Helicobacter pylori (hp), imodzi yamatenda ofala kwambiri mwa anthu. Ndi chinthu chowopsa matenda ambiri, monga chilonda cha chapamimba, gastritis matenda, chapamimba adnocarcinoma, ndipo ngakhale mucosa-ophatikiza ma chtpoids ogwirizana (chivundikiro). Kafukufuku wasonyeza kuti kulephera kwa HP kungachepetse chiopsezo cha khansa yam'mimba, kuwonjezera machiritso a zilonda zam'mimba, ndipo pakufunika kuphatikizidwa ndi mankhwala osokoneza bongo atha kuthetsa HP. Pali mitundu yosiyanasiyana yamankhwala omwe alipo: chithandizo choyambirira cha matenda amaphatikizapo mankhwala okwanira patatu, omwe amayembekeza chithandizo, komanso chithandizo chamankhwala. Mu 2007, dziko la American College of Gastroennology kuphatikiza katatu mankhwala ndi Cruthromycin ngati njira yoyamba yothandizira anthu omwe sanalandire zolephera ndipo sanakhalepo ndi ziwengo. Komabe, m'zaka makumi angapo zapitazi, kuchuluka kwa mankhwalawa kwa chithandizo chamankhwala chachitatu chakhala ≤80% m'maiko ambiri. Ku Canada, kuchuluka kwa Clarithromycin kwachuluka kuchokera 1% mu 1990 mpaka 11% mu 2003. Pakati pa anthu omwe alandiridwa, mankhwalawa adanenedwanso kupitirira 60%. Customycin kukana kungakhale chifukwa chachikulu cha kulephera kwa Eradication. Maastricht IV Prentkus Report m'malo okhala ndi Claithromycin (kukana kuchuluka kwa 15%) Kuphatikiza pa njira zomwe zili pamwambazi, Mlingo waukulu wa PPI kuphatikiza Amoxillin kapena maantibayotiki ena monga rifampicin, furazolisone, levofloxacin afotokozedwanso ngati chithandizo choyambirira.

Kupititsa patsogolo chithandizo chamankhwala

1.1 quadruple

Monga momwe kuchuluka kwa chithandizo chamankhwala katatu kumagwa, monga mankhwala, quadrupley ali ndi vuto lalikulu. Shaikh et al. Kuchita odwala 175 ndi matenda a HP, kugwiritsa ntchito protocol (pp) kusanthula ndi cholinga. Zotsatira za cholinga chofuna kuwunika (zikuluzikulu) Mankhwala okwanira ali ndi vuto lalikulu: pp = 91% (102/112, 95% CI: 84-95), 84-91, 95%: (102-91, 95% CI: 77 ~ 90). Ngakhale kupambana kwakukulu kwa HP Eraication kunachepa pambuyo poti chithandizo chilichonse cha Tale, chomwe chidzachitika chithandizo cha tincture chomwe chimakhala ndi mtengo waukulu (95%) ngati mankhwala pambuyo pa kulephera kwa chithandizo chamankhwala. Kafukufuku wina adazindikiranso izi: Pambuyo pa kulephera kwa katswiri wazachipatala ndi levoflexacin ma chithandizo cha barpy anali 67%, kwa iwo omwe amadwala ma penicillin, kwa iwo omwe amayembekeza mankhwalawa amakondedwa. Zachidziwikire, kugwiritsa ntchito tincture quadyle mankhwala kuli ndi kuthekera kwakukulu kwa zochitika zoyipa, monga nseru, kupweteka m'mimba, kupweteka kwambiri, koma chifukwa chakumaso, kupweteka kwambiri kungagwiritsidwe ntchito ngati chithandizo chokwanira. Ndizofunikira kulimbikitsa kuchipatala.

