Helicobacter pylori (Hp), daya daga cikin cututtuka masu yaduwa a cikin mutane. Yana da haɗari ga cututtuka da yawa, irin su ciwon ciki, gastritis na kullum, adenocarcinoma na ciki, har ma da ƙwayoyin lymphoid na mucosa (MALT) lymphoma. Bincike ya nuna cewa kawar da Hp na iya rage hadarin kamuwa da cutar kansar ciki, da kuma kara yawan maganin ulcer, kuma a halin yanzu ana bukatar a hada da magunguna na iya kawar da Hp kai tsaye. Akwai zaɓuɓɓukan kawar da asibiti iri-iri da ake samu: jiyya ta farko don kamuwa da cuta ta haɗa da daidaitaccen jiyya na sau uku, farfaɗo mai tsattsauran ra'ayi, jiyya na jeri, da jiyya tare. A shekara ta 2007, Kwalejin Gastroenterology ta Amurka ta haɗu da farfadowa sau uku tare da clarithromycin a matsayin maganin farko don kawar da mutanen da ba su karbi clarithromycin ba kuma basu da ciwon penicillin. Koyaya, a cikin 'yan shekarun nan, adadin kawar da daidaitattun jiyya sau uku ya kasance ≤80% a yawancin ƙasashe. A Kanada, yawan juriya na clarithromycin ya karu daga 1% a cikin 1990 zuwa 11% a cikin 2003. Daga cikin mutanen da aka yi wa magani, an ba da rahoton yawan juriyar maganin ya wuce 60%. Juriya na Clarithromycin na iya zama babban dalilin gazawar kawarwa. Rahoton yarjejeniya Maastricht IV a cikin wuraren da ke da tsayin daka ga clarithromycin (yawan juriya sama da 15% zuwa 20%), maye gurbin daidaitaccen maganin sau uku tare da sau huɗu ko jiyya tare da expectorant da / ko babu sputum, yayin da carat Quadruple far za a iya amfani dashi azaman farko. -maganin layi a yankunan da ke da ƙananan juriya ga mycin. Baya ga hanyoyin da ke sama, an ba da shawarar yawan allurai na PPI da amoxicillin ko madadin maganin rigakafi kamar rifampicin, furazolidone, levofloxacin a matsayin madadin magani na farko.

Inganta daidaitaccen jiyya sau uku

1.1 Jiyya huɗu

Yayin da adadin kawar da daidaitattun jiyya sau uku ya faɗi, a matsayin magani, jiyya sau huɗu yana da babban adadin kawarwa. Shaikh et al. bi da marasa lafiya 175 tare da kamuwa da cutar Hp, ta amfani da bincike da niyya ta kowace yarjejeniya (PP). Sakamakon niyya don bi da bincike (ITT) yayi kimanta ƙimar kawar da daidaitaccen maganin sau uku: PP = 66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72; Ƙwararren ƙwayar cuta yana da ƙimar kawarwa mafi girma: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Ko da yake an rage nasarar kawar da Hp bayan kowane maganin da ba a yi amfani da shi ba, maganin tincture sau hudu ya tabbatar da cewa yana da yawan kawar da shi (95%) a matsayin magani bayan rashin nasarar maganin sau uku. Wani binciken kuma ya cimma matsaya mai kama da haka: bayan gazawar daidaitaccen maganin sau uku da levofloxacin sau uku, ƙimar kawar da barium quadruple therapy ya kasance 67% da 65%, bi da bi, ga waɗanda ke fama da rashin lafiyar penicillin ko kuma sun sami babba cyclic lactone maganin rigakafi, expectorant quadruple far kuma an fi son. Hakika, yin amfani da tincture hudu far yana da mafi girma yiwuwa na m aukuwa, kamar tashin zuciya, zawo, ciwon ciki, melena, dizziness, ciwon kai, karfe dandano, da dai sauransu, amma saboda expectorant ne yadu amfani a kasar Sin, shi ne. in mun gwada da saukin samu, kuma yana da mafi girman adadin kawarwa za a iya amfani da shi azaman magani. Yana da daraja a inganta a cikin asibitin.

