I-Helicobacter pylori (Hp), esinye sezifo ezithelelanayo ezivame kakhulu kubantu. Kuyisici esiyingozi sezifo eziningi, njengesilonda esiswini, i-gastric gastric adenocarcinoma, ngisho ne-mucosa-associated lymphoid tissue (MALT) lymphoma. Izifundo zibonise ukuthi ukuqeda i-Hp kunganciphisa ingozi yomdlavuza wesisu, kwandise izinga lokwelapha izilonda, futhi okwamanje okudingeka kuhlanganiswe nemithi kungaqeda i-Hp ngqo. Kunezindlela ezahlukahlukene zokuqeda imitholampilo ezitholakalayo: ukwelashwa kokuqala kokutheleleka kufaka phakathi ukwelashwa okuphindwe kathathu okujwayelekile, ukwelashwa okuphindwe kane okuphumayo, ukwelashwa okulandelanayo, kanye nokwelashwa okuhambisanayo. Ngo-2007, i-American College of Gastroenterology yahlanganisa ukwelashwa okuphindwe kathathu ne-clarithromycin njengokwelashwa kokuqala kokuqeda abantu ababengazange bathole i-clarithromycin futhi ababengenayo i-penicillin allergy. Kodwa-ke, emashumini eminyaka amuva nje, izinga lokuqeda ukwelashwa okuphindwe kathathu okujwayelekile libe ngu-≤80% emazweni amaningi. ECanada, izinga lokumelana ne-clarithromycin likhuphuke lisuka ku-1% ngo-1990 laya ku-11% ngo-2003. Phakathi kwabantu abelashwa, izinga lokumelana nemithi labikwa ukuthi lidlula u-60%. Ukumelana ne-Clarithromycin kungaba yimbangela eyinhloko yokwehluleka kokuqeda. Umbiko we-Maastricht IV ovumelana ngawo ezindaweni ezinokumelana okuphezulu ne-clarithromycin (izinga lokumelana elingaphezu kuka-15% kuya ku-20%), othatha indawo yokwelashwa okujwayelekile okuphindwe kathathu ngokwelashwa okuphindwe kane noma okulandelanayo nge-expectorant kanye/noma okungenasikhwehlela, kuyilapho ukwelashwa kwe-carat Quadruple kungasetshenziswa futhi njengokwelashwa kokuqala ezindaweni ezinokumelana okuphansi ne-mycin. Ngaphezu kwezindlela ezingenhla, imithamo ephezulu ye-PPI kanye ne-amoxicillin noma ama-antibiotic ahlukile njenge-rifampicin, i-furazolidone, i-levofloxacin nayo iphakanyiswe njengokwelashwa okunye komugqa wokuqala.

Ukuthuthukiswa kokwelashwa okuphindwe kathathu okujwayelekile

1.1 Ukwelashwa okuphindwe kane

Njengoba izinga lokuqeda ukwelashwa okuphindwe kathathu lincipha, njengomuthi, ukwelashwa okuphindwe kane kunezinga eliphezulu lokuqeda. UShaikh nabanye baphathe iziguli ezingu-175 ezinegciwane le-Hp, besebenzisa ukuhlaziywa kwephrothokholi (PP) kanye nenhloso. Imiphumela yokuhlaziywa kwenhloso yokwelapha (ITT) ihlole izinga lokuqeda ukwelashwa okuphindwe kathathu okujwayelekile: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); ukwelashwa okuphindwe kane kunezinga eliphezulu lokuqeda: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Nakuba izinga lempumelelo lokuqeda i-Hp linciphile ngemva kokwelashwa ngakunye okuhlulekile, ukwelashwa okuphindwe kane kwe-tincture kubonakale kunezinga eliphezulu lokuqeda (95%) njengomuthi ngemva kokwehluleka kokwelashwa okuphindwe kathathu okujwayelekile. Olunye ucwaningo lufinyelele esiphethweni esifanayo: ngemuva kokwehluleka kokwelashwa okujwayelekile okuphindwe kathathu kanye nokwelashwa okuphindwe kathathu kwe-levofloxacin, izinga lokuqeda ukwelashwa okuphindwe kathathu kwe-barium lalingu-67% no-65%, ngokulandelana, kulabo ababenomzimba ongezwani ne-penicillin noma ababethole imithi emikhulu yokwelapha i-lactone. Ezigulini ezinemithi yokwelapha i-cyclic lactone, ukwelashwa okuphindwe kathathu kwe-expectorant nakho kuyathandwa. Yiqiniso, ukusetshenziswa kwe-tincture ukwelashwa okuphindwe kathathu kunamathuba aphezulu emicimbi emibi, njengesicanucanu, uhudo, ubuhlungu besisu, i-melena, isiyezi, ikhanda elibuhlungu, ukunambitheka kwensimbi, njll., kodwa ngoba i-expectorant isetshenziswa kabanzi eShayina, kulula ukuyithola, futhi inezinga eliphezulu lokuqeda lingasetshenziswa njengokwelashwa okwelaphayo. Kufanelekile ukukhuthazwa emtholampilo.

