Helicobacter pylori (Hp), ib qho ntawm cov kab mob sib kis ntau tshaj plaws hauv tib neeg. Nws yog ib qho kev pheej hmoo rau ntau yam kab mob, xws li mob plab, mob plab, mob plab adenocarcinoma, thiab txawm tias mucosa-associated lymphoid nqaij (MALT) lymphoma. Cov kev tshawb fawb tau pom tias kev tshem tawm ntawm Hp tuaj yeem txo qhov kev pheej hmoo ntawm kev mob qog noj ntshav, nce kev kho mob ntawm cov kab mob, thiab tam sim no yuav tsum tau ua ke nrog cov tshuaj tuaj yeem tshem tawm Hp ncaj qha. Muaj ntau yam kev kho mob tshem tawm cov kev xaiv muaj: thawj kab kev kho mob rau tus kab mob muaj xws li cov txheej txheem triple therapy, expectorant quadruple therapy, sequential therapy, thiab concomitant therapy. Xyoo 2007, American College of Gastroenterology tau muab kev kho triple nrog clarithromycin ua ib txoj kab kev kho thawj zaug rau kev tshem tawm cov neeg uas tsis tau txais clarithromycin thiab tsis muaj tshuaj penicillin. Txawm li cas los xij, nyob rau xyoo tsis ntev los no, qhov kev tshem tawm ntawm tus qauv kho peb zaug tau ≤80% hauv ntau lub tebchaws. Hauv tebchaws Canada, qhov kev tiv thaiv ntawm clarithromycin tau nce los ntawm 1% hauv xyoo 1990 mus rau 11% xyoo 2003. Ntawm cov tib neeg kho, cov tshuaj tiv thaiv kab mob tseem tau tshaj tawm txog 60%. Clarithromycin tsis kam yuav yog qhov ua rau muaj kev tshem tawm tsis ua haujlwm. Maastricht IV kev pom zoo qhia nyob rau hauv cov cheeb tsam uas muaj kev tiv thaiv siab rau clarithromycin (kuj tus nqi ntau dua 15% mus rau 20%), hloov cov txheej txheem triple therapy nrog plaub fab lossis kev kho mob raws sij hawm nrog expectorant thiab / lossis tsis muaj hnoos qeev, thaum carat Quadruple therapy kuj tseem siv tau ua thawj zaug. - Kev kho kab mob hauv cov cheeb tsam uas tsis muaj zog tiv thaiv mycin. Ntxiv rau cov hau kev saum toj no, kev siv tshuaj ntau ntawm PPI ntxiv rau amoxicillin lossis lwm yam tshuaj tua kab mob xws li rifampicin, furazolidone, levofloxacin kuj tau pom zoo ua lwm txoj hauv kev kho thawj kab.

Kev txhim kho ntawm tus qauv triple therapy

1.1 Quadruple therapy

Raws li kev tshem tawm tus nqi ntawm tus qauv triple therapy poob, raws li kev kho mob, plaub txoj kev kho plaub hau muaj qhov kev tshem tawm siab. Shaikh et al. kho 175 tus neeg mob uas muaj tus kab mob Hp, siv ib txoj cai (PP) tsom xam thiab lub hom phiaj. Cov txiaj ntsig ntawm lub hom phiaj los kho (ITT) kev tshuaj ntsuam xyuas qhov kev tshem tawm ntawm tus qauv kho peb zaug: PP = 66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72); quadruple therapy muaj kev tshem tawm ntau dua: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Txawm hais tias qhov ua tau zoo ntawm Hp tshem tawm tau txo qis tom qab txhua qhov kev kho tsis ua tiav, plaub qhov kev kho mob ntawm tincture tau ua pov thawj tias muaj kev tshem tawm siab (95%) raws li kev kho mob tom qab tsis ua tiav ntawm kev kho peb zaug. Lwm txoj kev tshawb fawb kuj tau mus txog qhov zoo sib xws: tom qab tsis ua tiav ntawm kev kho triple thiab levofloxacin triple therapy, qhov kev tshem tawm ntawm barium quadruple therapy yog 67% thiab 65%, feem, rau cov neeg uas tsis haum rau penicillin lossis tau txais loj hauv cov neeg mob. cyclic lactone tshuaj tua kab mob, expectorant quadruple therapy kuj nyiam. Tau kawg, kev siv tincture plaub hau kev kho mob muaj qhov tshwm sim ntau dua ntawm cov xwm txheej tsis zoo, xws li xeev siab, raws plab, mob plab, melena, kiv taub hau, mob taub hau, xim hlau saj, thiab lwm yam, tab sis vim tias cov expectorant tau siv dav hauv Suav teb, nws yog. kuj yooj yim kom tau, thiab muaj ib tug ntau dua eradication tus nqi yuav siv tau raws li kev kho mob. Nws tsim nyog txhawb nqa hauv tsev kho mob.

