Helicobacter pylori (HP), yog ib qho ntawm cov kab mob sib kis feem ntau hauv tib neeg. Nws yog qhov txaus ntshai rau ntau yam kab mob, xws li mob plab hnyuv, mob plab zom mov, thiab txawm tias cov nqaij lympoid (malt) lymphoma. Cov kev tshawb fawb tau pom tias kev quab yuam ntawm HP tuaj yeem txo qhov kev pheej hmoo mob plab hnyuv, thiab tam sim no yuav tsum tau ua ke nrog cov tshuaj muaj peev xwm ncaj qha hp. Muaj ntau yam tshuaj kho mob eradication xaiv muaj cov qauv triple kho, cia siab tias tus kws kho mob quadrup, thiab kev kho mob ib zaug, thiab kev kho mob ib zaug. Xyoo 2007, American Collegenterology Raws li kev kho peb npaug rau kev rho tawm ntawm cov neeg uas tsis tau txais kev fab lus yooj yim. Txawm li cas los xij, nyob rau hauv decades tsis ntev los no, qhov kev sib tw ntawm kev sib tw ntawm txheem triple kho mob tau ≤ 45 hauv ntau lub tebchaws. Hauv tebchaws Canada, cov nqi cuam tshuam tsis kam ntawm 1% xyoo 199% nyob rau hauv cov tib neeg kho mob tseem ceeb tshaj 60%. Clarithromycin Kuj yuav yog qhov tseem ceeb ua rau kev sib deev tsis ua hauj lwm. Maxastict IV Kev Tshaj Tawm Txog Kev Tshaj Tawm hauv cov cheeb tsam uas muaj kev kho plaub ntug nrog plaub zaug, thaum hloov cov hnoos qeev, thaum tus qauv plaub hau, thaum carat plaub -Txawm txoj kev kho mob hauv cov cheeb tsam uas muaj kev tiv taus qis rau myrcin. Ntxiv rau cov txheej txheem saum toj no, cov koob tshuaj saum npoo PPI ntxiv rau Amoxicillin lossis Alternative, Furoflousics xws li RevoFloxacin kuj tau pom zoo ua lwm txoj kev ua ntej-kab.

Kev Txhim Kho ntawm Txheem Triple Kho

1.1 Quadruple kev kho mob

Raws li cov xwm txheej uas muaj kev sib tw ntawm cov qauv kev tsheb kauj vab, raws li txoj kev kho mob, Quadrupher Kev kho mob muaj lub zog loj. Shaikh li al. Kho 175 cov neeg mob uas muaj tus mob HP, siv ib cov qauv (PP) tsom xam thiab lub hom phiaj. Cov txiaj ntsig ntawm lub hom phiaj los kho (TTT) Kev tsom xam ntsuas qhov qauv ntawm Trastration Trastration: PP = 66% (49% (49/79, 95% CIK: 51-72); Quadruple kev kho mob muaj qhov nce qib siab: PP = 91% (102/34%: (102/121, 95% CI: 77 ~ 90). Txawm hais tias qhov ua tiav ntawm HP ERADICATION tau txo qis tom qab kev kho mob ua tsis tiav ntawm tincture (95%) raws li kev ua tiav ntawm tus qauv kev kho mob. Lwm txoj kev tshawb nrhiav kuj tau txog qhov kev txiav txim siab zoo sib xws: Tom qab kev ua txhaum cai ntawm kev kho mob ntawm barium Cyclic lactone tshuaj tua kab mob, cia siab rau quadruple kev kho yog tseem nyiam. Ntawm chav kawm, kev siv Tincture Quadruple Quadruple Quadruple ntawm cov xwm txheej tsis zoo, mob plab, tab sis vim tias qhov kev cia siab tau siv nyob rau hauv Suav teb, nws yog Qhov yooj yim tau txais, thiab muaj cov nqi txuas ntxiv yuav tuaj yeem siv los ua kev kho mob kho mob. Nws tsim nyog kev txhawb nqa hauv tsev kho mob.

