Helicobacter pylori (Hp), chimwe chezvirwere zvinotapukira zvakanyanya muvanhu. Icho chinokonzera njodzi kune zvirwere zvakawanda, zvakadai segastric ulcer, chronic gastritis, gastric adenocarcinoma, uye kunyange mucosa-associated lymphoid tissue (MALT) lymphoma. Zvidzidzo zvakaratidza kuti kupedzwa kweHp kunogona kuderedza njodzi yegomarara remudumbu, kuwedzera kurapa kwemaronda, uye parizvino inoda kusanganiswa nemishonga inogona kubvisa zvakananga Hp. Pane nzira dzakasiyana dzekupedza kiriniki dzinowanikwa: kurapwa kwekutanga kwechirwere kunosanganisira kurapa katatu, expectorant quadruple therapy, sequential therapy, uye concomitant therapy. Muna 2007, American College of Gastroenterology yakabatanidza kurapa katatu neclarithromycin senzira yekutanga yekurapa yekupedza vanhu vasina kugamuchira clarithromycin uye vasina penicillin allergy. Nekudaro, mumakumi emakore achangopfuura, mwero wekubvisa kweyakajairwa katatu kurapwa kwave ≤80% munyika zhinji. MuCanada, mwero wekusagadzikana kweclarithromycin wakawedzera kubva pa1% muna 1990 kusvika pa11% muna 2003. Pakati pevanhu vakarapwa, mwero wekuramba nemishonga wakatonzi wakapfuura 60%. Clarithromycin kuramba kunogona kunge kuri chikonzero chikuru chekukundikana kwekupedza. Maastricht IV chibvumirano cheshumo munzvimbo dzine kuramba kwakanyanya kuclarithromycin (yero yekuramba inopfuura 15% kusvika 20%), ichitsiva kurapa kutatu nekatatu kana kutevedzana kurapwa neexpectorant uye/kana isina sputum, nepo carat Quadruple therapy inogona zvakare kushandiswa seyokutanga. -line therapy munzvimbo dzine kushomeka kwemycin. Pamusoro penzira dziri pamusoro apa, kuyerwa kwakakwira kwePPI pamwe neamoxicillin kana mamwe maantibioti akadai serifampicin, furazolidone, levofloxacin akakurudzirwawo seimwe nzira yekurapa mutsara wekutanga.

Kuvandudzwa kweakajairika katatu kurapwa

1.1 Quadruple therapy

Sezvo mwero wekupedzwa kweyakajairwa katatu kurapa uchidonha, semushonga, quadruple therapy ine mwero wekupedza. Shaikh et al. vakarapa varwere 175 vane Hp utachiona, vachishandisa per protocol (PP) kuongorora uye chinangwa. Mhedzisiro yechinangwa chekurapa (ITT) ongororo yakaongorora chiyero chekubviswa kweiyo yakajairwa katatu kurapwa: PP = 66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72); quadruple therapy ine chiyero chepamusoro chekupedza: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Kunyangwe budiriro yeHp kupedzwa yakaderedzwa mushure mekutadza kurapwa kwega kwega, kurapwa katatu kwetincture kwakaratidza kuve neyakakura yekubvisa (95%) semushonga mushure mekutadza kweyakajairwa katatu kurapwa. Imwe ongororo yakasvikawo pamhedziso yakafanana: mushure mekutadza kweyakajairwa katatu therapy uye levofloxacin katatu therapy, chiyero chekupedza barium quadruple therapy yaive 67% uye 65%, zvichiteerana, kune avo vairwara nepenicillin kana kuti vakagamuchira hombe Muvarwere vane cyclic lactone antibiotics, expectorant quadruple therapy inodiwawo. Ehezve, kushandiswa kwetincture quadruple therapy kune mukana wepamusoro wezviitiko zvinorwadza, senge kusvotwa, manyoka, kurwadziwa mudumbu, melena, dzungu, musoro, kuravira kwesimbi, nezvimwewo, asi nekuti iyo expectorant inoshandiswa zvakanyanya muChina, iri. zviri nyore kuwana, uye ine Mwero wepamusoro wekubvisa unogona kushandiswa semushonga wekugadzirisa. Zvakakodzera kusimudzira mukiriniki.

