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 kurwanya cyane Clarithromycine (igipimo cyo kurwanya hejuru ya 15% kugeza kuri 20%), igasimbuza imiti isanzwe inshuro eshatu hamwe n’ubuvuzi bwa kane cyangwa uburyo bukurikiranye hamwe n’ibisohoka kandi / cyangwa nta spumum, mu gihe ubuvuzi bwa karat Quadruple nabwo bushobora gukoreshwa nkubwa mbere -umurongo wo kuvura mubice bifite imbaraga nke zo kurwanya mycin. 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 byubushake bwo 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 no kuvura levofloxacin triple, igipimo cyo kurandura imiti ya barium quadruple cyari 67% na 65%, ku bari bafite allergie kuri penisiline cyangwa bakiriye binini Mu barwayi bafite antibiyotike ya cyclic lactone, imiti ya quadruple ivura nayo irahitamo. Birumvikana ko ikoreshwa rya tincure quadruple therapy rifite amahirwe menshi yo kuba ibintu bibi, nko kugira isesemi, impiswi, kubabara munda, melena, umutwe, umutwe, uburyohe bwa metallic, nibindi, ariko kubera ko ibyuka bikoreshwa cyane mubushinwa, ni ugereranije byoroshye kubona, kandi ifite Igipimo kinini cyo kurandura gishobora gukoreshwa nkumuti wo gukosora. Birakwiye kuzamurwa mumavuriro.

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 ryibigereranyo 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 nuko 5d ya mbere (cyangwa 7d) ikoresha amoxicilline kugirango isenye umuyoboro wa Clarithromycin efflux kurukuta rw'akagari, bigatuma ingaruka za Clarithromycine zikora 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, ipiganwa, nyuma yibyumweru 2 bivurwa, igipimo cyo kurandura Hp mumatsinda menshi ya dose cyari 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 nubuvuzi butatu bwonyine bwongereye igipimo cyo kurandura Hp (ibigeragezo 4 byateganijwe, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), nabyo bigabanya 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. . itandukaniro mugipimo cyo kurandura hagati yitsinda, ariko amatsinda yose ya probiotic yari afite inyungu mukurinda ingaruka mbi kuruta itsinda rishinzwe kugenzura, kandi nta tandukaniro rikomeye ryagaragaye mu guhura n’ibibazo bibi mu matsinda ya probiotic. 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.