Helicobacter pylori (Hp), imwe mu ndwara zandura cyane mu bantu. Nibintu bishobora gutera indwara nyinshi, nk'ibisebe byo mu gifu, gastrite idakira, gastric adenocarcinoma, ndetse na lymphoma tissue (MALT) lymphoma. Ubushakashatsi bwerekanye ko kurandura Hp bishobora kugabanya ibyago byo kurwara kanseri yo mu gifu, bikongera umuvuduko wo gukira ibisebe, kandi kuri ubu bigomba guhuzwa n’imiti bishobora kurandura burundu Hp. Hariho uburyo butandukanye bwo kurandura amavuriro burahari: kuvura umurongo wa mbere wanduye harimo kuvura inshuro eshatu, kuvura inshuro enye, kuvura kwa kane, kuvura bikurikiranye, hamwe no kuvura hamwe. Mu 2007, Ishuri Rikuru ry’Abanyamerika rya Gastroenterology ryahujije ubuvuzi butatu na clarithromycine nk'umurongo wa mbere wo kurandura abantu batabonye Clarithromycine kandi badafite allergie ya penisiline. Nyamara, mu myaka ya vuba aha, igipimo cyo kurandura imiti itatu y’ubuvuzi cyabaye ≤ 80% mu bihugu byinshi. Muri Kanada, igipimo cyo kurwanya clarithromycine cyavuye kuri 1% mu 1990 kigera kuri 11% muri 2003. Mu bantu bavuwe, bivugwa ko umubare w’ibiyobyabwenge warenze 60%. Kurwanya Clarithromycin bishobora kuba intandaro yo kurandura burundu. Raporo y’ubwumvikane bwa Maastricht IV mu turere dufite imbaraga nyinshi zo kurwanya clithithromycine (igipimo cyo kurwanya hejuru ya 15% kugeza kuri 20%), igasimbuza imiti itatu y’ubuvuzi hamwe na quadruple cyangwa ivura ikurikiranye hamwe na exporant na / cyangwa nta spumum, mu gihe ubuvuzi bwa karat Quadruple nabwo bushobora gukoreshwa nkumuti wambere wambere mubice bifite kurwanya bike bya mycine. Usibye uburyo bwavuzwe haruguru, dosiye nyinshi za PPI wongeyeho amoxicilline cyangwa antibiyotike zindi nka rifampicin, furazolidone, levofloxacin nazo zatanzwe nk'ubundi buryo bwo kuvura umurongo wa mbere.

Gutezimbere ubuvuzi busanzwe butatu

1.1 Ubuvuzi bune

Mugihe igipimo cyo kurandura ubuvuzi busanzwe butatu bugabanuka, nkumuti, ubuvuzi bwa kane bufite igipimo kinini cyo kurandura. Shaikh n'abandi. yavuye abarwayi 175 banduye Hp, bakoresheje isesengura rya protocole (PP). Ibisubizo by'umugambi wo kuvura (ITT) byasesenguye igipimo cyo kurandura ubuvuzi busanzwe butatu: PP = 66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72); ubuvuzi bwa kane bufite igipimo cyo kurandura hejuru: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Nubwo intsinzi yo kurandura Hp yagabanutse nyuma yubuvuzi bwananiranye, kuvura inshuro enye za tincure byagaragaye ko bifite umuvuduko mwinshi (95%) nkumuti nyuma yo kunanirwa kwivuza inshuro eshatu. Ubundi bushakashatsi nabwo bwageze ku mwanzuro nk'uwo: nyuma yo kunanirwa kuvura inshuro eshatu hamwe no kuvura levofloxacin triple, igipimo cyo kurandura imiti ya barium quadruple cyari 67% na 65%, ku bantu bari bafite allergique kuri penisiline cyangwa bakiriye binini Mu barwayi bafite antibiyotike ya lactone ya cyclicale, hakoreshwa kandi imiti ya kane. Birumvikana ko gukoresha tincure quadruple therapy bifite amahirwe menshi yo kuba ibintu bibi, nko kugira isesemi, impiswi, ububabare bwo munda, melena, umutwe, umutwe, uburyohe bwa metallic, nibindi, ariko kubera ko ibyuka bikoreshwa cyane mubushinwa, biroroshye kubibona, kandi bifite igipimo kinini cyo kurandura gishobora gukoreshwa nkumuti wo gukemura. Birakwiye kuzamurwa mu ivuriro.

