Helicobacter pylori (Hp), otu n'ime ọrịa na-efe efe na-adịkarị na mmadụ. Ọ bụ ihe ize ndụ maka ọtụtụ ọrịa, dị ka ọnya afọ, gastritis na-adịghị ala ala, gastric adenocarcinoma, na ọbụna mucosa-ejikọta ọnụ lymphoid anụ ahụ (MALT) lymphoma. Nnyocha e mere egosiwo na ikpochapụ Hp nwere ike ibelata ohere nke ọrịa kansa afọ, mụbaa ọnụ ọgụgụ ọgwụgwọ ọnya, na ugbu a ọ dị mkpa ijikọ ya na ọgwụ nwere ike ikpochapụ Hp ozugbo. Enwere nhọrọ ikpochapụ ụlọ ọgwụ dị iche iche dị: ọgwụgwọ nke mbụ maka ọrịa na-agụnye usoro ọgwụgwọ ugboro atọ, expectorant quadruple therapy, usoro ọgwụgwọ usoro, na ọgwụgwọ concomitant. N'afọ 2007, American College of Gastroenterology jikọtara ọgwụgwọ ugboro atọ na clarithromycin dị ka usoro ọgwụgwọ mbụ maka ikpochapụ ndị mmadụ na-enwetaghị clarithromycin na enweghị nrịanrịa penicillin. Agbanyeghị, n'ime iri afọ ndị na-adịbeghị anya, ọnụego mkpochapụ nke usoro ọgwụgwọ ugboro atọ abụrụla ≤80% n'ọtụtụ mba. Na Canada, ọnụ ọgụgụ nguzogide clarithromycin abawanyela site na 1% na 1990 ruo 11% na 2003. N'ime ndị a na-agwọ ọrịa, a kọdịrị ọnụ ọgụgụ nguzogide ọgwụ ahụ gafere 60%. Nguzogide Clarithromycin nwere ike ịbụ isi ihe na-akpata mkpochapụ. Maastricht IV nkwenye na-akọ na mpaghara nwere nnukwu nguzogide clarithromycin (ọnụego nguzogide n'elu 15% ruo 20%), dochie usoro ọgwụgwọ ugboro atọ na anọ ma ọ bụ usoro ọgwụgwọ na expectorant na / ma ọ bụ enweghị sputum, ebe enwere ike iji ọgwụgwọ carat Quadruple mee ihe dị ka nke mbụ. -usoro ọgwụgwọ na mpaghara nwere obere iguzogide mycin. Na mgbakwunye na usoro ndị a dị n'elu, akwadoro nnukwu doses nke PPI gbakwunyere amoxicillin ma ọ bụ ọgwụ nje ndị ọzọ dị ka rifampicin, furazolidone, levofloxacin dị ka usoro ọgwụgwọ mbụ.

