Helicobacter pylori (Hp), mid ka mid ah cudurada faafa ee ugu badan ee bini'aadamka. Waa arrin halis u ah cudurro badan, sida boogaha caloosha, gastritis-ka daba-dheeraada, adenocarcinoma gastric, iyo xitaa unugyada lymphoid-ka ee xuubka-xiran (MALT) lymphoma. Daraasaduhu waxay muujiyeen in ciribtirka Hp uu yarayn karo halista kansarka gastric, kordhinta heerka daawaynta boogaha, oo hadda loo baahan yahay in lagu daro daawooyinka ay si toos ah u ciribtiri karto Hp. Waxaa jira xulashooyin kala duwan oo daaweyn ah oo la heli karo: daawaynta safka koowaad ee caabuqa waxaa ka mid ah daawaynta caadiga ah ee saddexlaha ah, daawaynta afar geesoodka ah, daawaynta isku xigta, iyo daawaynta isku xidhan. Sannadkii 2007, Kulliyadda Gastroenterology ee Maraykanka waxay isku dartay daawaynta saddex-geesoodka ah ee clarithromycin oo ah daawaynta safka koowaad ee ciribtirka dadka aan helin clarithromycin oo aan lahayn xasaasiyad penicillin. Si kastaba ha ahaatee, tobannaankii sano ee la soo dhaafay, heerka ciribtirka daawaynta caadiga ah ee saddex-jibbaaran waxay ahayd ≤80% waddamada intooda badan. Kanada, heerka iska caabbinta clarithromycin wuxuu ka kordhay 1% 1990 ilaa 11% 2003. Shakhsiyaadka la daweeyay, heerka caabbinta daroogada ayaa xitaa la sheegay inay ka badan tahay 60%. Iska caabbinta Clarithromycin waxay noqon kartaa sababta ugu weyn ee ciribtirka fashilka. Maastricht IV warbixinta la isku raacsan yahay ee meelaha iska caabbinta sare leh ee clarithromycin (heerka iska caabbinta ka badan 15% ilaa 20%), ku beddelashada daawaynta caadiga ah ee saddex jibaaran afar jibbaaran ama daawaynta isku xigxiga leh expectorant iyo/ama aan xaako lahayn, halka daawaynta carat Quadruple sidoo kale loo isticmaali karo sidii ugu horeysay. -daawaynta khadka ee meelaha leh iska caabbinta hoose ee mycin. Marka lagu daro hababka kor ku xusan, qiyaaso badan oo PPI ah oo lagu daray amoxicillin ama antibiyootiko kale sida rifampicin, furazolidone, levofloxacin ayaa sidoo kale la soo jeediyay inay noqoto daawaynta safka kowaad ee beddelka ah.

Hagaajinta daaweynta caadiga ah ee saddex-geesoodka ah

1.1 daawaynta afar jibaaran

Marka heerka ciribtirka heerka daawaynta caadiga ah ee saddex-geesoodka ah uu hoos u dhaco, dawo ahaan, daawaynta afar jibaaran waxay leedahay heer ciribtir sare leh. Sheekh iyo al. lagu daweeyay 175 bukaan oo qaba caabuqa Hp, iyadoo la isticmaalayo falanqeyn iyo ujeedo kasta borotokool (PP). Natiijooyinka la doonayo in lagu daweeyo (ITT) falanqaynta ayaa qiimeeyay heerka ciribtirka ee daaweynta caadiga ah ee saddexlaha ah: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); daawaynta afar jibbaaran waxay leedahay heer sare oo ciribtirka: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Inkasta oo heerka guusha ciribtirka Hp uu hoos u dhacay ka dib markii daaweyn kasta oo guuldarreysatay, daawaynta afar jibbaaran ee tincture waxay caddaysay in ay leedahay heer sare oo ciribtirka (95%) sida daawaynta ka dib markii ay ku guuldareysatay daaweynta caadiga ah ee saddex-geesoodka ah. Daraasad kale ayaa sidoo kale gaadhay gabagabo la mid ah: ka dib markii ay ku guuldareysatay daaweynta saddex-geesoodka ah iyo levofloxacin, heerka ciribtirka barium afar jibbaaran wuxuu ahaa 67% iyo 65%, siday u kala horreeyaan, kuwa xasaasiyadda u leh penicillin ama si weyn u qaatay bukaannada qaba Antibiyootigyada lactone-ka ee wareegga wareegga ah, daawaynta afar-jibbaarka ah ayaa sidoo kale la door bidaa. Dabcan, isticmaalka tincture therapy afar jibbaaran waxay leedahay itimaalka sare ee dhacdooyinka xun, sida lallabbo, shuban, calool xanuun, melena, dawakhaad, madax-xanuun, dhadhan macdan, iwm. Si fudud loo heli karo, oo leh Heer sare oo ciribtirka ayaa loo isticmaali karaa daawaynta. Way mudan tahay in lagu dalacsiiyo rugta caafimaadka.

