Helicobacter pylori (Hp), imodzi mwa matenda opatsirana omwe amapezeka kwambiri mwa anthu. Ndichiwopsezo cha matenda ambiri, monga chilonda cham'mimba, gastritis yosatha, gastric adenocarcinoma, ngakhale mucosa-associated lymphoid tissue (MALT) lymphoma. Kafukufuku wasonyeza kuti kuthetsedwa kwa Hp kungachepetse chiopsezo cha khansa ya m'mimba, kuonjezera machiritso a zilonda zam'mimba, ndipo pakalipano ayenera kuphatikizidwa ndi mankhwala akhoza kuthetseratu Hp. Pali njira zingapo zothetsera matenda zomwe zilipo: chithandizo choyambirira cha matenda chimaphatikizapo chithandizo chokhazikika katatu, expectorant quadruple therapy, sequential therapy, ndi concomitant therapy. Mu 2007, American College of Gastroenterology inaphatikiza chithandizo cha katatu ndi clarithromycin ngati njira yoyamba yothetsera anthu omwe sanalandire clarithromycin komanso omwe analibe ziwengo za penicillin. Komabe, m'zaka zaposachedwa, chiwopsezo chothetsera chithandizo chamankhwala katatu chakhala ≤80% m'maiko ambiri. Ku Canada, kukana kwa clarithromycin kwakwera kuchoka pa 1% mu 1990 kufika pa 11% mu 2003. Pakati pa anthu omwe amathandizidwa, chiwerengero cha kukana mankhwala chinanenedwa kuti chinaposa 60%. Kukana kwa Clarithromycin kungakhale chifukwa chachikulu cha kulephera kuthetsa. Malipoti ogwirizana a Maastricht IV m'madera omwe akukana kwambiri clarithromycin (kukana kupitirira 15% mpaka 20%), m'malo mwa mankhwala ochiritsira katatu ndi katatu kapena katatu ndi expectorant ndi/kapena opanda sputum, pamene carat Quadruple therapy ingagwiritsidwenso ntchito ngati yoyamba. - Chithandizo cha mzere m'malo otsika kukana mycin. Kuphatikiza pa njira zomwe zili pamwambazi, mlingo waukulu wa PPI kuphatikiza amoxicillin kapena maantibayotiki ena monga rifampicin, furazolidone, levofloxacin aperekedwanso ngati njira ina yochiritsira yoyamba.

Kupititsa patsogolo chithandizo chamankhwala katatu

1.1 Chithandizo chapawiri

Pamene chiwopsezo cha mankhwala ochiritsira katatu chikutsika, monga chithandizo, chithandizo cha katatu chimakhala ndi chiwopsezo chachikulu. Sheikh ndi al. adachiritsa odwala 175 omwe ali ndi matenda a Hp, pogwiritsa ntchito kusanthula kwa protocol (PP) ndi cholinga. Zotsatira za kusanthula kwa cholinga chochiza (ITT) zidayesa kuchuluka kwa kuthetseratu kwa chithandizo chapatatu: PP = 66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72); Chithandizo cha katatu chimakhala ndi chiwopsezo chachikulu: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI : 77 ~ 90). Ngakhale kuti kupambana kwa Hp kuthetseratu kunachepetsedwa pambuyo polephera chithandizo chilichonse, chithandizo chamankhwala katatu cha tincture chinali ndi chiwopsezo chachikulu (95%) ngati njira yothetsera kulephera kwa mankhwala katatu. Kafukufuku wina adafikanso pa mfundo yofananayo: pambuyo pakulephera kwa chithandizo chapatatu ndi levofloxacin katatu, kuchotsedwa kwa mankhwala a barium quadruple kunali 67% ndi 65%, motero, kwa iwo omwe anali matupi awo sagwirizana ndi penicillin kapena omwe adalandira chachikulu. cyclic lactone mankhwala, expectorant quadruple therapy amakondedwa. Kumene, ntchito tincture quadruple mankhwala ali ndi mwayi wapamwamba wa zochitika chokhwima, monga nseru, kutsegula m'mimba, kupweteka kwa m'mimba, melena, chizungulire, mutu, kulawa zitsulo, etc., koma chifukwa expectorant chimagwiritsidwa ntchito mu China, ndi. zosavuta kupeza, ndipo ali Mlingo wapamwamba kuthetsa angagwiritsidwe ntchito ngati mankhwala ochiritsira. Ndikoyenera kukwezedwa ku chipatala.

