HelicobaCter Pylori (HP), imwe mu ndwara zikunze kugaragara mu bantu. Ni ikintu cyangiza indwara nyinshi, nka ulcer gakomeye, gastritis idakira, kandi gastric Adencarcinoma, ndetse na Mucosa-ihuza lymphoide (malt) lymphoma. Ubushakashatsi bwerekanye ko kurandura HP bishobora kugabanya ibyago bya kanseri ya kanseri ya gastric, ongera igipimo cy'ibisebe by'ibisimbanyi, kandi muri iki gihe gikeneye guhuzwa n'ibiyobyabwenge birashobora kurandura burundu hp. Hano hari amahitamo atandukanye yo kurandura amakuru aboneka: Gufata umurongo wambere kwandura harimo kuvura inshuro eshatu, imivurane ya quadsople, kuvura imiti, no kuvura. Mu 2007, Ishuri Rikuru ry'Abanyamerika bo mu buvuzi bwa gastroente hamwe na clarmiromcin nk'umurongo wa mbere wo kurandura abantu batarakiriye Clarromamycin kandi nta allergisi. Ariko, mu myaka ya vuba aha, kurandura ubuvuzi bwinshuro eshatu zabaye ≤80% mu bihugu byinshi. Muri Kanada, igipimo cyo kurwanya Clarthromamcin cyiyongereye kuva 1% mu 1990 kugeza 11% mu 2003. Mu bantu bavuwe, umubare w'abantu bashinzwe ibiyobyabwenge wavuzwe ko urenze 60%. Kurwanya Clarthromcin birashobora kuba impamvu nyamukuru yo kurandura burundu. Raporo ya Maastricht IV mu bice hamwe no kurwanya cyane Clarthromcin (igipimo cyo kurwanya 15% kugeza kuri 20% hamwe no kuvura inshuro eshatu -Umuvugizi mu bice hamwe no kurwanya hasi. Usibye uburyo bwavuzwe haruguru, dosiye ndende ya PPI Yongeyeho Amoxicillin cyangwa ubundi antibicicique nka rifampicin, furazolidone, FOFOFLOXQUAN, byatanzwe nanone muburyo bundi bushya.

Gutezimbere Ubuvuzi Bwinshi

1.1 Kuvura Quadraple

Nk'ibipimo bya gatatu byo kuvura inshuro eshatu, nk'umuti, kuvura quadruple bifite igipimo cyo kurandura burundu. Shaikh et al. Yavuwe abarwayi 175 hamwe na HP yanduye, ukoresheje protocole (PP) isesengura nubushake. Ibisubizo byubushake bwo kuvura (ITT) byasuzumwe igipimo cyimikorere ya gatatu ya gatatu: PP = 49/74, 95% Ci: 55% (49/79, 95% Ci: 51-72); Umuti wa kane utanga igipimo cyo kurandura hejuru: PP = 91% (102/9), ITT = 84%: 95% Ci: 77 ~ 90). Nubwo igipimo cyo kurandura HP cyagabanutse nyuma yo kuvura buri cyananiranye, kuvura kane bya tincture byagaragaye ko bifite igipimo cyo kurandura burundu (95%) nkumuti nyuma yo kuvura gatatu eshatu. Ubundi bushakashatsi bwageze ku mwanzuro nk'uwo: Nyuma yo kuvura inshuro eshatu no kunanirwa kuvura inshuro eshatu, kurandura ubuvuzi bw'ibicurane byari 67% na 65%, ku barwayi ba peniciline cyangwa bari bakiriwe mu barwayi cyclic amatara antibiotique, kuvura ubwato bwa quadruple nabyo birakundwa. Birumvikana ko ikoreshwa rya TINCCURE CLAUPPLE rifite amahirwe menshi yibintu bibi, nka Nasesea, umubabaro winda, usukuye, ariko kuberako imitekerereze yakoreshejwe cyane mubushinwa, ni Biroroshye kubona kubona, kandi bifite igipimo cyo kuranduka hejuru kirashobora gukoreshwa nkigikorwa cyo gukosora. Birakwiye ko duteza imbere mu ivuriro.