1.2 SQT

An yi amfani da SQT tare da PPI + amoxicillin na kwanaki 5, sannan a bi da su tare da PPI + clarithromycin + metronidazole na kwanaki 5. A halin yanzu ana ba da shawarar SQT azaman maganin kawar da layin farko don Hp. Meta-bincike na gwaje-gwaje masu sarrafa bazuwar guda shida (RCTs) a cikin Koriya dangane da SQT shine 79.4% (ITT) da 86.4% (PP), da kawar da HQ na SQT Adadin ya fi daidaitaccen jiyya sau uku, 95% CI: 1.403 ~ 2.209), tsarin na iya zama cewa 5d na farko (ko 7d) na amfani da amoxicillin don lalata tashar clarithromycin efflux akan bangon tantanin halitta, yana sa tasirin clarithromycin ya fi tasiri. Ana amfani da SQT sau da yawa azaman magani don gazawar daidaitaccen jiyya sau uku a ƙasashen waje. Koyaya, binciken ya nuna cewa adadin kawar da jiyya sau uku (82.8%) akan tsawan lokaci (14d) ya fi na tsarin jiyya na gargajiya (76.5%). Ɗaya daga cikin binciken kuma ya gano cewa babu wani bambanci mai mahimmanci a cikin ƙimar kawar da Hp tsakanin SQT da daidaitattun magungunan sau uku, wanda zai iya kasancewa da alaka da mafi girma na juriya na clarithromycin. SQT yana da dogon hanya na jiyya, wanda zai iya rage yarda da haƙuri kuma bai dace da yankunan da ke da tsayin daka ga clarithromycin ba, don haka SQT na iya yin la'akari da lokacin da aka hana yin amfani da tincture.

1.3 Sahabi far

Magungunan rakiyar shine PPI hade da amoxicillin, metronidazole da clarithromycin. Wani bincike-bincike ya nuna cewa adadin kawar da kai ya fi daidaitattun jiyya sau uku. Wani bincike-bincike kuma ya gano cewa adadin kawar da kai (90%) ya fi na daidaitaccen jiyya sau uku (78%). Yarjejeniyar Maastricht IV tana ba da shawarar cewa za a iya amfani da SQT ko jiyya tare da rashin jin daɗi, kuma ƙimar kawar da hanyoyin warkewa biyu iri ɗaya ne. Koyaya, a cikin wuraren da clarithromycin ke jure wa metronidazole, yana da fa'ida tare da maganin lokaci-lokaci. Duk da haka, saboda maganin da ke tattare da shi ya ƙunshi nau'o'in maganin rigakafi guda uku, za a rage zaɓin maganin rigakafi bayan gazawar jiyya, don haka ba a ba da shawarar a matsayin tsarin jiyya na farko ba sai dai wuraren da clarithromycin da metronidazole ke jure wa. Mafi yawa ana amfani dashi a wuraren da ke da ƙarancin juriya ga clarithromycin da metronidazole.

1.4 high kashi far

Nazarin ya gano cewa haɓaka kashi da/ko yawan sarrafa PPI da amoxicillin ya fi 90%. Ana ɗaukar tasirin ƙwayoyin cuta na amoxicillin akan Hp a matsayin dogaro da lokaci, sabili da haka, yana da inganci don ƙara yawan gudanarwa. Abu na biyu, lokacin da aka kiyaye pH a cikin ciki tsakanin 3 da 6, ana iya hana maimaitawa yadda ya kamata. Lokacin da pH a cikin ciki ya wuce 6, Hp ba zai sake yin kwafi ba kuma yana kula da amoxicillin. Ren et al sun gudanar da gwaje-gwajen sarrafawa bazuwar a cikin marasa lafiya 117 tare da marasa lafiya na Hp. An ba rukunin masu yawan adadin amoxicillin 1g, tid da rabeprazole 20mg, bid, kuma ƙungiyar kulawa an ba su amoxicillin 1g, tid da rabeprazole. 10mg, tayin, bayan makonni 2 na jiyya, ƙimar kawar da Hp na babban kashi shine 89.8% (ITT), 93.0% (PP), mahimmanci fiye da ƙungiyar kulawa: 75.9% (ITT), 80.0% (PP), P <0.05. Wani bincike daga Amurka ya nuna cewa amfani da esomeprazole 40 mg, ld + amoxicillin 750 mg, 3 days, ITT = 72.2% bayan kwanaki 14 na jiyya, PP = 74.2%. Franceschi et al. an sake nazarin jiyya guda uku: 1 daidaitaccen maganin sau uku: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 high-dose far: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, hanya na magani ne 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, bid treatment for 5d, lansoprazole 30mg bid, carat An yi maganin tayin 500mg da tinidazole 500mg karo na kwanaki 5. Adadin kawar da tsarin jiyya guda uku sune: 55%, 75%, da 73%. Bambance-bambancen da ke tsakanin babban magani da daidaitaccen maganin sau uku yana da mahimmanci a kididdiga, kuma an kwatanta bambanci da SQT. Ba shi da mahimmanci a ƙididdiga. Tabbas, bincike ya nuna cewa babban adadin omeprazole da amoxicillin ba su inganta ƙimar kawar da su yadda ya kamata ba, mai yiwuwa saboda CYP2C19 genotype. Yawancin ppis suna narkar da enzyme ta hanyar cyp2c19, don haka ƙarfin metabolite na cyp2c19 na iya shafar metabolism na PPI. Esomeprazole yana haɓaka ta hanyar cytochrome P450 3 A4 enzyme, wanda zai iya rage tasirin CYP2C19 gene zuwa wani matsayi. Bugu da ƙari, ban da PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, ana kuma bada shawarar azaman madadin magani mai girma.