1.2 SQT

SQT yavuwe na PPI + amoxicillin iminsi 5, hanyuma ivurwa na PPI + clarithromycin + metronidazole iminsi 5. Kuri ubu SQT irasabwa nkumurongo wambere wo kurandura burundu Hp. Meta-isesengura ryibigeragezo bitandatu byateganijwe (RCTs) muri Koreya ishingiye kuri SQT ni 79.4% (ITT) na 86.4% (PP), naho HQ kurandura SQT Igipimo kiri hejuru yubuvuzi busanzwe butatu, 95% CI: 1.403 ~ 2.209), uburyo bushobora kuba aribwo buryo bwa 5d (cyangwa 7d) bwifashisha umuyoboro wa amoxicilline. Clarithromycin ikora neza. SQT ikoreshwa kenshi nkumuti wo kunanirwa kuvura inshuro eshatu mumahanga. Nyamara, ubushakashatsi bwerekanye ko igipimo cyo kuvura inshuro eshatu (82.8%) mugihe kinini (14d) kiri hejuru yicy'ubuvuzi bwa kera (76.5%). Ubushakashatsi bumwe bwagaragaje kandi ko nta tandukaniro rikomeye ryagaragaye mu bipimo byo kurandura Hp hagati ya SQT n’ubuvuzi busanzwe butatu, bushobora kuba bufitanye isano n’igipimo kinini cyo kurwanya clarithromycine. SQT ifite inzira ndende yo kuvura, ishobora kugabanya kubahiriza abarwayi kandi ntibikwiriye ahantu hashobora guhangana na clarithromycine, bityo SQT irashobora gutekerezwa mugihe ibuza gukoresha tincure.

1.3 Kuvura abasangirangendo

Ubuvuzi buherekejwe ni PPI ihujwe na amoxicillin, metronidazole na clarithromycin. Meta-isesengura ryerekanye ko igipimo cyo kurandura cyari hejuru yubuvuzi busanzwe butatu. Ubundi meta-isesengura ryerekanye kandi ko igipimo cyo kurandura (90%) cyari hejuru cyane ugereranije n’ubuvuzi busanzwe butatu (78%). Ubwumvikane bwa Maastricht IV bwerekana ko ubuvuzi bwa SQT cyangwa bufatika bushobora gukoreshwa mugihe hatabonetse ababisohora, kandi ibipimo byo kurandura imiti yombi birasa. Ariko, mubice aho Clarithromycine irwanya metronidazole, nibyiza cyane hamwe no kuvura hamwe. Ariko, kubera ko ubuvuzi buherekeza bugizwe nubwoko butatu bwa antibiotike, guhitamo antibiyotike bizagabanuka nyuma yo kunanirwa kuvurwa, ntabwo rero bisabwa nka gahunda yambere yo kuvura usibye uduce twa Clarithromycine na metronidazole birwanya. Ahanini ikoreshwa mubice bifite imbaraga nke za Clarithromycine na metronidazole.

1.4

Ubushakashatsi bwerekanye ko kongera igipimo na / cyangwa inshuro zo kuyobora PPI na amoxicillin birenze 90%. Ingaruka ya bagiteri yica amoxicilline kuri Hp ifatwa nkigihe giterwa nigihe, bityo rero, nibyiza cyane kongera inshuro zubuyobozi. Icya kabiri, iyo pH mu gifu ikomeje hagati ya 3 na 6, kwigana birashobora guhagarikwa neza. Iyo pH mu gifu irenze 6, Hp ntizongera kwigana kandi yunvikana na amoxicilline. Ren et al yakoze ibizamini byateganijwe kubarwayi 117 bafite abarwayi ba Hp-positif. Itsinda ryinshi-ryahawe amoxicillin 1g, tid na rabeprazole 20mg, isoko, naho itsinda rishinzwe kugenzura ryahawe amoxicillin 1g, tid na rabeprazole. 10mg, gupiganira, nyuma yibyumweru 2 bivurwa, igipimo cyo kurandura Hp cyitsinda ryinshi ryabaye 89.8% (ITT), 93.0% (PP), hejuru cyane ugereranije nitsinda rishinzwe kugenzura: 75.9% (ITT), 80.0% (PP), P <0.05. Ubushakashatsi bwakorewe muri Amerika bwerekanye ko ukoresheje esomeprazole 40 mg, ld + amoxicillin 750 mg, iminsi 3, ITT = 72.2% nyuma yiminsi 14 yo kwivuza, PP = 74.2%. Franceschi n'abandi. wasubije inyuma gusesengura uburyo butatu: 1 yubuvuzi butatu: lansoola 30mg, isoko, clarithromycin 500mg, isoko, amoxicillin 1000mg, isoko, 7d; Ubuvuzi 2 buhanitse: Lansuo Carbazole 30mg, isoko, clarithromycin 500mg, isoko, amoxicillin 1000mg, tid, inzira yo kuvura ni 7d; 3SQT: lansoprazole 30mg, isoko + amoxicillin 1000mg, kuvura isoko kuri 5d, lansoprazole 30mg isoko, karat 500mg isoko na tinidazole 500mg yatanzwe muminsi 5. Igipimo cyo kurandura uburyo butatu bwo kuvura cyari: 55%, 75%, na 73%. Itandukaniro riri hagati yubuvuzi bukabije hamwe nubuvuzi butatu bwo kuvura bwari bufite imibare, kandi itandukaniro ryagereranijwe na SQT. Ntabwo ari imibare ikomeye. Birumvikana ko ubushakashatsi bwerekanye ko imiti myinshi ya omeprazole na amoxicillin ivura itigeze iteza imbere igipimo cyo kurandura burundu, wenda bitewe na genotype ya CYP2C19. PPI nyinshi zahinduwe na enzyme ya CYP2C19, bityo imbaraga za CYP2C19 gene metabolite zishobora kugira ingaruka kuri metabolism ya PPI. Esomeprazole ikoreshwa cyane na cytochrome P450 3 A4 enzyme, ishobora kugabanya ingaruka za gen CYP2C19 kurwego runaka. Mubyongeyeho, usibye PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, birasabwa kandi nk'uburyo bwo kuvura cyane.