1.2 sqt

Sqt yavuwe na PPI + Amoxicillillin iminsi 5, hanyuma ifatwa na PPI + ClarmithYCIN + metronidazole iminsi 5. SQT irasabwe nkaba dorasion yumurongo wambere kuri HP. Meta-Isesengura ryimanza esheshatu zigenzurwa (RCT) muri Koreya zishingiye kuri SQT ni 79.4% (PP), na HP), 96% (95% Ci: 15% Ci: 1.403 - 2. SQT ikunze gukoreshwa nkumuti wo kunanirwa kwivuza muri bitatu mu mahanga. Ariko, ubushakashatsi bwerekanye ko igipimo cyo kurandura inshuro eshatu (82.8%) hejuru yigihe kinini (14d) kirenze iyo mvugo ya kera (76.5%). Ubushakashatsi bumwe bwasanze kandi nta tandukaniro rikomeye muri SHAKA HP hagati ya SQT na Squale, bishobora kuba bifitanye isano n'igipimo kinini cya Corgatimromycin. Sqt ifite igihe kirekire cyo kuvura, ishobora kugabanya kubahiriza kandi ntabwo ikwiriye kubahiriza kandi idakwiriye kurwanywa cyane kuri Corrithromcin, bityo Sqt irashobora gusuzumwa mugihe bivuguruzanya.

1.3 Umuvugizi wa mugenzi wawe

Kuvura imiti ni PPI ihujwe na amoxicilline, metronidazole na Clarmimmin. Meta-Isesengura yerekanaga ko igipimo cyo kurandura cyari hejuru yubuvuzi busanzwe. Undi meta-Isesengura kandi yasanze igipimo cyo kurandura (90%) cyari kirenze urugero kuruta uko kuvura inshuro eshatu (78%). Maastricht IV ubwumvikane bwerekana ko SQT cyangwa imyuka ishobora gukoreshwa mugihe hatabayeho ibiteganijwe, kandi igipimo cyibipimo byibintu byombi birasa. Ariko, mu turere clarmimycin arwanya metronidazole, ni byiza cyane hamwe no kuvura. Ariko, kubera ko imyuka iherekeje igizwe nubwoko butatu bwa antibiyotike, guhitamo antibiyotike bizagabanuka nyuma yo kunanirwa kuvura, bityo ntibisabwa nka gahunda ya mbere yo kuvura usibye ibibanza byambere ClarmidaZos na MetronidaZole birwanya. Ahanini ikoreshwa mubice hamwe no kurwanya Clarthromcin na metronidazole.

1.4 Ubuvuzi bwo hejuru

Ubushakashatsi bwasanze kongera igipimo na / cyangwa inshuro yubuyobozi bwa PPI na Amoxicillin birenze 90%. Ingaruka za bagiteri za amoxicilline kuri hp zifatwa nkigihe-biterwa, bityo, nibyiza kongera inshuro zubutegetsi. Icya kabiri, iyo PH mu gifu abungabunzwe hagati ya 3 na 6, kwigana birashobora kubuzwa neza. Iyo PH mu gifu irenze 6, HP ntizongera kwigana kandi yumva Amoxicillin. Ren et al yakoreye ibigeragezo byagenzuwe mubarwayi 117 bafite abarwayi ba HP-beza. Itsinda rihe hejuru ryahawe Amoxicillin 1g, rid, muri Rabephrazole 20mg, isoko, kandi itsinda rishinzwe kugenzura Amoxicillin 1g, ridwazole. 10mg, isoko, nyuma yibyumweru 2 byo kuvura, igipimo cyo kurandura HP Itsinda ryikigo cyinshi cyari 89.8% (ITT), hejuru cyane, hejuru cyane, 80.0% (PP), P <0.05. Ubushakashatsi bwaturutse muri Amerika bwerekanye ko gukoresha esomeprazole 40 mg, ld + amoxicillin 750 mg, iminsi 3, ITT = 72.2% nyuma yiminsi 14 yo kuvura, 74.2%. Franceschi et al. gusubira inyuma isesengurwa inshuro eshatu: 1MGLELA 30MG, isoko, ClarmiromyCin 500mg, isoko, isoko, 7D; Ubuvuzi 2 bwo hejuru: Lansuo Carbazole 30mg, isoko, Clarmiromycin 500mg, isoko, Amoxicillin 1000mg, TID, inzira yo kwivuza ni 7d; 3Sqt: LansOprazole 30mg, isoko + Amoxicillin 1000mg, gufata isoko rya 5mg, muri 500mg isoko 500mg yavuwe iminsi 5. Kurandura ibiciro byubutegetsi butatu bwo kuvura byari: 55%, 75%, na 73%. Itandukaniro riri hagati yubuvuzi burebure hamwe nubuvuzi bwikubye gatatu ni imibare ifite akamaro, kandi itandukaniro ryagereranijwe na SQT. Ntabwo ari ngombwa. Birumvikana ko ubushakashatsi bwerekanye ko ubuvuzi bwo hejuru bwa Omeprazole na Amoxicillilline butanoza neza ibiciro, birashoboka ko bitewe na Cyp2C19 Genotype. PPI nyinshi ni metabolied na Cyp2C19 enzyme, niko imbaraga za Cyp2C19 Gen Metabolite irashobora kugira ingaruka kuri metabolism ya PPI. Esomeprazole ahanini yandura na Cytochrome P450 3 A4 ENZzme, ishobora kugabanya ingaruka za Cyp2C19 ku rugero runaka. Byongeye kandi, usibye PPI, Amoxicillin, rifampingine, furazolidone, Abalefloxacin, nabyo birasabwa nkubundi buryo bwo kuvura.

