Helicobacter pylori (Hp), yog ib hom kab mob sib kis uas neeg feem ntau kis. Nws yog ib qho ua rau muaj ntau yam kab mob, xws li mob qog hauv plab, mob plab hnyuv ntev, mob qog hauv plab, thiab txawm tias mob qog hauv cov qog ntawm cov qog hauv lub plab (MALT) lymphoma. Cov kev tshawb fawb tau qhia tias kev tshem tawm Hp tuaj yeem txo qhov kev pheej hmoo ntawm mob qog hauv plab, ua rau cov qog kho tau zoo dua, thiab tam sim no yuav tsum tau ua ke nrog cov tshuaj uas tuaj yeem tshem tawm Hp ncaj qha. Muaj ntau txoj kev xaiv tshem tawm hauv kev kho mob: kev kho mob thawj zaug rau kev kis kab mob suav nrog kev kho mob peb zaug, kev kho mob plaub zaug uas siv expectorant, kev kho mob ua ntu zus, thiab kev kho mob ua ke. Xyoo 2007, American College of Gastroenterology tau muab kev kho mob peb zaug nrog clarithromycin ua kev kho mob thawj zaug rau kev tshem tawm cov neeg uas tsis tau txais clarithromycin thiab tsis muaj kev ua xua rau penicillin. Txawm li cas los xij, nyob rau xyoo tas los no, qhov kev tshem tawm ntawm kev kho mob peb zaug tau ≤80% hauv feem ntau lub tebchaws. Hauv Canada, tus nqi tiv thaiv ntawm clarithromycin tau nce ntxiv los ntawm 1% hauv xyoo 1990 mus rau 11% hauv xyoo 2003. Ntawm cov neeg kho mob, tus nqi tiv thaiv tshuaj tau tshaj tawm tias tshaj 60%. Kev tiv thaiv Clarithromycin tej zaum yuav yog qhov ua rau tsis ua tiav. Maastricht IV daim ntawv tshaj tawm kev pom zoo hauv thaj chaw uas muaj kev tiv thaiv siab rau clarithromycin (tus nqi tiv thaiv ntau dua 15% txog 20%), hloov kev kho mob peb zaug nrog plaub zaug lossis kev kho mob sib law liag nrog expectorant thiab / lossis tsis muaj hnoos qeev, thaum carat Quadruple kev kho mob kuj tseem siv tau ua thawj kab kev kho mob hauv thaj chaw uas tsis muaj kev tiv thaiv mycin. Ntxiv rau cov txheej txheem saum toj no, cov koob tshuaj PPI ntau ntxiv rau amoxicillin lossis lwm yam tshuaj tua kab mob xws li rifampicin, furazolidone, levofloxacin kuj tau hais tias yog lwm txoj kev kho mob thawj kab.

Kev txhim kho ntawm kev kho mob peb zaug

1.1 Kev kho mob plaub zaug

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

1.2 SQT

SQT tau kho nrog PPI + amoxicillin rau 5 hnub, tom qab ntawd kho nrog PPI + clarithromycin + metronidazole rau 5 hnub. SQT tam sim no raug pom zoo ua thawj kab kev kho mob rau Hp. Ib qho kev tshuaj xyuas ntawm rau qhov kev sim tshuaj randomized (RCTs) hauv Kauslim Teb raws li SQT yog 79.4% (ITT) thiab 86.4% (PP), thiab HQ kev tshem tawm ntawm SQT Tus nqi siab dua li tus qauv triple therapy, 95% CI: 1.403 ~ 2.209), lub tshuab yuav yog tias thawj 5d (lossis 7d) siv amoxicillin los rhuav tshem clarithromycin efflux channel ntawm phab ntsa cell, ua rau cov nyhuv ntawm clarithromycin zoo dua. SQT feem ntau yog siv los ua kev kho rau kev ua tsis tiav ntawm tus qauv triple therapy txawv teb chaws. Txawm li cas los xij, kev tshawb fawb tau qhia tias tus nqi triple therapy eradication (82.8%) dhau sijhawm ntev (14d) siab dua li ntawm cov kev kho mob classical sequential (76.5%). Ib txoj kev tshawb fawb kuj pom tias tsis muaj qhov sib txawv tseem ceeb hauv Hp eradication tus nqi ntawm SQT thiab tus qauv triple therapy, uas tej zaum yuav muaj feem cuam tshuam nrog tus nqi siab dua ntawm kev tiv thaiv clarithromycin. SQT muaj kev kho mob ntev dua, uas yuav txo qhov kev ua raws li tus neeg mob thiab tsis haum 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 mob nrog tus khub