1.2 TSI

SQT tau kho nrog PPI + amoxicillin rau 5 hnub, tom qab ntawd kho nrog PPI + clarithromycin + metronidazole rau 5 hnub. SQT tam sim no tau pom zoo ua thawj kab kev kho mob rau Hp. Ib qho kev tshuaj ntsuam meta-kev soj ntsuam ntawm rau 6 qhov kev sim ntsuas randomized (RCTs) hauv Kaus Lim Kauslim raws li SQT yog 79.4% (ITT) thiab 86.4% (PP), thiab HQ tshem tawm ntawm SQT Tus nqi siab dua tus qauv triple therapy, 95% CI: 1.403 ~ 2.209), cov txheej txheem yuav yog thawj 5d (lossis 7d) siv amoxicillin los rhuav tshem cov clarithromycin efflux channel ntawm phab ntsa ntawm tes, ua rau cov nyhuv ntawm clarithromycin zoo dua. SQT feem ntau yog siv los ua kev kho mob rau kev ua tsis tiav ntawm tus qauv triple therapy txawv teb chaws. Txawm li cas los xij, cov kev tshawb fawb tau pom tias qhov kev kho mob triple tshem tawm tus nqi (82.8%) dhau lub sijhawm ncua (14d) yog siab dua li ntawm kev kho mob ua ntu zus (76.5%). Ib txoj kev tshawb fawb kuj pom tias tsis muaj qhov sib txawv tseem ceeb hauv Hp tshem tawm cov nqi ntawm SQT thiab tus qauv triple therapy, uas tej zaum yuav cuam tshuam rau tus nqi siab dua ntawm clarithromycin tsis kam. SQT muaj kev kho mob ntev dua, uas tuaj yeem txo cov neeg mob ua raws li cov cai thiab tsis tsim nyog rau thaj chaw uas muaj kev tiv thaiv siab rau clarithromycin, yog li SQT yuav raug txiav txim siab thaum contraindications rau kev siv tincture.

1.3 Kev kho tus khub

Nrog kev kho mob yog PPI ua ke nrog amoxicillin, metronidazole thiab clarithromycin. Ib qho kev ntsuam xyuas meta pom tau tias qhov kev tshem tawm tau siab dua li tus qauv kho peb zaug. Lwm qhov kev tshuaj ntsuam meta kuj pom tau tias qhov kev tshem tawm (90%) tau siab dua li cov qauv kev kho peb zaug (78%). Maastricht IV Consensus qhia tias SQT lossis kev kho mob sib xyaw tuaj yeem siv thaum tsis muaj expectorants, thiab cov nqi tshem tawm ntawm ob txoj kev kho mob zoo sib xws. Txawm li cas los xij, hauv cov cheeb tsam uas clarithromycin tiv taus metronidazole, nws muaj txiaj ntsig zoo dua nrog kev kho mob sib xyaw. Txawm li cas los xij, vim tias cov kev kho mob nrog rau muaj peb hom tshuaj tua kab mob, kev xaiv cov tshuaj tua kab mob yuav txo qis tom qab kev kho tsis ua haujlwm, yog li nws tsis pom zoo raws li thawj txoj kev kho mob tshwj tsis yog rau thaj chaw uas clarithromycin thiab metronidazole tiv taus. Feem ntau siv rau hauv thaj chaw uas tsis tshua muaj kev tiv thaiv rau clarithromycin thiab metronidazole.