1.2 SQT

SQT idathandizidwa ndi PPI + amoxicillin kwa masiku 5, kenako PPI + clarithromycin + metronidazole kwa masiku asanu. SQT pakali pano ikulimbikitsidwa ngati njira yoyamba yochotsera Hp. Meta-analysis of six randomized controlled trials (RCTs) ku Korea yochokera ku SQT ndi 79.4% (ITT) ndi 86.4% (PP), ndi HQ kuthetsa SQT Mlingo ndi wapamwamba kuposa mankhwala katatu, 95% CI: 1.403 ~ 2.209), makinawo angakhale akuti 5d yoyamba (kapena 7d) imagwiritsa ntchito amoxicillin kuwononga njira ya clarithromycin efflux pakhoma la cell, zomwe zimapangitsa kuti clarithromycin ikhale yogwira mtima. SQT nthawi zambiri imagwiritsidwa ntchito ngati njira yothetsera kulephera kwa chithandizo chamankhwala katatu kunja. Komabe, kafukufuku wasonyeza kuti chiwopsezo chothetsera chithandizo cha katatu (82.8%) pa nthawi yotalikirapo (14d) ndichokwera kuposa chamankhwala otsatizana (76.5%). Kafukufuku wina adapezanso kuti panalibe kusiyana kwakukulu mu chiwerengero cha Hp kuthetsa pakati pa SQT ndi mankhwala ochiritsira katatu, omwe angakhale okhudzana ndi mlingo wapamwamba wa clarithromycin resistance. SQT ili ndi chithandizo chotalikirapo, chomwe chingachepetse kutsata kwa odwala ndipo sichiyenera kumadera omwe ali ndi kukana kwa clarithromycin, kotero SQT ikhoza kuganiziridwa ngati zotsutsana ndi kugwiritsa ntchito tincture.

1.3 Chithandizo chothandizira

Chithandizo chotsatira ndi PPI chophatikizidwa ndi amoxicillin, metronidazole ndi clarithromycin. Kusanthula kwa meta kunawonetsa kuti chiwopsezo chothetsa chinali chokwera kuposa chithandizo chokhazikika katatu. Kusanthula kwina kwa meta kudapezanso kuti chiwopsezo chothetsa (90%) chinali chokwera kwambiri kuposa chamankhwala ochiritsira katatu (78%). Maastricht IV Consensus akusonyeza kuti SQT kapena mankhwala opatsirana angagwiritsidwe ntchito ngati palibe expectorants, ndipo chiwerengero cha kuthetsa mankhwala awiriwa ndi ofanana. Komabe, m'madera omwe clarithromycin imagonjetsedwa ndi metronidazole, imakhala yopindulitsa kwambiri ndi mankhwala osakanikirana. Komabe, chifukwa mankhwala otsatizanawo ali ndi mitundu itatu ya maantibayotiki, kusankha kwa maantibayotiki kumachepetsedwa pambuyo pakulephera kwamankhwala, motero sikuvomerezeka ngati njira yoyamba yamankhwala kupatula madera omwe clarithromycin ndi metronidazole samva. Nthawi zambiri amagwiritsidwa ntchito m'madera omwe ali ndi vuto lochepa la clarithromycin ndi metronidazole.

1.4 mankhwala a mlingo waukulu

Kafukufuku wapeza kuti kuchulukitsa kwa mlingo ndi/kapena pafupipafupi makonzedwe a PPI ndi amoxicillin ndikoposa 90%. Mphamvu ya bactericidal ya amoxicillin pa Hp imatengedwa kuti imadalira nthawi, chifukwa chake, ndiyothandiza kwambiri kuonjezera kuchuluka kwa makonzedwe. Kachiwiri, pH m'mimba ikasungidwa pakati pa 3 ndi 6, kubwereza kumatha kuletsedwa bwino. pH m'mimba ikapitilira 6, Hp sidzabwerezanso ndipo imakhudzidwa ndi amoxicillin. Ren et al adayesa mayeso osasinthika mwa odwala 117 omwe ali ndi odwala omwe ali ndi Hp. Gulu la mlingo waukulu linapatsidwa amoxicillin 1g, tid ndi rabeprazole 20mg, bid, ndipo gulu lolamulira linapatsidwa amoxicillin 1g, tid ndi rabeprazole. 10mg, bid, pambuyo pa masabata a 2 a chithandizo, mlingo wa Hp kuthetsa kwa gulu la mlingo waukulu unali 89.8% (ITT), 93.0% (PP), wapamwamba kwambiri kuposa gulu lolamulira: 75.9% (ITT), 80.0% (PP), P <0.05. Kafukufuku wochokera ku United States anasonyeza kuti kugwiritsa ntchito esomeprazole 40 mg, ld + amoxicillin 750 mg, masiku atatu, ITT = 72.2% pambuyo pa masiku 14 a mankhwala, PP = 74.2%. Franceschi et al. retrospectively kusanthula mankhwala atatu: 1 muyezo katatu mankhwala: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 mankhwala a mlingo waukulu: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, njira ya chithandizo ndi 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, bid chithandizo cha 5d, lansoprazole 30mg bid, carat The 500mg bid ndi tinidazole 500mg bid adathandizidwa kwa masiku asanu. Miyezo ya kuthetsedwa kwa mitundu itatu yamankhwala inali: 55%, 75%, ndi 73%. Kusiyanitsa pakati pa mankhwala a mlingo waukulu ndi mankhwala ochiritsira katatu kunali kofunikira kwambiri, ndipo kusiyana kwake kunafanizidwa ndi SQT. Zosafunikira pakuwerengera. Zachidziwikire, kafukufuku wawonetsa kuti kumwa kwambiri kwa omeprazole ndi amoxicillin sikunathandizire kuthetseratu, mwina chifukwa cha CYP2C19 genotype. Ma PPI ambiri amapangidwa ndi CYP2C19 enzyme, kotero mphamvu ya CYP2C19 gene metabolite ingakhudze kagayidwe ka PPI. Esomeprazole makamaka zimapukusidwa ndi cytochrome P450 3 A4 puloteni, amene akhoza kuchepetsa mphamvu ya CYP2C19 jini kumlingo. Kuphatikiza apo, kuwonjezera pa PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, akulimbikitsidwanso ngati njira yochizira kwambiri.