Mmelite usoro ọgwụgwọ ugboro atọ

1.1 ọgwụgwọ anọ

Ka ọnụ ọgụgụ mkpochapụ nke usoro ọgwụgwọ atọ ọkọlọtọ na-ada, dị ka ọgwụgwọ, ọgwụgwọ anọ nwere ọnụ ọgụgụ dị elu nke mkpochapụ. Shaikh et al. gwọchara ndị ọrịa 175 nwere ọrịa Hp, na-eji nyocha na ebumnuche kwa protocol (PP). Nsonaazụ nke ebumnuche ịgwọ (ITT) nyocha nyochara ọnụ ọgụgụ mkpochapụ nke usoro ọgwụgwọ atọ ọkọlọtọ: PP=66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72); Usoro ọgwụgwọ anọ nwere ọnụ ọgụgụ mkpochapụ dị elu: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Ọ bụ ezie na ọnụ ọgụgụ ịga nke ọma nke mkpochapụ Hp belatara mgbe ọgwụgwọ ọ bụla dara ada, ọgwụgwọ anọ nke tincture gosipụtara na ọ nwere ọnụ ọgụgụ mkpochapụ dị elu (95%) dị ka ihe ngwọta mgbe ọdịda nke usoro ọgwụgwọ ugboro atọ gasịrị. Ọmụmụ ihe ọzọ rutekwara nkwubi okwu yiri nke ahụ: mgbe ọdịda nke usoro ọgwụgwọ atọ na levofloxacin mechiri emechi, ọnụ ọgụgụ mkpochapụ nke barium quadruple therapy bụ 67% na 65%, n'otu n'otu, maka ndị nwere penicillin nfụkasị ahụ ma ọ bụ nwetagoro buru ibu na ndị ọrịa nwere ọrịa shuga. Ọgwụ nje lactone cyclic, ọgwụgwọ quadruple expectorant na-amasịkwa. N'ezie, ojiji nke tincture quadruple ọgwụgwọ nwere a elu ihe gbasara nke puru omume nke oghom omume, dị ka ọgbụgbọ, afọ ọsịsa, abdominal mgbu, melena, dizziness, isi ọwụwa, dara uto, wdg, ma n'ihi na expectorant na ọtụtụ-eji na China, ọ bụ dị mfe ịnweta, ma nwee ọnụ ọgụgụ mkpochapụ dị elu nwere ike iji mee ihe dị ka ọgwụgwọ ọgwụgwọ. Ọ bara uru ịkwalite na ụlọ ọgwụ.

1.2 SQT

A na-agwọ SQT na PPI + amoxicillin maka ụbọchị 5, wee gwọọ ya na PPI + clarithromycin + metronidazole maka ụbọchị 5. A na-atụ aro SQT ugbu a dị ka ọgwụgwọ mkpochapụ nke mbụ maka Hp. Meta-analysis of isii randomized control tests (RCTs) na Korea dabere na SQT bụ 79.4% (ITT) na 86.4% (PP), na HQ mkpochapụ nke SQT Ọnụego ahụ dị elu karịa usoro ọgwụgwọ ugboro atọ, 95% CI: 1.403 ~ 2.209), usoro nwere ike ịbụ na 5d mbụ (ma ọ bụ 7d) na-eji amoxicillin mebie ọwa clarithromycin efflux na mgbidi cell, na-eme ka mmetụta clarithromycin dịkwuo irè. A na-ejikarị SQT eme ihe dị ka ọgwụgwọ maka ọdịda nke usoro ọgwụgwọ ugboro atọ na mba ọzọ. Agbanyeghị, ọmụmụ egosila na ọnụọgụ mkpochapụ ọgwụgwọ atọ (82.8%) karịa ogologo oge (14d) dị elu karịa nke usoro ọgwụgwọ oge gboo (76.5%). Otu nnyocha chọpụtakwara na ọ dịghị ihe dị ịrịba ama dị ịrịba ama na ọnụego mkpochapụ Hp n'etiti SQT na usoro ọgwụgwọ atọ, nke nwere ike jikọta na ọnụ ọgụgụ dị elu nke nguzogide clarithromycin. SQT nwere usoro ọgwụgwọ ogologo oge, nke nwere ike ibelata nnabata onye ọrịa na ọ gaghị adabara mpaghara nwere oke nguzogide clarithromycin, yabụ enwere ike ịtụle SQT mgbe contraindications maka ojiji tincture.

1.3 ọgwụgwọ mkpakọrịta

Usoro ọgwụgwọ na-esote bụ PPI jikọtara ya na amoxicillin, metronidazole na clarithromycin. Nnyocha meta gosiri na ọnụ ọgụgụ mkpochapụ ahụ dị elu karịa usoro ọgwụgwọ ugboro atọ. Meta-nyocha ọzọ chọpụtakwara na ọnụ ọgụgụ mkpochapụ (90%) dị elu nke ukwuu karịa nke usoro ọgwụgwọ ugboro atọ (78%). Nkwekọrịta Maastricht IV na-atụ aro na enwere ike iji SQT ma ọ bụ ọgwụgwọ concomitant na-enweghị ndị na-atụ anya ya, na ọnụ ọgụgụ mkpochapụ nke ọgwụgwọ abụọ ahụ yiri. Otú ọ dị, na mpaghara ebe clarithromycin na-eguzogide metronidazole, ọ na-akawanye mma na ọgwụgwọ concomitant. Otú ọ dị, n'ihi na ọgwụgwọ na-eso ya nwere ụdị ọgwụ nje atọ, a ga-ebelata nhọrọ nke ọgwụ nje mgbe ọgwụgwọ ahụ kwụsịrị, n'ihi ya, a naghị atụ aro ya dị ka usoro ọgwụgwọ mbụ ma e wezụga ebe clarithromycin na metronidazole na-eguzogide ọgwụ. A na-ejikarị ya na mpaghara nwere obere iguzogide clarithromycin na metronidazole.