1.2 SQT

SQT waxaa lagu daweeyay PPI + amoxicillin 5 maalmood, ka dibna lagu daaweeyay PPI + clarithromycin + metronidazole 5 maalmood. SQT hadda waxaa lagula taliyaa inay noqoto daawaynta dabar-goynta safka koowaad ee Hp. Falanqaynta-meta ee lix tijaabo oo la kantaroolay (RCTs) ee Kuuriya oo ku salaysan SQT waa 79.4% (ITT) iyo 86.4% (PP), iyo ciribtirka HQ ​​ee SQT Heerku wuxuu ka sarreeyaa daawaynta saddex-geesoodka ah, 95% CI: 1.403 ~ 2.209), farsamadu waxay noqon kartaa in 5d (ama 7d) ee ugu horreeya ay isticmaalaan amoxicillin si ay u burburiyaan kanaalka dheecaanka clarithromycin ee derbiga unugyada, taasoo ka dhigaysa saameynta clarithromycin mid waxtar leh. SQT waxaa badanaa loo isticmaalaa dawo ahaan guuldarada daawaynta saddex-laabka ah ee dibadda. Si kastaba ha ahaatee, daraasaduhu waxay muujiyeen in heerka ciribtirka daawaynta saddex-geesoodka ah (82.8%) ee muddada dheer (14d) uu ka sarreeyo ta daaweynta isku xigxiga ee qadiimiga ah (76.5%). Mid ka mid ah daraasaddan ayaa sidoo kale lagu ogaaday in aysan jirin farqi weyn oo u dhexeeya heerarka ciribtirka Hp ee u dhexeeya SQT iyo daawaynta saddex-geesoodka ah, taas oo laga yaabo inay la xiriirto heerka sare ee caabbinta clarithromycin. SQT waxay leedahay daaweyn dheer, taas oo yareyn karta u hoggaansanaanta bukaanka oo kuma habboona meelaha iska caabbinta sare leh ee clarithromycin, sidaas darteed SQT waxaa laga yaabaa in la tixgeliyo marka liddi ku ah isticmaalka tincture.

1.3 Daaweynta wehel

Daaweynta la socota waa PPI oo lagu daray amoxicillin, metronidazole iyo clarithromycin. Falanqaynta maadada ayaa muujisay in heerka ciribtirka uu ka sarreeyay daawaynta caadiga ah ee saddexlaha ah. Falanqaynta kale ee maadada ayaa sidoo kale lagu ogaaday in heerka ciribtirka (90%) uu aad uga sarreeyo kan daawaynta saddex-laabka ah (78%). Maastricht IV Consensus waxay soo jeedinaysaa in SQT ama daawaynta isku dhafan loo isticmaali karo maqnaanshaha filashooyinka, iyo heerarka ciribtirka labada daawaynta waa isku mid. Si kastaba ha ahaatee, meelaha clarithromycin ay u adkaysato metronidazole, waxay aad ugu faa'iido badan tahay daaweynta isku dhafan. Si kastaba ha ahaatee, sababtoo ah daawaynta la socotaa waxay ka kooban tahay saddex nooc oo antibiyootik ah, doorashada antibiyootiga waa la dhimi doonaa ka dib marka daawadu guuldareysato, sidaas darteed laguma talinayo qorshaha daaweynta koowaad marka laga reebo meelaha ay clarithromycin iyo metronidazole iska caabinayaan. Inta badan waxaa loo isticmaalaa meelaha iska caabbinta yar ee clarithromycin iyo metronidazole.

