuse izinga lokuphelisa i-Hp (izilingo ezi-4 ezilawulwa ngokungacwangciswanga, n=915, RR=l.13, 95% CI: 1.05) ~1.21), lukwanciphisa iziphumo ezingalunganga kuquka norhudo. UZhao Baomin et al. babonise ukuba indibaniselwano yeeprobiotics inokuphucula kakhulu izinga lokuphelisa, nokuba emva kokunciphisa ikhosi yonyango, kusekho izinga eliphezulu lokuphelisa. Uphononongo lwezigulane ezingama-85 ezinezigulane ezine-Hp luye lwahlulwahlulwa lwaba ngamaqela ama-4 e-Lactobacillus 20 mg bid, i-clarithromycin 500 mg bid, kunye ne-tinidazole 500 mg bid. , B. cerevisiae, iLactobacillus idityaniswe nebifidobacteria, i-placebo iveki e-1, gcwalisa iphepha lemibuzo malunga nophando lweempawu qho ngeveki kangangeeveki ezi-4, emva kweeveki ezi-5 ukuya kwezi-7 ukujonga usulelo, olu phononongo lufumanise: iqela leeprobiotic kunye nentuthuzelo Akukho mahluko mkhulu kwizinga lokuphelisa phakathi kwamaqela, kodwa onke amaqela eeprobiotic ayeluncedo ngakumbi ekuthinteleni iimpendulo ezimbi kuneqela lolawulo, kwaye akukho mahluko mkhulu kwiziganeko zeempendulo ezimbi phakathi kwamaqela eeprobiotic. Indlela iiprobiotics ezitshabalalisa ngayo i-Hp ayikacaci, kwaye inokuthintela okanye ingasebenzi kwiindawo zokunamathela ezikhuphisanayo kunye nezinto ezahlukeneyo ezifana nee-organic acids kunye neebacteriopeptides. Nangona kunjalo, ezinye izifundo zifumanise ukuba indibaniselwano yeeprobiotics ayiphuculi izinga lokuphelisa, elinokuthi linxulunyaniswe nefuthe elongezelelweyo leeprobiotics kuphela xa ii-antibiotics zingasebenzi kakuhle. Kusekho indawo enkulu yophando kwi-joint probiotics, kwaye kufuneka uphando olongezelelweyo kwiintlobo, izifundo zonyango, izalathiso kunye nexesha lokulungiselela iiprobiotic.

Izinto ezichaphazela izinga lokususwa kwe-Hp

Izinto ezininzi ezichaphazela ukupheliswa kwe-Hp ziquka ukunganyangeki kwee-antibiotics, ummandla wejografi, ubudala besigulana, imeko yokutshaya, ukuthobela umthetho, ixesha lonyango, uxinano lweebhaktheriya, i-chronic atrophic gastritis, uxinaniso lwe-asidi yesisu, impendulo yomntu ngamnye kwi-PPI, kunye ne-CYP2C19 gene polymorphism. Ubukho. Izifundo zibike ukuba kuhlalutyo oluqhelekileyo, ubudala, indawo yokuhlala, amayeza, isifo sesisu, ukudibana kwaso, imbali yokupheliswa, i-PPI, indlela yonyango, kunye nokunamathela kunyango kunxulunyaniswa namazinga okupheliswa. Ukongeza, ezinye izifo ezingapheliyo, ezifana nesifo seswekile, uxinzelelo lwegazi oluphezulu, isifo sezintso esingapheliyo, isifo sesibindi esingapheliyo, kunye nesifo semiphunga esingapheliyo nazo zinokunxulunyaniswa nezinga lokupheliswa kwe-Hp. Nangona kunjalo, iziphumo zophando lwangoku azifani, kwaye kufuneka ezinye izifundo ezinkulu.