Gutegura mikorobe

Kongera mikorobe yibidukikije (MEA) mubuvuzi busanzwe birashobora kugabanya ingaruka mbi, ariko biracyavugwaho rumwe niba igipimo cyo kurandura Hp gishobora kwiyongera. Isesengura ryakozwe ryerekanye ko ubuvuzi butatu bwa B. sphaeroide bufatanije n’ubuvuzi butatu bwonyine bwongereye igipimo cyo kurandura Hp (ibigeragezo 4 byateganijwe, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), bigabanya kandi ingaruka mbi zirimo impiswi. Zhao Baomin n'abandi. yerekanye kandi ko guhuza porotiyotike bishobora kuzamura cyane igipimo cyo kurandura, nubwo nyuma yo kugabanya inzira yo kuvura, haracyari igipimo kinini cyo kurandura. Ubushakashatsi bwakozwe ku barwayi 85 bafite abarwayi ba Hp-positifike bwatoranijwe mu matsinda 4 ya Lactobacillus 20 mg, isoko rya Clarithromycine 500 mg, na tinidazole 500 mg. . amatsinda. Uburyo bukoreshwa na porotiyotike yo kurandura Hp buracyasobanutse, kandi burashobora kubuza cyangwa kudakora hamwe n’ahantu hafatirwa amarushanwa hamwe nibintu bitandukanye nka acide organic na bacteriopeptides. Nyamara, ubushakashatsi bumwe bwerekanye ko guhuza porotiyotike bidahindura igipimo cyo kurandura burundu, ibyo bikaba bishobora kuba bifitanye isano ningaruka zidasanzwe za porotiyotike gusa mugihe antibiyotike zidafite akamaro. Haracyariho umwanya munini wubushakashatsi muri probiotics ihuriweho, kandi ubushakashatsi buracyakenewe kubwoko, amasomo yo kuvura, ibimenyetso hamwe nigihe cyo kwitegura probiotic.

Ibintu bigira ingaruka ku gipimo cyo kurandura Hp

Mu bintu byinshi bigira ingaruka ku kurandura Hp harimo kurwanya antibiyotike, akarere ka geografiya, imyaka y’abarwayi, uko itabi rihagaze, kubahiriza, igihe cyo kuvura, ubwinshi bwa bagiteri, gastrite idakira ya gastrite, kwibanda kuri aside gastricike, igisubizo cya buri muntu kuri PPI, na CYP2C19 gene polymorphism. Kubaho. Ubushakashatsi bwerekanye ko mu isesengura rimwe, imyaka, aho batuye, imiti, indwara zo mu gifu, kwandura, amateka yo kurandura, PPI, inzira yo kuvura, no kubahiriza imiti bifitanye isano n’igipimo cyo kurandura. Byongeye kandi, indwara zimwe zishobora kuba karande, nka diyabete, hypertension, indwara zimpyiko zidakira, indwara zumwijima zidakira, nindwara zidakira zidakira nazo zishobora kuba zifitanye isano no kurandura Hp. Nyamara, ibisubizo byubushakashatsi burimo ntabwo aribyo, kandi birakenewe ubundi bushakashatsi bunini.