1.2 sqt

SQT tau kho nrog PPI + Amoxicillin rau 5 hnub, tom qab ntawd kho nrog PPI + ClaraTromycin + metronidazole rau 5 hnub. SQT tam sim no tau pom zoo tias yog thawj-kab eradication kev kho mob rau HP. Kev txheeb xyuas meta-tsom xam ntawm rau Randomized tswj kev sim (RCTS) hauv SQT yog siab dua tus qauv triple, 95% CI: 1.403 ~ 2.209), tus txheej txheem yuav yog thawj zaug 5D (lossis 7D) siv Amoxicillin los rhuav tshem lub xovtooj ntawm tes, ua rau cov nyhuv ntawm cov ntsiab lus ntawm tes, ua rau cov txiaj ntsig ntawm tes, ua rau cov nyhuv ntawm lub meejcyromycin ua tau zoo dua. SQT feem ntau siv los ua cov tshuaj tsis ua tiav ntawm cov qauv triple kho nyob txawv teb chaws. Txawm li cas los xij, kev tshawb fawb pom tau hais tias kev siv peb npaug kev kho mob uas muaj kev sib tw (14D) ntau dua li ntawm cov txheej txheem sib txuas (76.5%). Ib txoj kev tshawb nrhiav kuj tau pom tias tsis muaj qhov sib txawv ntawm HP ERADICATION nyob nruab nrab ntawm SQT kev kho mob, uas yuav cuam tshuam nrog ntau dua ntawm cov ntsiab lus meej ntawm cov ntsiab lus meej meej. SQT muaj sijhawm ntev dua ntawm kev kho mob, uas tuaj yeem txo cov neeg mob ua raws li cov chaw uas muaj lub siab xav tau thaum tsis muaj dab tsi rau tincture siv.

1.3 tus khub kev kho mob

Nrog kev kho mob yog PPI ua ke nrog amoxicillin, metronidazole thiab clarithromycin. Kev tsom xam meta-tsom kwm qhia tau tias kev sib tw sib luag yog siab dua tus qauv kev kho peb lub sijhawm. Lwm cov Meta-tsom xam tau pom tias qhov xwm txheej sib luag (90%) tau nce siab dua li ntawm cov qauv kev kho mob triple (78%). MASACTHT IV Kev tsom xam hais tias sqt lossis concomitant kev kho mob tuaj yeem siv nyob rau hauv qhov tsis muaj kev cia siab, thiab kev siv nyiaj ntawm ob qho kev kho mob zoo sib xws. Txawm li cas los xij, hauv cov cheeb tsam uas tiv taus Metronidazole, nws yog qhov zoo dua nrog cov kev kho mob sib txawv. Txawm li cas los xij, vim tias kev kho mob nrog peb cov tshuaj tua kab mob, yog li nws tsis pom zoo raws li thaj chaw uas tsis ua haujlwm tshwj tsis yog qhov chaw uas muaj kev tiv thaiv. Feem ntau siv nyob rau hauv cov cheeb tsam uas muaj qis tsis kam mus rau Claritomycin thiab metronidazole.

1.4 Kev Kho Mob Siab

Cov kev tshawb fawb pom tau tias nce qhov koob tshuaj thiab / lossis ntau zaus ntawm kev tswj hwm ntawm PPI thiab Amoxicillin ntau dua 90%. Cov kab mob ntawm amoxicillin ntawm HP yog suav hais tias yog lub sijhawm-nyob, thiab yog li ntawd, nws muaj peev xwm ua tau zoo dua los ua kom muaj ntau zaus ntawm kev tswj hwm. Thib ob, thaum lub ph plab yog tswj hwm ntawm 3 thiab 6, cov kev rov ua yuav ua tau zoo tsis muaj. Thaum lub pH hauv lub plab ntau dua 6, HP yuav tsis replicate thiab yog rhiab rau amoxicillin. Lub Npaws thiab cov kev txiav txim siab randomized hauv 117 tus neeg mob uas muaj cov neeg mob HP-zoo. Cov pab pawg neeg siab tau muab Amoxicillin 1G, Tid thiab Rabeprazole 20mg, pab pawg tau muab Amoxicillin 1G, Tid thiab RabePrazle. 10mg, twv, tom qab 2 lub lim tiam ntawm kev kho, tus nqi yuav siab dua yog 89.8% (itt), nws% (80.0% (pp), P <0.05. Kev kawm los ntawm Tebchaws Meskas tau pom tias siv cov roj ntsha hais tias 40 mg, LD + Amoxicillin 750 mg, 3 hnub, wb, 7 hnub ntawm kev kho, pp = 74.2%. Franceschi li al. Kev Kho Mob Peb Leeg: 1 Txheem Triple Kho: Lanso 30mm, Bid, Glexicillin 1000mg, Bid, 7d; 2 Cov tshuaj kho mob siab: Lansuo carbazole 30mg, twv, amoxicillin 1000mg, TID, chav kawm yog 7d; 3sqt: LANSoprazole 30mg, Bid + Ambicillin 1000MG, Lanodazole 30MG twv thiab Tinidazole 500mg twv tau txais kev kho rau 5 hnub. Qhov kev sib tw yuav ntawm peb txoj kev kho mob yog: 55%, 75%, thiab 73%. Qhov sib txawv ntawm kev kho mob siab thiab qauv triple kho tau yog cov ntsiab lus tseem ceeb, thiab qhov sib txawv tau muab piv nrog sqt. Tsis yog cov ntsiab lus tseem ceeb. Ntawm chav kawm, kev tshawb fawb tau pom tias cov kev kho mob omeprazole thiab amoxicillin thiab amoxicillin kev kho mob tsis zoo, tej zaum vim yog CYP2C19 Genotype. Feem ntau PPIS yog metabolized los ntawm CYP2C19 enzyme, yog li lub zog ntawm CYP2C19 gene metabolite yuav cuam tshuam rau metabolism hauv PPI. EsomePrazole feem ntau yog metabolized los ntawm cytochrome P450 3 A4 enzyme, uas tuaj yeem txo cov cawv ntawm CYP2C19 noob rau qee yam. Ib qho ntxiv, ntxiv rau PPI, Amoxicillin, Rifampidone, Furazolidone, Levofloxacin, kuj tau pom zoo raws li kev kho mob siab.