Haɗe-haɗe shirye-shiryen ƙananan ƙwayoyin cuta

Ƙara magungunan ƙwayoyin cuta na ƙwayoyin cuta (MEA) zuwa daidaitattun jiyya na iya rage mummunan halayen, amma har yanzu yana da jayayya ko za a iya ƙara ƙimar kawar da Hp. Wani bincike-bincike ya gano cewa maganin sau uku na B. sphaeroides tare da sau uku sau uku kawai ya karu da ƙimar kawar da Hp (4 bazuwar gwajin gwaji, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), kuma rage ragewa. mummunan halayen ciki har da gudawa. Zhao Baomin et al. Har ila yau, ya nuna cewa haɗuwa da ƙwayoyin rigakafi na iya inganta ƙimar kawar da su sosai, ko da bayan an rage tsawon lokacin jiyya, har yanzu akwai babban adadin kawar da shi. Nazarin marasa lafiya 85 tare da marasa lafiya Hp-tabbatacce an bazu cikin ƙungiyoyin 4 na Lactobacillus 20 mg bid, clarithromycin 500 mg bid, da tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus hade tare da bifidobacteria, placebo na mako 1, cika takardar tambaya game da bincike na alamomi a kowane mako don makonni 4, 5 zuwa 7 makonni daga baya don duba kamuwa da cuta, binciken ya gano: ƙungiyar probiotics da ta'aziyya Babu wani mahimmanci. bambanci a cikin adadin kawarwa tsakanin ƙungiyoyi, amma duk ƙungiyoyin probiotic sun fi dacewa wajen hana mummunan halayen fiye da ƙungiyar kulawa, kuma babu wani bambanci mai mahimmanci a cikin abubuwan da suka faru a tsakanin ƙungiyoyin probiotic. Hanyar da probiotics ke kawar da Hp har yanzu ba a fayyace ba, kuma yana iya hanawa ko hanawa tare da gasa wuraren mannewa da abubuwa daban-daban kamar Organic acid da bacteriopeptides. Duk da haka, wasu nazarin sun gano cewa haɗuwa da ƙwayoyin cuta ba su inganta yawan kawar da su ba, wanda zai iya kasancewa da alaka da ƙarin tasirin probiotics kawai lokacin da maganin rigakafi ba su da tasiri. Har yanzu akwai babban sararin bincike a cikin haɗin gwiwar probiotics, kuma ana buƙatar ƙarin bincike akan nau'ikan, darussan magani, alamomi da lokacin shirye-shiryen probiotic.

Abubuwan da ke shafar ƙimar kawar da Hp

Abubuwa da yawa da ke shafar kawar da Hp sun haɗa da juriya na ƙwayoyin cuta, yanki na yanki, shekarun haƙuri, matsayi na shan taba, yarda, lokacin jiyya, yawan kwayoyin cuta, gastritis na atrophic na kullum, ƙaddamar da acid na ciki, amsawar mutum ga PPI, da CYP2C19 gene polymorphism. Kasancewar. Nazarin ya ba da rahoton cewa a cikin bincike na univariate, shekaru, wurin zama, magani, cututtuka na gastrointestinal, cututtuka, tarihin kawarwa, PPI, hanyar jiyya, da kuma kula da jiyya suna hade da adadin kawarwa. Bugu da ƙari, wasu cututtukan da ke da wuyar gaske, irin su ciwon sukari, hauhawar jini, cututtukan koda, cututtukan hanta na yau da kullun, da cututtukan huhu na yau da kullun na iya kasancewa da alaƙa da ƙimar kawar da Hp. Duk da haka, sakamakon binciken na yanzu ba ɗaya ba ne, kuma ana buƙatar ƙarin karatu mai girma.