1.2 sqt

Sqt anathandizidwa ndi PPI + Amoxicillin kwa masiku 5, kenako kuthandizidwa ndi PPI + Custithromycin + metronidazole kwa masiku 5. Sqt ikulimbikitsidwa ngati njira yoyamba yothandizira HP. Kusanthula kwa Meta-Senani Yachisanu kokhazikika (Rcts) ku Korea Kutengera Sqt ndi 79.4% (mas), ma pp), ndi 7d) Clarithromycin Eflux Channen pakhoma la cell, ndikupangitsa mphamvu ya colotromycin kwambiri. Sqt nthawi zambiri imagwiritsidwa ntchito ngati njira yothetsera vuto la ma proderlele akunja. Komabe, kafukufuku wasonyeza kuti njira yothandizira katatu (82.8%) kwa nthawi yayitali (14D) ndiyokwera kuposa momwe zinthu zinakhalira. Kafukufuku wina anapezanso kuti kunalibe kusintha kwakukulu kwa HP kosiyanasiyana pakati pa sqt ndi muyeso wa katatu, zomwe zitha kukhala zokhudzana ndi kuchuluka kwa Cruithycin kukana. Sqt ili ndi chithandizo chakutali, chomwe chimachepetsa kutsatira kwa oleza mtima ndipo sichoyenera madera omwe ali ndi chiwonetsero chachikulu ku Claromycin, kotero sqt titha kulingaliridwa mukamagwiritsa ntchito tincture.

1.3

Kutsagana ndi mankhwala ndi ppi ophatikizidwa ndi Amoxicillin, metronidazole ndi colorromycin. Kusanthula kwa Meta, kunawonetsa kuti kuchuluka kwa eradication kunali kwakukulu kuposa chithandizo chamankhwala chapamwamba. Kusanthula kwinanso komwe kumapezekanso kuti kuchuluka kwa eradication (90%) kunali kwakukulu kwambiri kuposa chithandizo chachitatu (78%). Maastricht IV IVPUS UMODZIWA KUTI SQT kapena Concomentrapy ikhoza kugwiritsidwa ntchito pakalibe, ndipo kuchuluka kwa zotheka kuchiritsidwa ndi chimodzimodzi. Komabe, m'malo omwe Croithyycin amalimbana ndi metronidazole, ndizothandiza kwambiri ndi mankhwala othandiza. Komabe, chifukwa mankhwala omwe ali ndi omwe ali ndi mitundu itatu ya maantibayotiki, kusankha kwa maantibayotiki kudzachepetsedwa ntchito yochotsa chithandizo, motero sikulimbikitsidwa ngati dongosolo loyamba kupatula ma coolithromycin ndi metronazole sagwirizana. Ambiri amagwiritsidwa ntchito kwambiri m'malo okhala ndi zotsika pang'ono ku Claithromycin ndi metronidazole.

1.4 Mlingo wokwera

Kafukufuku wapeza kuti akuwonjezera kuchuluka kwa mankhwalawo ndi / kapena pafupipafupi kwa ppi ndi Amoxicillin ndi wamkulu kuposa 90%. Bactericidal zotsatira za Aoxicillin pa HP imawonedwa kuti ndizodalirika nthawi, chifukwa chake, ndizothandiza kwambiri kuwonjezera pafupipafupi makonzedwe a makonzedwe. Kachiwiri, pamene pH m'mimba imasungidwa pakati pa 3 ndi 6, mawuwo amatha kukhala mwaluso. Pamene pH m'mimba imapitilira 6, HP siyidzasinthiranso ndipo imagwirizana ndi Amoxicillin. Ren et anachititsa mayesero oyendetsedwa mosapita m'mbali odwala 117 odwala HP-OND. Gulu la mlingo linaperekedwa kwambiri la Amoxicillin 1g, tid ndi agalugi, kuti, ndi gulu lowongolera linaperekedwa Aoxicillin 1g, tid ndi agalu. 10Mg, Gran, Pambuyo pa masabata awiri chithandizo, ma hp eradication a gulu la anthu 89.8% (it), 93.9% (mas), pp), 0.05. Kafukufuku wochokera ku United States adawonetsa kuti kugwiritsa ntchito Esomeprazole 40 mg, ld + Amoxtillin 750 mg, 72.2% pambuyo pa masiku 14 a mankhwala, pp =2%. Franceschi et al. Kubwezeretsanso mankhwala atatu: 1 2 Mankhwala ochulukirapo - mankhwala a lasuo carbazole 30mmg, chojambula, choperewera, amoxicillin 1000mg, nthawi ya mankhwala ndi 7d; 3St: La Sosoprazole 30mg, Amoxicillin 1000mg, lansaprazole 30mg bied, caratg ya 500mg ya 500mg adalandiridwa kwa masiku 5. Kuchuluka kwa zochotsa zovomerezeka zitatuzi kunali: 55%, 75%, ndi 73%. Kusiyana pakati pa mankhwala osokoneza bongo ndi chithandizo chamankhwala chapamwamba chinali chofunikira kwambiri, ndipo kusiyana kwake kudayerekezedwa ndi sqt. Osati kwambiri. Zachidziwikire, maphunziro awonetsa kuti mankhwala apamwamba kwambiri ndi amoxicillin amawonetsa kuti chithandizo chamankhwala sichinathe kukonzanso kuchuluka kwa chizolowezi, mwina chifukwa cha cyp2c19 genotype. Ambiri a PPIS amapangidwa ndi cyp2c19 enzyme, kotero mphamvu ya Cyp2C19 Cenebolite ingakhudze kagayidwe wa PPI. Esomerazole makamaka ndi cytochrome p450 3 A4 Enzyme, yomwe imachepetsa gep2c19 Gene mpaka pamlingo wina. Kuphatikiza apo, kuwonjezera pa PPI, Amoxicillin, Rifampicin, furazolisone, levofloxacin, amalimbikitsidwanso ngati njira yothandizira mankhwala osokoneza bongo.