1.2 SQT

I-SQT yelashwe nge-PPI + amoxicillin izinsuku ezi-5, yabe isiphathwa nge-PPI + clarithromycin + metronidazole izinsuku ezi-5. I-SQT okwamanje inconywa njengokwelashwa komugqa wokuqala kokuqeda i-Hp. Ukuhlaziywa kwe-meta-analysis kwezilingo eziyisithupha ezilawulwa ngokungahleliwe (ama-RCT) eKorea ngokusekelwe ku-SQT kungu-79.4% (ITT) kanye no-86.4% (PP), kanye nokuqeda i-HQ kwe-SQT Izinga liphakeme kune-standard triple therapy, 95% CI: 1.403 ~ 2.209), indlela yokusebenza ingaba ukuthi i-5d yokuqala (noma i-7d) isebenzisa i-amoxicillin ukubhubhisa isiteshi se-clarithromycin efflux odongeni lweseli, okwenza umphumela we-clarithromycin usebenze kakhudlwana. I-SQT ivame ukusetshenziswa njengekhambi lokwehluleka kokwelashwa okujwayelekile okuthathu kwamanye amazwe. Kodwa-ke, izifundo zibonise ukuthi izinga lokuqeda ukwelashwa okuthathu (82.8%) esikhathini eside (14d) liphakeme kunelokwelashwa okulandelanayo kwakudala (76.5%). Ucwaningo olulodwa luthole nokuthi akukho mehluko obalulekile emazingeni okuqeda i-Hp phakathi kwe-SQT kanye nokwelashwa okujwayelekile okuphindwe kathathu, okungase kuhlotshaniswe nesilinganiso esiphezulu sokumelana ne-clarithromycin. I-SQT inenkambo yokwelashwa ende, okungase kunciphise ukuhambisana kwesiguli futhi akufaneleki ezindaweni ezinokumelana okuphezulu ne-clarithromycin, ngakho-ke i-SQT ingacatshangelwa lapho kusetshenziswa iziphazamiso zokusebenzisa i-tincture.

1.3 Ukwelashwa Okuhambisanayo

Ukwelashwa okuhambisanayo yi-PPI ehlanganiswe ne-amoxicillin, i-metronidazole kanye ne-clarithromycin. Ukuhlaziywa kwe-meta kubonise ukuthi izinga lokuqeda laliphezulu kune-triple therapy ejwayelekile. Okunye ukuhlaziywa kwe-meta kuphinde kwathola ukuthi izinga lokuqeda (90%) laliphezulu kakhulu kune-triple therapy ejwayelekile (78%). I-Maastricht IV Consensus iphakamisa ukuthi i-SQT noma ukwelashwa okuhambisanayo kungasetshenziswa uma kungekho ama-expectorant, futhi amazinga okuqeda alezi zindlela zokwelapha ezimbili afana. Kodwa-ke, ezindaweni lapho i-clarithromycin imelana ne-metronidazole, inenzuzo kakhulu ngokwelashwa okuhambisanayo. Kodwa-ke, ngoba ukwelashwa okuhambisanayo kuqukethe izinhlobo ezintathu zama-antibiotic, ukukhetha ama-antibiotic kuzoncishiswa ngemva kokwehluleka kokwelashwa, ngakho-ke akunconywa njengohlelo lokuqala lokwelashwa ngaphandle kwezindawo lapho i-clarithromycin kanye ne-metronidazole zimelana khona. Isetshenziswa kakhulu ezindaweni ezinokumelana okuphansi ne-clarithromycin kanye ne-metronidazole.