1.4 daawaynta qiyaasta sare

Daraasaduhu waxay ogaadeen in kordhinta qiyaasta iyo/ama inta jeer ee maamulka PPI iyo amoxicillin ay ka weyn tahay 90%. Saamaynta bakteeriyada amoxicillin ee Hp waxaa loo arkaa inay tahay mid waqti-ku-tiirsan, sidaas darteed, way ka waxtar badan tahay in la kordhiyo inta jeer ee maamulka. Marka labaad, marka pH ee caloosha lagu hayo inta u dhaxaysa 3 iyo 6, ku-noqoshada si wax ku ool ah ayaa loo joojin karaa. Marka pH-ga caloosha ku jiraa uu dhaafo 6, Hp mar dambe ma soo laaban doonto waxayna u nugul tahay amoxicillin. Ren et al waxay sameeyeen tijaabooyin la kantaroolay oo aan kala sooc lahayn 117 bukaan oo qaba bukaannada Hp-positive ah. Kooxda qiyaasta sare leh ayaa la siiyay amoxicillin 1g, tid iyo rabeprazole 20mg, bid, kooxda xakamaynta waxaa la siiyay amoxicillin 1g, tid iyo rabeprazole. 10mg, dalab, ka dib 2 toddobaad oo daaweyn ah, heerka ciribtirka Hp ee kooxda qiyaasta sare waxay ahayd 89.8% (ITT), 93.0% (PP), aad uga sarreeya kooxda kantaroolka: 75.9% (ITT), 80.0% (PP), P <0.05. Daraasad laga sameeyay Maraykanka ayaa muujisay in isticmaalka esomeprazole 40 mg, ld + amoxicillin 750 mg, 3 days, ITT = 72.2% ka dib 14 maalmood oo daaweyn ah, PP = 74.2%. Franceschi iyo al. dib-u-eegis lagu sameeyay saddex daawayn: 1 daawaynta saddexlaha ah ee caadiga ah: lansoola 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, bid, 7d; 2 daawaynta qiyaasta sare leh: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, koorsada daaweyntu waa 7d; 3SQT: lansoprazole 30mg, bid + amoxicillin 1000mg, daawaynta dalabka 5d, lansoprazole 30mg bid, carat Dalabka 500mg iyo dalabka tinidazole 500mg ayaa la daweeyey 5 maalmood. Heerarka ciribtirka saddexda hab daaweyn waxay ahaayeen: 55%, 75%, iyo 73%. Farqiga u dhexeeya daawaynta qiyaasta-sare iyo daawaynta caadiga ah ee saddex-geesoodka ah ayaa ahayd mid tira-koob ah, farqiga ayaa la barbardhigay SQT. Tirakoob ahaan ma aha mid muhiim ah. Dabcan, daraasaduhu waxay muujiyeen in qiyaasta sare ee omeprazole iyo amoxicillin aysan si wax ku ool ah u wanaajin heerarka ciribtirka, laga yaabee inay sabab u tahay genotype CYP2C19. Inta badan PPI-yada waxaa metabolized by enzyme CYP2C19, sidaas darteed xoogga CYP2C19 dheef-shiid kiimikaadka hidde-sidayaasha waxay saameyn kartaa dheef-shiid kiimikaadka PPI. Esomeprazole waxaa inta badan metabolized by cytochrome P450 3 A4 enzyme, kaas oo yarayn kara saamaynta CYP2C19 hidde ilaa xad. Intaa waxaa dheer, marka lagu daro PPI, amoxicillin, rifampicin, furazolidone, levofloxacin, ayaa sidoo kale lagula talinayaa sida beddelka daaweynta qiyaasta sare.