Neej Coj Microbial Npaj

Ntxiv cov qauv ecologial ecological ecological ecological ecents (mea) rau kev kho mob kho mob tuaj yeem txo cov kev tsis zoo, tab sis nws tseem muaj kev sib cav sib ceg, tab sis nws tseem muaj kev sib cav sib ceg yuav nce ntxiv. Ib qho kev txheeb xyuas meta-pom tias txoj kev sib tw ntawm B. Sphaeroids ntawm B. Spreadoids ntawm kev sim siab (4 Random tswj tus nqi (4 Random tswj tus nqi (4 Random tswj HP Cov kev tsis zoo xws li raws plab. Zhao Baunin li al. Kuj tseem pom tias kev sib xyaw ua ke tuaj yeem txhim kho cov kev sib tsoo, txawm tias qhov kev ua kom luv, tseem muaj tus nqi uas muaj kev cuam tshuam loj. Kev tshawb fawb ntawm 85 cov neeg mob HP-zoo tau muab tso rau hauv 4 pawg Lactobacillus 20 MG BID, ClaraTromycin 500 mg twv, thiab tinidazole 500 mg twv. , B. Cerevisiae, Lactobacillus ua ke nrog BIFIDobacteria, Party rau 1 lub lis piam tom qab los kuaj xyuas tus mob: Nrhiav tau pab pawg neeg: Probiotics Group thiab kev nplij siab tsis muaj qhov tseem ceeb Qhov sib txawv hauv cov pab pawg uas muaj kev sib txawv ntawm cov pab pawg, tab sis txhua pab pawg probiotic tau zoo tshaj nyob rau hauv pab pawg tsis zoo tshaj li cov kev tswj hwm ntawm cov kev tiv thaiv tsis zoo ntawm cov pab pawg probiotic. Tus txheej txheem los ntawm cov probiotics cuam tshuam hp tseem inhativate nrog cov khoom sib tw thiab ntau yam tshuaj xws li organic acids thiab bacterioperme. Txawm li cas los xij, qee cov kev tshawb fawb tau pom tias kev ua ke ntawm cov kev ua ke tsis txhim kho kev cuam tshuam nrog kev sib raug zoo ntawm cov promients ntawm cov probiotics tsuas yog thaum tshuaj tua kab mob yog qhov tsis muaj txiaj ntsig. Tseem muaj qhov chaw tshawb nrhiav zoo hauv kev sib koom tes, thiab kev tshawb fawb ntxiv rau ntawm cov hom, cov chav kho kev kho mob, kev taw qhia txog kev qhia tau thiab sijhawm ntawm probiotic.

Yam cuam tshuam rau HP Eadication tus nqi

Ntau yam cuam tshuam rau HP kev sib tw HP kev suav nrog lub sijhawm tshuaj tua kab, kev ua phem rau ppi, thiab CyP2C19 gene polymorphism. Lub xub ntiag. Cov kev tshawb fawb tau tshaj tawm tias nyob rau hauv kev tshawb xyuas tsis muaj kev paub, lub hnub nyoog, lub sijhawm muaj kev kho mob, PPI, chav kho mob muaj feem nrog kev ntsuas hluav taws xob. Ib qho ntxiv, qee cov kab mob uas muaj mob ntshav qab zib, ntshav qab zib, mob ntsws mob ntev, thiab mob ntsws ntev rau ntawm HP. Txawm li cas los xij, cov txiaj ntsig ntawm txoj kev tshawb fawb tam sim no tsis zoo li qub, thiab kev tshawb fawb ntau ntxiv yog xav tau.