1.4 ọgwụgwọ dose dị elu

Nnyocha achọpụtala na ịba ụba dose na/ma ọ bụ ugboro ole nchịkwa PPI na amoxicillin karịrị 90%. A na-ahụta mmetụta bactericidal nke amoxicillin na Hp ka ọ dabere na oge, ya mere, ọ ka mma ịbawanye ugboro nchịkwa. Nke abuo, mgbe pH dị n'ime afọ na-edobe n'etiti 3 na 6, enwere ike igbochi mmegharị ahụ nke ọma. Mgbe pH dị n'ime afọ karịrị 6, Hp agaghịzi emegharị ma na-enwe mmetụta nke amoxicillin. Ren et al mere nnwale ndị a na-achịkwaghị nke ọma na ndị ọrịa 117 nwere ndị ọrịa Hp dị mma. Otu ọgwụ dị elu ka enyere amoxicillin 1g, tid na rabeprazole 20mg, bid, ma nyekwa otu njikwa ahụ amoxicillin 1g, tid na rabeprazole. 10mg, bid, mgbe izu 2 gachara, ọnụ ọgụgụ mkpochapụ Hp nke oke dose ahụ bụ 89.8% (ITT), 93.0% (PP), dị elu karịa otu njikwa: 75.9% (ITT), 80.0% (PP), P <0.05. Nnyocha sitere na United States gosiri na iji esomeprazole 40 mg, ld + amoxicillin 750 mg, ụbọchị 3, ITT = 72.2% mgbe ụbọchị 14 gachara ọgwụgwọ, PP = 74.2%. Franceschi et al. enyochaghachi azụ ọgwụgwọ atọ: 1 ọkọlọtọ ọgwụgwọ atọ: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 usoro ọgwụgwọ dị elu: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, usoro ọgwụgwọ bụ 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, ọgwụgwọ maka 5d, lansoprazole 30mg bid, carat A na-agwọta 500mg bid na tinidazole 500mg bid maka ụbọchị 5. Ọnụego mkpochapụ nke usoro ọgwụgwọ atọ ahụ bụ: 55%, 75%, na 73%. Ọdịiche dị n'etiti usoro ọgwụgwọ dị elu na usoro ọgwụgwọ ugboro atọ bụ ihe dị ịrịba ama, ma e jiri ya tụnyere SQT. Ọ bụghị ọnụ ọgụgụ dị ịrịba ama. N'ezie, ọmụmụ egosila na oke ọgwụ omeprazole na amoxicillin emeghị ka ọnụ ọgụgụ mkpochapụ dị mma, ikekwe n'ihi genotype CYP2C19. Ọtụtụ PPI na-emeziwanye site na enzyme CYP2C19, yabụ ike nke metabolite gene CYP2C19 nwere ike imetụta metabolism nke PPI. Esomeprazole bụ metabolized nke ọma site na cytochrome P450 3 A4 enzyme, nke nwere ike ibelata mmetụta nke mkpụrụ ndụ CYP2C19 ruo n'ókè ụfọdụ. Na mgbakwunye, na mgbakwunye na PPI, a na-atụ aro amoxicillin, rifampicin, furazolidone, levofloxacin dị ka usoro ọgwụgwọ dị elu.