Kukonzekera kwa tizilombo toyambitsa matenda

Kuonjezera ma microbial ecological agents (MEA) ku chithandizo chanthawi zonse kumatha kuchepetsa zotsatirapo, komabe pali mkangano ngati chiwopsezo cha Hp chiwonjezeke. Meta-analysis inapeza kuti chithandizo cha katatu cha B. sphaeroides chophatikizidwa ndi chithandizo cha katatu chokha chinawonjezera kuchuluka kwa Hp kuthetsa (mayesero a 4 osadziwika, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), amachepetsanso zotsatira zoyipa kuphatikizapo kutsekula m'mimba. Zhao Baomin et al. adawonetsanso kuti kuphatikiza kwa ma probiotics kumatha kusintha kwambiri chiwopsezo, ngakhale atafupikitsa njira yamankhwala, pakadali chiwopsezo chachikulu chothetsa. Kafukufuku wa odwala 85 omwe ali ndi Hp-positive odwala adasinthidwa mwachisawawa m'magulu anayi a Lactobacillus 20 mg bid, clarithromycin 500 mg bid, ndi tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus pamodzi ndi bifidobacteria, placebo kwa sabata la 1, lembani mafunso pa kafukufuku wa zizindikiro sabata iliyonse kwa masabata a 4, masabata 5 mpaka 7 kuti ayang'ane matendawa, phunzirolo linapeza: gulu la probiotics ndi chitonthozo Panalibe chofunika kwambiri. kusiyana kwa chiwerengero cha kuthetsa pakati pa magulu, koma magulu onse a probiotic anali opindulitsa kwambiri popewa zotsatira zoipa kusiyana ndi gulu lolamulira, ndipo panalibe kusiyana kwakukulu kwa zochitika zotsutsana ndi magulu a probiotic. Njira yomwe ma probiotics amachotsera Hp sichidziwikabe, ndipo imatha kuletsa kapena kuletsa ndi malo omamatira ampikisano ndi zinthu zosiyanasiyana monga ma organic acid ndi ma bacteriopeptides. Komabe, kafukufuku wina wapeza kuti kuphatikiza kwa ma probiotics sikuwongolera kuchuluka kwa kuthetseratu, zomwe zitha kukhala zokhudzana ndi kuwonjezereka kwa ma probiotics pokhapokha ngati maantibayotiki alibe mphamvu. Pakadali malo ofufuzira kwambiri ophatikiza ma probiotics, ndipo kafukufuku wowonjezera akufunika pamitundu, maphunziro amankhwala, zisonyezo ndi nthawi yokonzekera ma probiotic.

Zinthu zomwe zimakhudza kuchuluka kwa kutha kwa Hp

Zinthu zingapo zomwe zimakhudza kuwonongedwa kwa Hp zimaphatikizapo kukana kwa maantibayotiki, dera, zaka za odwala, kusuta fodya, kutsata, nthawi yamankhwala, kachulukidwe ka bakiteriya, matenda a atrophic gastritis, ndende ya asidi m'mimba, kuyankha kwa munthu ku PPI, ndi CYP2C19 gene polymorphism. Kukhalapo. Kafukufuku wasonyeza kuti kusanthula kosasintha, zaka, malo okhala, mankhwala, matenda a m'mimba, comorbidity, mbiri ya kutha, PPI, njira ya chithandizo, ndi kutsata mankhwala zimagwirizanitsidwa ndi ziwerengero zothetsa. Kuphatikiza apo, matenda ena osatha, monga matenda a shuga, kuthamanga kwa magazi, matenda a impso, matenda a chiwindi, komanso matenda am'mapapo amathanso kukhala okhudzana ndi kutha kwa Hp. Komabe, zotsatira za kafukufuku wamakono sizili zofanana, ndipo maphunziro ena akuluakulu amafunikira.