1.4 ukwelashwa ngomthamo ophezulu

Izifundo zithole ukuthi ukwandisa umthamo kanye/noma imvamisa yokuphathwa kwe-PPI kanye ne-amoxicillin kungaphezu kuka-90%. Umphumela wokubulala amagciwane we-amoxicillin ku-Hp ubhekwa njengoncike esikhathini, ngakho-ke, kusebenza kangcono ukwandisa imvamisa yokuphathwa. Okwesibili, lapho i-pH esiswini igcinwa phakathi kuka-3 no-6, ukuphindaphinda kungavinjelwa ngempumelelo. Lapho i-pH esiswini idlula u-6, i-Hp ngeke isaphindaphinda futhi izwa i-amoxicillin. URen nabanye benze izivivinyo ezilawulwa ngokungahleliwe ezigulini ezingu-117 ezineziguli ezine-Hp-positive. Iqembu le-dose ephezulu lanikezwa i-amoxicillin 1g, tid kanye ne-rabeprazole 20mg, bid, kanti iqembu lokulawula lanikezwa i-amoxicillin 1g, tid kanye ne-rabeprazole. 10mg, ibhidi, ngemva kwamasonto ama-2 okwelashwa, izinga lokuqeda i-Hp leqembu lomthamo ophezulu lalingu-89.8% (ITT), 93.0% (PP), liphakeme kakhulu kuneqembu lokulawula: 75.9% (ITT), 80.0% (PP), P <0.05. Ucwaningo oluvela e-United States lubonise ukuthi ukusebenzisa i-esomeprazole 40 mg, ld + amoxicillin 750 mg, izinsuku ezi-3, i-ITT = 72.2% ngemva kwezinsuku eziyi-14 zokwelashwa, i-PP = 74.2%. UFranceschi nabanye bahlaziye ngokuphindaphindiwe izindlela ezintathu zokwelapha: 1 ukwelashwa okuphindwe kathathu okujwayelekile: i-lansoola 30mg, ibhidi, i-clarithromycin 500mg, ibhidi, i-amoxicillin 1000mg, ibhidi, 7d; Ukwelashwa okunemithamo ephezulu oku-2: I-Lansuo Carbazole 30mg, i-bid, i-clarithromycin 500mg, i-bid, i-amoxicillin 1000mg, i-tid, inkambo yokwelashwa ingu-7d; 3SQT: i-lansoprazole 30mg, i-bid + i-amoxicillin 1000mg, ukwelashwa okunemithamo emi-5d, i-lansoprazole 30mg bid, i-carat I-bid engu-500mg kanye ne-tinidazole 500mg bid zelashwe izinsuku ezi-5. Amazinga okuqeda izindlela ezintathu zokwelashwa ayengu: 55%, 75%, kanye no-73%. Umehluko phakathi kokwelashwa okunemithamo ephezulu kanye nokwelashwa okuphindwe kathathu okujwayelekile wawubalulekile ngokwezibalo, futhi umehluko wawuqhathaniswa ne-SQT. Akubalulekile ngokwezibalo. Yiqiniso, izifundo zibonise ukuthi ukwelashwa okunemithamo ephezulu ye-omeprazole kanye ne-amoxicillin akuzange kuthuthukise ngempumelelo amazinga okuqeda, mhlawumbe ngenxa yohlobo lwe-CYP2C19. Ama-PPI amaningi aguqulwa yi-enzyme ye-CYP2C19, ngakho-ke amandla e-metabolite yezakhi zofuzo ze-CYP2C19 angathinta i-metabolism ye-PPI. I-Esomeprazole iguqulwa kakhulu yi-enzyme ye-cytochrome P450 3 A4, enganciphisa ithonya lezakhi zofuzo ze-CYP2C19 ngezinga elithile. Ngaphezu kwalokho, ngaphezu kwe-PPI, i-amoxicillin, i-rifampicin, i-furazolidone, i-levofloxacin, nayo inconywa njengendlela yokwelapha enomthamo ophezulu.