Kwitegura Microbial

Ongeraho ibidukikije bya mikorobe (Mea) kuri dorapy isanzwe irashobora kugabanya ibisubizo bibi, ariko biracyavuguruzanya niba igipimo cyo kurandura no kuramya HP gishobora kwiyongera. Meta-Isesengura yasanze ubuvuzi bwa gatatu bwa B. Sphaeroides yahujwe na triple yonyine yiyongereyeho urugero rwa HP (4 yagenzuwe na 915, 95% Ci: 1.21), nabyo Ibisubizo bibi birimo impiswi. Zhao Baomin et al. Yerekanye kandi ko guhuza proibiyoke zirashobora kunoza cyane umwanda, kabone niyo nyuma yo kugabanya inzira yo kwivuza, haracyari igipimo cyo kurandura burundu. Ubushakashatsi bwabarwayi 85 hamwe nabarwayi ba HP-ibyiza byatoranijwe mumatsinda 4 ya lactobacillus 20 mg , B. Itandukaniro mu kurandura urugero hagati y'amatsinda, ariko imitwe yose ya probiotic yari ifite inyungu mu gukumira ibintu bibi kuruta iyitsinda, kandi nta tandukaniro rikomeye ryagize mu itsinda ribi mu mitwe ya proiyotike. Uburyo bwa PANCISM bwararandukira HP ntigisobanutse, kandi bushobora kubuza cyangwa kudakora hamwe nimbuga zo guhatanira irushanwa hamwe nibintu bitandukanye nka aside kama na bagiteri. Ariko, ubushakashatsi bumwe na bumwe bwasanze guhuzabibi bya proigiyotike ntibifitanye isano ningaruka zinyongera za progiyotike gusa iyo antibiyotike idakora neza. Haracyari umwanya ukomeye wubushakashatsi mubisanzwe, kandi ubundi bushakashatsi burakenewe muburyo, amasomo yo kuvura, ibimenyetso no igihe cyimyiteguro ya proviyotike.

Ibintu bireba igipimo cyo kurandura HP

Ibintu byinshi bigira ingaruka kuri HP harimo kurwanya Antibiyotike, akarere ka geografiya, imyaka ihangana, ubukana bwa gistric, icyifuzo cya gistric, na Cyp2C19 Gene Polymorphism. Kuboneka. Inyigisho zavuze ko mu gusesengura kidasanzwe, imyaka, agace k'ahantu, imiti, uburwayi bwo guca burundu, imiterere yo kwivuza, no kubahiriza amarozi bifitanye isano no kurandura burundu. Byongeye kandi, indwara zimwe na zimwe zishobora kuba, nka diyabete, indwara zimpyisi, indwara zidakira, indwara zikira z'ibiharo, n'indwara y'ibihaha karande birashobora kandi bifitanye isano no kurandura HP. Ariko, ibisubizo byubushakashatsi ubu ntabwo ari bimwe, kandi nibindi byinshi bikenewe.