Helikobager Pylori (HP), chimwe chezvirwere zvinotapukira muvanhu. Icho chinhu njodzi kune zvakawanda zvezvirwere zvakawanda, zvakadai segastric ulcer, chisingaperi gastritis, gastric adenoarcinma, uye kunyange mucosa-yakabatana lymphoid tishu (Malt) Lymphoma. Zvidzidzo zvakaratidza kuti kutsauka kweHP kunogona kuderedza njodzi yegomarara reGastric, Wedzera mari yekurapa yeruter, uye ikozvino inoda kusanganiswa nemishonga inogona kuora zvakananga hp. Kune akasiyana-siyana ekiriniki ekiriniki sarudzo inowanikwa: Yekutanga-mutsara kurapwa kwehutachiona kunosanganisira triple trapy Therapy Therapy kurapwa, kutevedzera kurapwa, uye kurapa kwekurapa. Muna 2007, iyo American College yeGastroenterology Inoraphi neClarithomycin seyekutanga-mutsara wekurapa kwevanhu vasina kugamuchira clarithromycin uye vasina penicillin allergy. Nekudaro, mumakumi emakore apfuura, chiyero chekushambadzira cheTraple Triple Therapy chave chiri ≤80% munyika zhinji. MuCanada, iyo Rate Rate yeClarithmycin yakawedzera kubva pa1% muna1990 kusvika ku19% muna 2003. Pakati peVanhu Vakaitwa, iyo Rwiyo Rwakashata Rakaitwa rakatotaurwa kupfuura makumi matanhatu muzana. Clarithromycin kuramba kunogona kuve chikonzero chikuru chekubvisa kutadza. Ma Sastirt iv ivensus rondedzero munzvimbo dzakakwirira dzekupokana kuClarithomycin -Pamhepo kurapwa munzvimbo dzine nzvimbo dzinodzika kupokana kuNycin. Kuwedzera kune nzira dziri pamusoro, madhayeti eppi pamwe ne ppi oxicillin kana imwe mishonga inorwisa mishonga yakadai saRifumicin, Furzolidone, Levofloxacin yakakurudzirwa seimwe nzira yekutanga-mutsara.

Kuvandudzwa kweTraple Triple Therapy

1.1 Quadruple Therapy

Sezvo chiyero chekushambadzira cheyakajairwa katatu kurapa, semushonga, quadruple kurapa kune chiyero chepamusoro chekushambadzira. Shaikh et al. Kuitirwa varwere 175 neHP utachiona, kushandisa protocol (pp) kuongororwa uye chinangwa. Mhedzisiro yechinangwa chekurapa (ITT) kuongororwa kweiyo yekubvisa chiyero chekurapa CI: 51-72); Quadruple Therapy ine yakakwira yekubvisa chiyero: pp = 91% (102/112, 95-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Kunyangwe huwandu hwekubudirira hweHP kuderedzwa mushure mekunge mumwe nemumwe wakundikana kurapwa, kurapwa kwequadruple kweanoronga kwakarongeka (95%) semushonga wekutadza katatu kurapa. Chimwezve chidzidzo chakasvikawo mhedziso yakafanana: Mushure mekukundikana kweTraple Trapy Therapy Therapy Therapy Therapy Chandende Cyclic Lowtone Anstone, Exercearant Quadruple Therapy inofarirwa zvakare. Ehezve, kushandiswa kweTincture Quadruple Therapy ine mukana wepamusoro wezviitiko zvakashata, zvakadai sekurwadziwa, madhisheya, melena, musoro, simbi, simbi inoshandiswa zvakanyanya muChina, ndizvo Zviri nyore kuwana, uye ane chiyero chepamusoro chekushambadzira chinogona kushandiswa sekurapa kurapwa. Izvo zvakakosha kusimudzira mukiriniki.