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

1.4 kev kho mob siab

Cov kev tshawb fawb pom tau tias kev nce koob tshuaj thiab/lossis zaus ntawm kev siv PPI thiab amoxicillin ntau dua 90%. Cov nyhuv tua kab mob ntawm amoxicillin rau Hp yog suav tias yog nyob ntawm lub sijhawm, thiab yog li ntawd, nws zoo dua los nce zaus ntawm kev siv. Qhov thib ob, thaum pH hauv plab tswj hwm ntawm 3 thiab 6, qhov kev rov ua dua tuaj yeem raug txwv tsis pub ua tau zoo. Thaum pH hauv plab tshaj 6, Hp yuav tsis rov ua dua thiab rhiab heev rau amoxicillin. Ren et al tau ua qhov kev sim tshuaj randomized hauv 117 tus neeg mob uas muaj cov neeg mob Hp-positive. Pawg neeg noj tshuaj ntau tau muab amoxicillin 1g, tid thiab rabeprazole 20mg, bid, thiab pawg tswj tau muab amoxicillin 1g, tid thiab rabeprazole. 10mg, twv, tom qab 2 lub lis piam ntawm kev kho mob, tus nqi tshem tawm Hp ntawm pawg koob tshuaj siab yog 89.8% (ITT), 93.0% (PP), siab dua li pawg tswj hwm: 75.9% (ITT), 80.0% (PP), P <0.05. Ib txoj kev tshawb fawb los ntawm Tebchaws Meskas tau qhia 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. rov qab tshuaj xyuas peb txoj kev kho mob: 1 tus qauv triple kev kho mob: lansoola 30mg, twv, clarithromycin 500mg, twv, amoxicillin 1000mg, twv, 7d; 2 kev kho mob siab heev: Lansuo Carbazole 30mg, twv, clarithromycin 500mg, twv, amoxicillin 1000mg, tid, chav kawm ntawm kev kho mob yog 7d; 3SQT: lansoprazole 30mg, twv + amoxicillin 1000mg, twv kev kho mob rau 5d, lansoprazole 30mg twv, carat 500mg twv thiab tinidazole 500mg twv tau kho rau 5 hnub. Cov nqi tshem tawm ntawm peb txoj kev kho mob yog: 55%, 75%, thiab 73%. Qhov sib txawv ntawm kev kho mob siab heev thiab kev kho mob peb zaug yog qhov tseem ceeb, thiab qhov sib txawv tau piv nrog SQT. Tsis tseem ceeb. Tau kawg, kev tshawb fawb tau qhia tias kev kho mob siab heev omeprazole thiab amoxicillin tsis tau txhim kho cov nqi tshem tawm, tej zaum vim yog CYP2C19 genotype. Feem ntau cov PPIs raug metabolized los ntawm CYP2C19 enzyme, yog li lub zog ntawm CYP2C19 gene metabolite yuav cuam tshuam rau 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 gene rau qee qhov. Tsis tas li ntawd, ntxiv rau PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, kuj pom zoo kom siv cov tshuaj ntau dua.

Kev npaj ua ke ntawm cov kab mob me me

Ntxiv cov kab mob me me (MEA) rau hauv kev kho mob ib txwm muaj peev xwm txo cov kev tsis zoo, tab sis nws tseem muaj kev tsis sib haum xeeb seb puas tuaj yeem nce tus nqi tshem tawm Hp. Ib qho kev tshuaj xyuas meta-analysis pom tias kev kho peb zaug ntawm B. sphaeroides ua ke nrog kev kho peb zaug ib leeg ua rau tus nqi tshem tawm Hp nce (4 qhov kev sim tshuaj randomized, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), kuj txo cov kev tsis zoo suav nrog raws plab. Zhao Baomin et al. kuj tau qhia tias kev sib xyaw ua ke ntawm probiotics tuaj yeem txhim kho tus nqi tshem tawm, txawm tias tom qab luv luv ntawm kev kho mob, tseem muaj tus nqi tshem tawm siab. Ib txoj kev tshawb fawb ntawm 85 tus neeg mob uas muaj cov neeg mob Hp-positive tau raug xaiv 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 lim tiam, sau daim ntawv nug txog kev tshawb fawb txog cov tsos mob txhua lub lim tiam rau 4 lub lim tiam, 5 txog 7 lub lim tiam tom qab los xyuas qhov kev kis kab mob, kev tshawb fawb pom: pawg probiotics thiab kev nplij siab Tsis muaj qhov sib txawv tseem ceeb hauv qhov kev tshem tawm ntawm cov pab pawg, tab sis txhua pawg probiotic muaj txiaj ntsig zoo dua hauv kev tiv thaiv cov kev tsis zoo dua li pawg tswj hwm, thiab tsis muaj qhov sib txawv tseem ceeb hauv qhov tshwm sim ntawm cov kev tsis zoo ntawm cov pab pawg probiotic. Lub tshuab uas probiotics tshem tawm Hp tseem tsis meej, thiab tej zaum yuav inhibit lossis inactivate nrog cov chaw sib tw adhesion thiab ntau yam tshuaj xws li cov organic acids thiab bacteriopeptides. Txawm li cas los xij, qee qhov kev tshawb fawb tau pom tias kev sib xyaw ua ke ntawm probiotics tsis txhim kho qhov kev tshem tawm, uas tej zaum yuav cuam tshuam nrog cov nyhuv 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 qhov xav tau ntawm cov hom, cov chav kawm kho mob, cov cim qhia thiab lub sijhawm ntawm kev npaj probiotic.

Cov yam tseem ceeb uas cuam tshuam rau tus nqi tshem tawm Hp

Muaj ntau yam uas cuam tshuam rau kev tshem tawm Hp suav nrog kev tiv thaiv tshuaj tua kab mob, thaj chaw nyob, hnub nyoog ntawm tus neeg mob, kev haus luam yeeb, kev ua raws li txoj cai, lub sijhawm kho mob, qhov ceev ntawm cov kab mob, mob plab atrophic, qhov concentration ntawm cov kua qaub hauv plab, kev teb ntawm tus kheej rau PPI, thiab CYP2C19 gene polymorphism. Qhov muaj. Cov kev tshawb fawb tau tshaj tawm tias hauv kev tshuaj xyuas univariate, hnub nyoog, thaj chaw nyob, tshuaj, kab mob plab hnyuv, kev mob ua ke, keeb kwm tshem tawm, PPI, kev kho mob, thiab kev ua raws li kev kho mob cuam tshuam nrog cov nqi tshem tawm. Tsis tas li ntawd, qee cov kab mob ntev, xws li ntshav qab zib, ntshav siab, kab mob raum ntev, kab mob siab ntev, thiab kab mob ntsws ntev kuj tseem yuav cuam tshuam nrog cov nqi 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.