Kuphatikiza pakukonzekera kwachipongwe

Kuonjezera zikhalidwe zachilengedwe zachilengedwe (Mea) kukhazikika kwa chithandizo kumachepetsa zovuta zina, koma ndikutsutsanabe ngati kuchuluka kwa HP Erad Vutoby ikhoza kuchuluka. Kusanthula pa Meta Yopezeka kuti chithandizo chachitatu cha B. SPHEEREESS CORPAPY DZIKO LAPANSI (4) Zhao Baomin et al. Anawonetsanso kuti kuphatikiza kwa maluso kumatha kusintha momwe mungathere, ngakhale atafupikitsa chithandizo, palipobe. Kafukufuku wa odwala 85 omwe ali ndi odwala omwe ali ndi HP adasankhidwa m'magulu anayi a lactobacillus 2000rromycin 500 mg bing, ndi tinminazole 500 mg. , B. Trevisiae, lactobacillus wophatikizidwa ndi bifidobacteria, lembani mafunso pa sabata iliyonse, koma pamasabata onsewa anali opindulitsa kwambiri poletsa zovuta zomwe zimachitika pakati pa magulu azolowera. Makina omwe ma valicor adachotsa HP ndikudziwikabe, ndipo amatha kuletsa kapena kuyikamo mawebusayiti opikisana ndi zinthu zosiyanasiyana monga organictides. Komabe, maphunziro ena awona kuti kuphatikiza kwa ma skiotic sikuwongolera kuchuluka kwa Eradication, komwe kungakhale kogwirizana ndi zotsatira zowonjezera za ma valoric pokhapokha ngati maantibayotiki sakhala opanda ntchito. Palibe malo ambiri ofufuza mu zolumikizana, ndipo kafukufuku wina amafunikira pamitundu, maphunziro othandizira, ziwonetsero ndi nthawi yokonzekera bwino.

Zinthu zomwe zikukhudza kuchuluka kwa HP

Pali zinthu zingapo zomwe zimakhudza HP, zotsutsana ndi antibakic, zaka zotsalira, zongosuta, nthawi ya cyp2c19 Genermorphism. Kukhalapo. Kafukufuku adanenanso kuti mwa kusanthula kosalekeza, zaka zokhalamo, mankhwala, mankhwala am'mimba, komoma, matenda, matendawa amagwirizanitsidwa ndi mitengo yothetsera mavuto. Kuphatikiza apo, ena omwe angakhale ndi matenda a shuga, matenda oopsa, matenda a impso, matenda a chiwindi osachiritsa, komanso matenda am'mapapo amathanso kukhala okhudzana ndi vuto la HP. Komabe, zotsatira za phunziroli sizofanana, ndipo maphunziro ena ambiri amafunikira.