1.2 SQT

SQT yakarapwa naPPI + amoxicillin kwemazuva mashanu, akabva abatwa naPPI + clarithomycin + metronidazole kwemazuva mashanu. Sqt parizvino inokurudzirwa seyekutanga-mutsara wekubvisa kurapa kweHP. Kuongorora meta kwematanhatu ekudzorwa mitengo yekudzora ~ 2.209), iyo mechanism inogona kunge iri iyo yekutanga 5D (kana 7D) inoshandisa Amoxicillin yekuparadza iyo clarithromycin efflux chiteshi, ichiita kuti mhedzisiro yeClarithomycly inoshanda. SQT inowanzoshandiswa semushonga wekutadza kwekutora katatu kurapa kunze kwenyika. Nekudaro, zvidzidzo zvakaratidza kuti katatu marapiro ekurapa kujekesa (82.8%) Pamusoro peiyo nguva (14D) yakakwira kupfuura iyo yekushomeka kwekutevedzana (76,5%). Imwe fundo yakawanawo kuti pakanga pasina musiyano wakakosha muHP Kugadziriswa kweSQT uye kwakajairika katatu kurapa, izvo zvinogona kuve zvine chekuita nehuwandu hwepamusoro hwekuramba kweClaromycin kuramba. SQt ine kosi refu yekurapa, iyo inogona kuderedza kutevedzera kwemurwere uye haina kukodzera kutevedzera nzvimbo nekukwira zvakanyanya kuClarithomycin, saka SQT inogona kutariswa kana ichishandiswa kwekushandiswa kwetincture.

1.3 shamwari yekurapa

Kuperekedza kurapwa kwePpi kwakabatanidzwa neAmoxicillin, metronidazole uye clarithromycin. Kuongorora meta-ongororo kwakaratidza kuti chiyero chekubvisa chakakwira kupfuura iyo yakajairwa katatu kurapa. Imwe meta-kuongororwa zvakare yakaona kuti chiyero chekubvisa (90%) chakanyanya kukwirira kupfuura icho cheyakajairwa katatu kurapa (78%). Iyo Maasttir iv Consensus inoratidza kuti SQt kana kurapa kwekurapa kunogona kushandiswa mukusavapo kwevanotarisira, uye maratidziro ezvipenga zviviri zvakafanana. Nekudaro, munzvimbo dzinongoshandiswa ku clarithomycin kurwisa metronidazole, zvinobatsira zvakanyanya nekurapa kwakatanhamara. Nekudaro, nekuti kurapwa kunoenderana nemhando nhatu dzemishonga inorwisa mabhakitiriya, sarudzo yemishonga inorwisa mabhakitiriya, saka haina kukurudzirwa sehurongwa hwekutanga kurapa kunze kwenzvimbo dzinogara uye metronidazole zvinopesana. Inonyanya kushandiswa munzvimbo dzine kudzika kupokana kuClarithomycin uye metronidazole.

1.4 Yakakwirira Dhivha Kurapa

Zvidzidzo zvakawana kuti kuwedzera iyo dosi uye / kana kuwanda kwekutungamira kwePPI uye Amoxicillin yakakura kupfuura 90%. Iyo bacterididal mhedzisiro yeAmoxillin paHP inoonekwa kunge iri nguva-inotsamira, uye saka, inoshanda kuwedzera kuwanda kwekutonga. Kechipiri, apo iyo pH mudumbu ichichengetwa pakati pe3 ne6, kudzokorora kunogona kudzivirirwa zvinobudirira. Kana iyo pH mumudumbu inopfuura 6, HP haichadzoreredze uye inoteerera kune AmOTIOLILYIN. Ren et al a akaitisa mabviro akasarudzika ekudzora miedzo mu 117 varwere vane hp-yakanaka varwere. Boka rakakwira-dosi rakapihwa amoxicillin 1G, tid uye rabeprazole 20mg, bidhi, uye boka rekutonga rakapihwa Amoxillin 1G, tid uye rabeprazole. 10mg, bhiza, mushure memavhiki maviri ekurapa, iyo HP yekushambadzira yeboka rakakwirira dosi yaive 89.8% (ITT), yakanyanya kukwirisa, P <0.05. Chidzidzo kubva kuUnited States chakaratidza kuti uchishandisa Eomprazole 40 mg, ld aroxillin 750 mg, mazuva matatu, iTT = 72.2% mushure memazuva gumi nemana ekurapa, pp = 74.2%. Franceschi et al. Kudzoreredza kuongorora matatu kurapwa: 1 Triple Traple Therapy: LansOola 30mg, Bid, Clarithromycin 500mg, Bid, amoxicillin 1000mg, bid, 7d; 2 Yakakwira-DOSE Therapy: Lansuo Carbazole 30mg, Bid, Clarithromycin 500mg, emoxicillin 1000mg, tid, nzira yekurapa iri 7d; 3SQT: Lansoprazole 30mg, Bid + Amoxicillin 1000mg, Bidhi Kurapa kwe5D, Carar the 500mg Bid uye Tinidazole 500mg Bid akarapwa kwemazuva mashanu. Mitemo yekubvisa yeiyo matatu marapirwo egadziri: 55%, 75%, uye 73%. Musiyano uripo pakati pehomwe-dosi kurapa uye yakajairwa trapy kurapwa yaive yakanyanya kukosha, uye musiyano wakafananidzwa neSQT. Kwete zvakanyanya kukosha. Ehezve, zvidzidzo zvakaratidza kuti yakakwira-dosi omeprazole uye ammoxillinollin kurapwa hakuna kunyatso kugadzirisa mareti ekubvisa, pamwe nekuda kweiyo cyp2c19 genotype. Vazhinji ppis metabolized neiyo Cyp2c19 enzyme, saka simba reCyp2c19 gene Metabolite rinogona kukanganisa metabolism ye ppi. Esomeprazole inonyanya kuve metabolized neCytochrome P450 3 A4 Enzyme, iyo inogona kuderedza iyo Sesviki yeCyp2c19 gene kune imwe nhanho. Uye zvakare, kuwedzera kune PPI, amoxicillin, rifumampin, furazoolidone, quevofloxacin, inokurudzirwa zvakare seyakanyanya kurapa nzira yekurapa.