1.2 SQT

SQT yakarapwa nePPI + amoxicillin kwemazuva mashanu, ndokuzorapwa nePPI + clarithromycin + metronidazole kwemazuva mashanu. SQT parizvino inokurudzirwa seyekutanga-mutsara wekubvisa kurapa kweHp. Meta-analysis yezvitanhatu randomized controlled trials (RCTs) muKorea inobva pa SQT ndeye 79.4% (ITT) uye 86.4% (PP), uye HQ kubviswa kweSQT Chiyero chakakwirira kudarika chiyero chetatu katatu, 95% CI: 1.403 ~ 2.209), iyo nzira inogona kunge iri yekutanga 5d (kana 7d) inoshandisa amoxicillin kuparadza clarithromycin efflux chiteshi pamadziro emadziro, zvichiita kuti mhedzisiro ye clarithromycin ishande. SQT inowanzo shandiswa semushonga wekutadza kurapa kwakajairwa katatu kunze kwenyika. Nekudaro, ongororo dzakaratidza kuti iyo katatu therapy eramination rate (82.8%) pamusoro penguva yakawedzerwa (14d) yakakwira kupfuura iyo yeclassical sequential therapy (76.5%). Imwe ongororo yakawanawo kuti pakanga pasina misiyano yakakura muHp yekubvisa mitengo pakati peSQT uye yakajairwa katatu therapy, iyo inogona kunge yakabatana nehuwandu hwepamusoro hwekupikisa clarithromycin. SQT ine nguva yakareba yekurapa, iyo inogona kuderedza kutevedza kwemurwere uye haina kukodzera nzvimbo dzine kupikisa kwakanyanya ku clarithromycin, saka SQT inogona kutariswa kana inopesana nekushandiswa kwetincture.

1.3 Companion therapy

Kurapa kunoenderana nePPI yakasanganiswa neamoxicillin, metronidazole uye clarithromycin. Meta-analysis yakaratidza kuti chiyero chekupedza chaive chakakwira kupfuura chiyero chekurapa katatu. Imwe meta-kuongorora yakawanawo kuti chiyero chekupedza (90%) chaive chakanyanya kukwirira pane icho cheyakajairwa katatu kurapwa (78%). Maastricht IV Consensus inoratidzira kuti SQT kana kurapa kunopindirana kunogona kushandiswa mukushayikwa kwezvinotarisirwa, uye kubviswa kwemaitiro maviri ekurapa kwakafanana. Zvisinei, munzvimbo dzine clarithromycin isingagadziriswi nemetronidazole, zvinobatsira zvakanyanya nekurapa pamwe chete. Zvakadaro, nekuti mushonga unoenderana nerudzi urwu une marudzi matatu emishonga inorwisa mabhakitiriya, sarudzo yemishonga inodzikiswa mushure mekukundikana kwekurapa, saka hazvikurudzirwe sechirongwa chekutanga chekurapa kunze kwenzvimbo dzinodzivirirwa neclarithromycin nemetronidazole. Inonyanya kushandiswa munzvimbo dzine kushomeka kwekudzivirira ku clarithromycin uye metronidazole.

1.4 kurapa kwakanyanya

Zvidzidzo zvakawana kuti kuwedzera dosi uye / kana kuwanda kwekutonga kwePPI uye amoxicillin yakakura kupfuura 90%. Iyo bactericidal mhedzisiro yeamoxicillin paHp inoonekwa seyakatarisana nenguva, uye saka, inoshanda zvakanyanya kuwedzera kuwanda kwekutonga. Kechipiri, kana pH iri mudumbu ichichengetwa pakati pe3 ne6, kudzokorora kunogona kudziviswa. Kana iyo pH mudumbu ichipfuura 6, Hp haichazodzokorora uye inonzwira amoxicillin. Ren et al akaita zviedzo zvakadzorwa zvisina kurongeka muvarwere ve117 vane Hp-positive varwere. Boka repamusoro-dose rakapihwa amoxicillin 1g, tid uye rabeprazole 20mg, bid, uye boka rekutonga rakapihwa amoxicillin 1g, tid uye rabeprazole. 10mg, bhidhi, mushure memavhiki e2 ekurapwa, Hp kubviswa kwehuwandu hwehuwandu hwehuwandu hwehuwandu hwakanga huri 89.8% (ITT), 93.0% (PP), yakakwirira zvikuru kupfuura boka rekutonga: 75.9% (ITT), 80.0% (PP), P <0.05. Chidzidzo kubva kuUnited States chakaratidza kuti kushandisa esomeprazole 40 mg, ld + amoxicillin 750 mg, mazuva matatu, ITT = 72.2% mushure memazuva gumi nemana ekurapwa, PP = 74.2%. Franceschi et al. retrospectively akaongorora marapirwo matatu: 1 yakajairika katatu therapy: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 high-dose therapy: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, nzira yekurapa i7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, bid treatment ye5d, lansoprazole 30mg bid, carat The 500mg bid uye tinidazole 500mg bid zvakarapwa kwemazuva mashanu. Kupedzwa kwemareji matatu ekurapwa aive: 55%, 75%, uye 73%. Musiyano pakati pe-high-dose therapy uye yakajairwa katatu therapy yaive yakakosha, uye musiyano wakaenzaniswa neSQT. Hazvina kukosha. Ehe, zvidzidzo zvakaratidza kuti yakakwira-dose omeprazole uye amoxicillin kurapa hakuna kunyatso kuvandudza mwero wekupedza, pamwe nekuda kweCYP2C19 genotype. MaPPI mazhinji anogadziriswa neCYP2C19 enzyme, saka simba reCYP2C19 gene metabolite rinogona kukanganisa metabolism yePPI. Esomeprazole inonyanya kushandiswa ne cytochrome P450 3 A4 enzyme, inogona kuderedza simba reCYP2C19 gene kusvika pamwero wakati. Mukuwedzera, kunze kwePPI, amoxicillin, rifampicin, furazolidone, levofloxacin, inokurudzirwawo seimwe nzira yekurapa yakawanda.