1.4 kev kho mob siab

Cov kev tshawb fawb tau pom tias kev nce koob tshuaj thiab / lossis zaus ntawm kev tswj hwm ntawm PPI thiab amoxicillin ntau dua 90%. Cov kab mob bactericidal ntawm amoxicillin ntawm Hp yog suav tias yog nyob ntawm lub sijhawm, thiab yog li ntawd, nws yog qhov zoo dua los ua kom muaj kev tswj hwm ntau zaus. Qhov thib ob, thaum pH hauv plab yog tswj hwm ntawm 3 thiab 6, qhov rov ua dua tuaj yeem cuam tshuam tau zoo. Thaum pH hauv plab siab tshaj 6, Hp yuav tsis rov ua dua thiab nkag siab rau amoxicillin. Ren et al tau ua qhov kev sim ntsuas randomized hauv 117 tus neeg mob uas muaj Hp-zoo. Cov pab pawg muaj koob tshuaj tau muab amoxicillin 1g, tid thiab rabeprazole 20mg, twv, thiab pawg tswj hwm tau muab amoxicillin 1g, tid thiab rabeprazole. 10mg, twv, tom qab 2 lub lis piam ntawm kev kho mob, Hp tshem tawm tus nqi siab ntawm pawg tshuaj yog 89.8% (ITT), 93.0% (PP), ntau dua li pawg tswj hwm: 75.9% (ITT), 80.0% (PP), P <0.05. Kev tshawb fawb los ntawm Tebchaws Meskas tau pom tias siv esomeprazole 40 mg, ld + amoxicillin 750 mg, 3 hnub, ITT = 72.2% tom qab 14 hnub ntawm kev kho mob, PP = 74.2%. Franceschi et al. retrospectively soj ntsuam peb cov kev kho mob: 1 standard triple therapy: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 kev kho mob siab: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, kev kho mob yog 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, twv kho rau 5d, lansoprazole 30mg bid, carat Lub 500mg twv thiab tinidazole 500mg twv tau kho rau 5 hnub. Qhov kev tshem tawm ntawm peb txoj kev kho mob yog: 55%, 75%, thiab 73%. Qhov sib txawv ntawm kev kho mob siab thiab kev kho tus qauv triple yog qhov tseem ceeb, thiab qhov sib txawv tau muab piv nrog SQT. Tsis yog qhov tseem ceeb. Tau kawg, cov kev tshawb fawb tau pom tias koob tshuaj omeprazole thiab amoxicillin kev kho mob tsis zoo txhim kho kev tshem tawm cov nqi, tej zaum vim yog CYP2C19 genotype. Feem ntau PPIs yog metabolized los ntawm CYP2C19 enzyme, yog li lub zog ntawm CYP2C19 noob metabolite tuaj yeem cuam tshuam cov metabolism ntawm PPI. Esomeprazole feem ntau yog metabolized los ntawm cytochrome P450 3 A4 enzyme, uas tuaj yeem txo qhov cuam tshuam ntawm CYP2C19 noob rau qee qhov. Tsis tas li ntawd, ntxiv rau PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, kuj raug pom zoo ua lwm txoj kev kho mob siab.