Yakasanganiswa microbial kugadzirira

Kuwedzera microbial ecrological vamiririri (Mea) kuSandard Therapy kunogona kuderedza kuita zvakaipa, asi ichiri kupokana ingave mwero wekujekesa denderedzwa anogona kuwedzera. Kuongorora meta-meta kwakawana kuti kurapa kweB. Kuita kwakashata kunosanganisira manyoka. Zhao baomin et al. Zvakare pachena zvakaratidza kuti kusanganiswa kweProbiot Conse kunogona kuvandudza zvakanyanya chiyero chekubvisa, kunyangwe mushure mekupfupisa kosi yekurapa, kuchine chiyero chakanyanya kutsauka. Kudzidza kwevarwere 85 nevarwere veHP-kwakanaka kwakarongeka mumapoka mana eLactobacillus 20 mg bid, clarithromycin 500 mg bid, uye tinidazole 500 mg bid. . Kusiyanisa muyero yekubvisa pakati pemapoka, asi mapoka ese emapuranga aive achibatsira kuita zvakaipa kupfuura boka rekutonga, uye pakanga pasina musiyano wakakosha mune zviitiko zvakashata pakati pemapoka emapoka akaronga. Iyo Mechanism iyo probiotrics inobvisa HP ichiri kujeka, uye inogona inhibit kana isingamone neyemakwikwi esitession nzvimbo uye zvinhu zvakasiyana-siyana senge acids nehutachiona. Nekudaro, zvimwe zvidzidzo zvakaona kuti kusanganiswa kweProbiot's hazvivandudze chiyero chekubvisa, icho chinogona kunge chine chekuita nekuwedzera kwemhedzisiro yePROBIOTS chete apo mishonga inoraswa nayo isingabatsiri. Pachine nzvimbo huru yekutsvaga mubatanidzwa proint probiotic, uye kumwezve kutsvagisa kunodiwa kumhando, makosi ekurapa, zviratidzo uye nguva yekugadzirira probiotic.

Zvinhu zvinokanganisa HP Kujekesa Rate

Zvinhu zvinoverengeka zvinokonzeresa HP Kupararira Zvinokisheni Kubatanidza, Geographic Restillisance, Geographic Dunhu, Kuparadza, Kurapa, Kubata Kwemunhu, Kupindura kwePPI, uye Cyp2c19 geru Polymorphism. Kuvapo. Zvidzidzo zvacho zvataura kuti mukusarudzika kwekuziva, zera, chirwere chekugara, mushonga, nhoroondo yekubvisa, PPI, kurapwa kwakabatana uye kurapwa kwakabatana nemitero yekubvisa. Uye zvakare, zvimwe zvirwere zvisingaperi, zvakadai seshuga, hypertension, chirwere chechirwere chechirongo, chirwere chechiratidzo chechirume chisingaperi chinogona kunge chine chekuita nehuwandu hweHP. Nekudaro, mhedzisiro yezvidzidzo zvazvino haina kufanana, uye zvimwe zviitiko zvikuru-zviyero zvinodikanwa.