Nkwadebe microbial jikọtara ọnụ

Ịgbakwunye microbial ecological agents (MEA) na ọgwụgwọ ọkọlọtọ nwere ike ibelata mmeghachi omume ọjọọ, mana ọ ka na-arụrịta ụka ma enwere ike ịbawanye ọnụego mkpochapụ Hp. A meta-analysis chọpụtara na atọ ọgwụgwọ nke B. sphaeroides jikọtara ya na atọ ọgwụgwọ naanị mụbara Hp mkpochapụ (4 randomized njikwa ule, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), na-ebelatakwa. mmeghachi omume ọjọọ gụnyere afọ ọsịsa. Zhao Baomin et al. gosikwara na nchikota nke probiotics nwere ike imeziwanye ọnụ ọgụgụ mkpochapụ nke ukwuu, ọbụlagodi mgbe emechara usoro ọgwụgwọ ahụ, a ka nwere oke mkpochapụ. Achọpụtara ọmụmụ nke ndị ọrịa 85 nwere ndị ọrịa Hp n'ime otu anọ nke Lactobacillus 20 mg bid, clarithromycin 500 mg, na tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus jikọtara ya na bifidobacteria, placebo maka izu 1, jupụta ajụjụ gbasara nchọpụta mgbaàmà kwa izu maka izu 4, 5 ruo 7 izu mgbe e mesịrị iji chọpụta ọrịa ahụ, nchọpụta ahụ chọpụtara: otu probiotics na nkasi obi Enweghị ihe dị ịrịba ama. ọdịiche dị na ọnụ ọgụgụ mkpochapụ dị n'etiti otu ndị ahụ, mana ndị otu probiotic niile na-aba uru n'igbochi mmeghachi omume ọjọọ karịa otu njikwa, ọ dịghịkwa ọdịiche dị ịrịba ama na mmeghachi omume ọjọọ n'etiti otu probiotic. Usoro nke probiotics na-ekpochapụ Hp ka amabeghị, ma nwee ike igbochi ma ọ bụ mebie ya site na saịtị adhesion asọmpi yana ihe dị iche iche dị ka organic acid na bacteriopeptides. Otú ọ dị, ụfọdụ nnyocha achọpụtala na nchikota nke probiotics adịghị eme ka ọnụ ọgụgụ mkpochapụ dị mma, nke nwere ike jikọta na mmetụta ọzọ nke probiotics nanị mgbe ọgwụ nje na-adịchaghị irè. A ka nwere nnukwu ohere nyocha na probiotics nkwonkwo, yana nyocha ọzọ dị mkpa maka ụdị, usoro ọgwụgwọ, ihe ngosi na oge nkwadebe probiotic.

Ihe ndị na-emetụta ọnụego mkpochapụ Hp

Ọtụtụ ihe na-emetụta mkpochapụ Hp gụnyere nguzogide ọgwụ nje, mpaghara mpaghara, afọ onye ọrịa, ọnọdụ ise siga, nnabata, oge ọgwụgwọ, njupụta nje, gastritis na-adịghị ala ala, mkpokọta acid gastric, nzaghachi onye ọ bụla na PPI, na CYP2C19 gene polymorphism. Ọnụnọ ya. Nnyocha e mere na-akọ na na nyocha nke univariate, afọ, ebe obibi, ọgwụ, ọrịa eriri afọ, comorbidity, mkpochapụ akụkọ ihe mere eme, PPI, usoro ọgwụgwọ, na nrubeisi ọgwụgwọ jikọtara ya na ọnụ ọgụgụ mkpochapụ. Na mgbakwunye, ụfọdụ ọrịa na-adịghị ala ala nwere ike ime, dị ka ọrịa shuga, ọbara mgbali elu, ọrịa akụrụ na-adịghị ala ala, ọrịa imeju na-adịghị ala ala, na ọrịa ngụgụ na-adịghị ala ala nwekwara ike jikọta ọnụ na mkpochapụ Hp. Otú ọ dị, nsonaazụ nke ọmụmụ ihe ugbu a abụghị otu, a chọkwara ọmụmụ ihe ndị ọzọ buru ibu.