Yakasanganiswa microbial kugadzirira

Kuwedzera microbial ecological agents (MEA) pakurapa kwakajairwa kunogona kuderedza maitiro akashata, asi zvichiri kupokana kuti mwero wekupedza Hp unogona kuwedzera here. Meta-analysis yakawana kuti kurapa katatu kweB sphaeroides kwakasanganiswa nekatatu therapy chete kwakawedzera Hp eradication rate (4 randomized controlled trials, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), zvakare kuderedza maitiro asina kunaka anosanganisira manyoka. Zhao Baomin et al. zvakare yakaratidza kuti kusanganiswa kweprobiotics kunogona kuvandudza zvakanyanya chiyero chekupedza, kunyangwe mushure mekupfupisa nzira yekurapa, kuchine yakakwirira yekubvisa mwero. Chidzidzo chevarwere makumi masere nevashanu vane Hp-positive varwere chakaitwa zvisina tsarukano mumapoka mana eLactobacillus 20 mg bid, clarithromycin 500 mg bid, uye tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus yakasanganiswa ne bifidobacteria, placebo kwevhiki 1, zadza mubvunzo wekuongorora kwezviratidzo vhiki imwe neimwe kwemavhiki e4, 5 kusvika kumavhiki e7 gare gare kutarisa hutachiona, chidzidzo chakawana: probiotics boka uye nyaradzo Kwakanga kusina kukosha. mutsauko mukupedza chiyero pakati pemapoka, asi mapoka ese eprobiotic aive akanyanya kubatsira mukudzivirira kuita kwakashata kupfuura boka rekutonga, uye pakanga pasina misiyano yakakura muchiitiko chekusawirirana pakati pemapoka eprobiotic. Iyo nzira iyo probiotics inoparadza Hp haisati yanyatsojeka, uye inogona kuvharidzira kana kusashanda nemakwikwi ekunamatira nzvimbo uye zvakasiyana siyana senge organic acids uye bacteriopeptides. Nekudaro, zvimwe zvidzidzo zvakawana kuti kusanganiswa kweprobiotics hakugadzirise mwero wekupedza, izvo zvinogona kunge zvine chekuita nekuwedzera mhedzisiro yeprobiotics chete kana mishonga inorwisa mabhakitiriya isingaite. Pachine nzvimbo huru yekutsvagisa mujoint probiotics, uye kumwe kutsvagisa kunodiwa pamhando, makosi ekurapa, zviratidzo uye nguva yekugadzirira kweprobiotic.

Zvinhu zvinokanganisa Hp eradication rate

Zvinhu zvakawanda zvinokanganisa kupedzwa kweHp zvinosanganisira kuramba kwemishonga inorwisa mabhakitiriya, nharaunda yenzvimbo, zera remurwere, chimiro chekuputa, kutevedzera, nguva yekurapa, hutachiona hwehutachiona, kusingaperi atrophic gastritis, gastric acid concentration, mhinduro yemunhu kuPPI, uye CYP2C19 gene polymorphism. Kuvapo. Zvidzidzo zvakashuma kuti mune univariate ongororo, zera, nzvimbo yekugara, mishonga, chirwere chemudumbu, comorbidity, nhoroondo yekubvisa, PPI, nzira yekurapa, uye kuomerera kwekurapa zvinosanganiswa nemazinga ekupedza. Uye zvakare, zvimwe zvirwere zvisingaperi zvisingaperi, senge chirwere cheshuga, hypertension, chirwere cheitsvo chisingaperi, chirwere chechiropa chisingaperi, uye chirwere chemapapu chisingaperi chinogona zvakare kuve chine chekuita nekupedza chiyero cheHp. Zvisinei, migumisiro yechidzidzo chezvino haina kufanana, uye zvimwe zvidzidzo zvakakura zvinodiwa.