Combined microbial npaj

Ntxiv cov tshuaj microbial ecological (MEA) rau cov qauv kev kho mob tuaj yeem txo cov kev tsis zoo, tab sis nws tseem muaj teeb meem seb Hp tshem tawm tus nqi tuaj yeem nce ntxiv. Ib qho kev ntsuam xyuas meta pom tau tias kev kho triple ntawm B. sphaeroides ua ke nrog triple therapy ib leeg nce Hp eradication rate (4 randomized tswj kev sim, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), kuj txo. kev phiv xws li raws plab. Zhao Baomin et al. kuj pom tau hais tias kev sib xyaw ntawm probiotics tuaj yeem txhim kho qhov kev tshem tawm tau zoo, txawm tias tom qab ua kom luv luv ntawm kev kho mob, tseem muaj kev tshem tawm siab. Kev tshawb fawb ntawm 85 cov neeg mob uas muaj Hp-zoo tau raug muab faib ua 4 pawg ntawm Lactobacillus 20 mg bid, clarithromycin 500 mg bid, thiab tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus ua ke nrog bifidobacteria, placebo rau 1 lub lis piam, sau cov lus nug ntawm kev tshawb fawb cov tsos mob txhua lub lis piam rau 4 lub lis piam, 5 mus rau 7 lub lis piam tom qab kuaj tus kab mob, txoj kev tshawb no pom: pab pawg neeg probiotics thiab kev nplij siab tsis muaj qhov tseem ceeb. Qhov sib txawv ntawm qhov kev tshem tawm ntawm cov pab pawg, tab sis tag nrho cov pab pawg probiotic muaj txiaj ntsig zoo dua los tiv thaiv kev cuam tshuam tsis zoo tshaj li pawg tswj hwm, thiab tsis muaj qhov sib txawv tseem ceeb hauv qhov tshwm sim ntawm qhov tsis zoo ntawm cov pab pawg probiotic. Lub tshuab uas probiotics tshem tawm Hp tseem tsis meej, thiab tuaj yeem cuam tshuam lossis tsis ua haujlwm nrog cov chaw sib tw adhesion thiab ntau yam khoom xws li organic acids thiab bacteriopeptides. Txawm li cas los xij, qee qhov kev tshawb fawb tau pom tias kev sib xyaw ntawm probiotics tsis txhim kho qhov kev tshem tawm, uas tej zaum yuav cuam tshuam rau cov txiaj ntsig ntxiv ntawm probiotics tsuas yog thaum cov tshuaj tua kab mob tsis zoo. Tseem muaj qhov chaw tshawb fawb zoo hauv kev sib koom ua ke probiotics, thiab kev tshawb fawb ntxiv yog xav tau ntawm hom, kev kho mob, kev qhia thiab lub sijhawm ntawm kev npaj probiotic.

Cov xwm txheej cuam tshuam rau Hp tshem tawm tus nqi

Ntau yam cuam tshuam rau Hp tshem tawm suav nrog tshuaj tua kab mob, thaj chaw thaj chaw, cov neeg mob hnub nyoog, kev haus luam yeeb, kev ua raws cai, lub sijhawm kho, kab mob ceev, mob atrophic gastritis, gastric acid concentration, tus neeg teb rau PPI, thiab CYP2C19 gene polymorphism. Lub xub ntiag. Cov kev tshawb fawb tau qhia tias nyob rau hauv univariate tsom xam, hnub nyoog, thaj chaw nyob, tshuaj, kab mob plab, comorbidity, eradication keeb kwm, PPI, chav kawm ntawm kev kho mob, thiab kev kho mob adherence yog txuam nrog eradication npaum li cas. Tsis tas li ntawd, qee cov kab mob uas muaj peev xwm ua tau ntev, xws li ntshav qab zib, ntshav siab, kab mob raum, kab mob siab, thiab kab mob ntsws ntev kuj tseem cuam tshuam txog kev tshem tawm ntawm Hp. Txawm li cas los xij, cov txiaj ntsig ntawm kev tshawb fawb tam sim no tsis zoo ib yam, thiab xav tau kev tshawb fawb loj ntxiv.