Ukulungiswa kwamagciwane okuhlanganisiwe

Ukwengeza ama-microbial ecosystem agents (MEA) ekwelashweni okujwayelekile kunganciphisa ukusabela okubi, kodwa kusaphikiswana ngokuthi izinga lokuqeda i-Hp lingakhushulwa yini. Ukuhlaziywa kwe-meta kuthole ukuthi ukwelashwa okuthathu kwe-B. sphaeroides kuhlanganiswe nokwelashwa okuthathu kuphela kwandise izinga lokuqeda i-Hp (izilingo ezi-4 ezilawulwa ngokungahleliwe, n=915, RR=l.13, 95% CI: 1.05) ~1.21), futhi kunciphisa ukusabela okubi okuhlanganisa nesifo sohudo. UZhao Baomin nabanye babonise nokuthi ukuhlanganiswa kwama-probiotic kungathuthukisa kakhulu izinga lokuqeda, ngisho nangemva kokunciphisa inkambo yokwelashwa, kusenezinga eliphezulu lokuqeda. Ucwaningo lweziguli ezingu-85 ezineziguli ezine-Hp lwahlelwa ngamaqembu angu-4 e-Lactobacillus 20 mg bid, i-clarithromycin 500 mg bid, kanye ne-tinidazole 500 mg bid. , B. cerevisiae, i-Lactobacillus ehlanganiswe ne-bifidobacteria, i-placebo isonto eli-1, gcwalisa uhlu lwemibuzo ngocwaningo lwezimpawu njalo ngesonto amasonto ama-4, amasonto ama-5 kuya kwangu-7 kamuva ukuhlola ukutheleleka, ucwaningo luthole: iqembu lama-probiotic kanye nenduduzo Akukho mehluko obalulekile esilinganisweni sokuqeda phakathi kwamaqembu, kodwa wonke amaqembu ama-probiotic ayenenzuzo enkulu ekuvimbeleni ukusabela okubi kuneqembu lokulawula, futhi kwakungekho mehluko obalulekile ekwehlekeni kokusabela okubi phakathi kwamaqembu ama-probiotic. Indlela ama-probiotic aqeda ngayo i-Hp ayikacaci, futhi ingavimbela noma ingasebenzi ngezindawo zokunamathela ezincintisanayo nezinto ezahlukahlukene ezifana nama-organic acid nama-bacteriopeptides. Kodwa-ke, ezinye izifundo zithole ukuthi ukuhlanganiswa kwama-probiotic akuthuthukisi izinga lokuqeda, okungase kuhlotshaniswe nomphumela owengeziwe wama-probiotic kuphela lapho ama-antibiotic engasebenzi kahle. Kusenendawo enkulu yocwaningo kuma-probiotic ahlangene, futhi kudingeka ucwaningo olwengeziwe ngezinhlobo, izifundo zokwelapha, izinkomba kanye nesikhathi sokulungiselela ama-probiotic.

Izici ezithinta izinga lokususwa kwe-Hp

Izici eziningana ezithinta ukususwa kwe-Hp zifaka phakathi ukumelana nama-antibiotic, indawo yezwe, ubudala besiguli, isimo sokubhema, ukuhambisana nomthetho, isikhathi sokwelashwa, ukuminyana kwamagciwane, i-atrophic gastritis engapheli, ukuhlushwa kwe-asidi yesisu, impendulo yomuntu ngamunye ku-PPI, kanye ne-CYP2C19 gene polymorphism. Ukuba khona. Izifundo zibike ukuthi ekuhlaziyweni okuhlukile, ubudala, indawo yokuhlala, imithi, isifo sesisu, ukuhlangana okufanayo, umlando wokususwa, i-PPI, inkambo yokwelashwa, kanye nokunamathela kokwelashwa kuhlotshaniswa namazinga okususwa. Ngaphezu kwalokho, ezinye izifo ezingaba khona ezingamahlalakhona, njengesifo sikashukela, umfutho wegazi ophakeme, isifo sezinso esingamahlalakhona, isifo sesibindi esingamahlalakhona, kanye nesifo samaphaphu esingamahlalakhona nazo zingase zihlobane nezinga lokususwa kwe-Hp. Kodwa-ke, imiphumela yocwaningo lwamanje ayifani, futhi kudingeka izifundo ezinkulu ezengeziwe.