Diyaarinta microbial isku dhafan

Ku darida wakiilada deegaanka ee microbial (MEA) ee daaweynta caadiga ah waxay yarayn kartaa falcelinta xun, laakiin wali waa muran ka taagan yahay in heerka ciribtirka Hp la kordhin karo. Falanqaynta maadada ayaa lagu ogaaday in daaweynta saddex-geesoodka ah ee B. sphaeroides oo ay weheliso daawaynta saddex-geesoodka ah oo keliya ayaa kordhisay heerka ciribtirka Hp (4 tijaabo oo la kala soocay, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), sidoo kale hoos u dhig falcelinta xun oo uu ku jiro shuban. Zhao Baomin iyo al. sidoo kale waxay muujisay in isku-dhafka probiotics ay si weyn u wanaajin karto heerka ciribtirka, xitaa ka dib marka la gaabiyo koorsada daaweynta, weli waxaa jira heer sare oo ciribtirka. Daraasad lagu sameeyay 85 bukaan oo qaba Hp-positive bukaan ayaa loo kala saaray 4 kooxood oo Lactobacillus 20 mg bid, clarithromycin 500 mg bid, iyo tinidazole 500 mg bid. , B. cerevisiae, Lactobacillus oo ay weheliso bifidobacteria, placebo 1 toddobaad, buuxi su'aal-ururinta ku saabsan cilmi-baarista calaamadaha toddobaad kasta toddobaad kasta 4, 5 illaa 7 toddobaad ka dib si loo hubiyo caabuqa, daraasaddu waxay heshay: kooxda probiotics iyo raaxada Ma jirin wax muhiim ah farqiga u dhexeeya heerka ciribtirka u dhexeeya kooxaha, laakiin dhammaan kooxaha probiotics ayaa aad uga faa'iido badan ka hortagga falcelinta xun marka loo eego kooxda kantaroolka, mana jirin farqi weyn oo u dhexeeya dhacdooyinka falcelinta xun ee kooxaha probiotics. Habka ay probiotics ku cirib tirto Hp ayaan wali cadda, waxaana laga yaabaa in la joojiyo ama la joojiyo goobaha ku dheggan ee tartanka iyo walxaha kala duwan sida acids organic iyo bacteriopeptides. Si kastaba ha ahaatee, cilmi-baarisyada qaarkood waxay ogaadeen in isku-darka probiotics aysan hagaajineynin heerka ciribtirka, taas oo laga yaabo inay la xiriirto saameynta dheeraadka ah ee probiotics kaliya marka antibiyootiga ay yihiin kuwo aan waxtar lahayn. Wali waxaa jira meel weyn oo cilmi baaris ah oo ku jirta probiotics-ka wadajirka ah, waxaana loo baahan yahay cilmi baaris dheeraad ah oo ku saabsan noocyada, koorsooyinka daaweynta, calaamadaha iyo waqtiga diyaarinta probiotics.

Qodobbada saameeya heerka ciribtirka Hp

Dhowr arrimood oo saameeya ciribtirka Hp waxaa ka mid ah iska caabbinta antibiyootiga, gobolka juqraafi, da'da bukaanka, heerka sigaarka, u hoggaansanaanta, waqtiga daaweynta, cufnaanta bakteeriyada, gastritis-ka atrophic dabadheeraad ah, xoojinta acid gastric, jawaabta shaqsi ee PPI, iyo CYP2C19 hidda-wadaha polymorphism. Joogitaanka. Cilmi-baaristu waxay soo warisay in falanqaynta kala-duwanaanshaha, da'da, aagga la deggan yahay, daawada, cudurrada caloosha iyo mindhicirka, isku-dhafka, taariikhda ciribtirka, PPI, koorsada daaweynta, iyo u hoggaansanaanta daaweynta waxay la xiriiraan heerarka ciribtirka. Intaa waxaa dheer, qaar ka mid ah cudurrada daba-dheeraada ee suurtagalka ah, sida sonkorowga, dhiig-karka, cudurka kelyaha ee joogtada ah, cudurrada beerka ee joogtada ah, iyo cudurrada sambabada ee daba-dheeraada ayaa sidoo kale laga yaabaa inay la xiriiraan heerka ciribtirka Hp. Si kastaba ha ahaatee, natiijooyinka daraasaddan hadda la sameeyay isku mid maaha, waxaana loo baahan yahay daraasado waaweyn oo dheeraad ah.