Helicobacter pylori (HP), mid ka mid ah cudurada ugu badan ee cudurka faafa ee aadanaha. Waa wax khatar ah oo loogu talagalay cudurro badan, sida boogta caloosha, gaaska caloosha, caloosha caloosha, iyo xitaa xabka-xarkaha xuubka qanjidhada (Malt) Lympoma. Daraasaduhu waxay muujiyeen ciribtirka in ciribtirka HP ay yareyn karto halista kansarka caloosha, waxay kordhin kartaa heerka dawaynta boogaha, oo haddana loo baahan yahay in lagu daro daroogada si toos ah u ciribtiri kara HP. Waxaa jira xulashooyinka kaladuwan ee ciribtirka tacliinta caafimaad ee la heli karo: Daaweynta safka koowaad ee cudurka waxaa ku jira dawada caadiga ah ee caadiga ah, daaweyntii sumcadaha, daaweynta isku xigta, iyo daaweynta walxaha wada-shaqeynta. Sanadkii 2007, kulleejada Mareykanka ee Gastrometerogyrology-ga oo isku-darka Trantromycin-ka sida daweynta safka koowaad ee ciribtirka dadka aan helin xasaasiyaddii dadka aan helin xasaasiyaddii dadka aan helin xasaasiyaddii 'Pinacicincy'. Si kastaba ha noqotee, sannadihii ugu dambeeyay, ciribtirka ciribtirka daaweynta caadiga ah ee daweyn ee caadiga ah waxay ahayd ≤80% wadamada badankood. Kanada gudaheeda, heerka caabbinta ee Clarithromycin ayaa kordhay 1% 1990 ilaa 11% sanadkii 2003. Waxaa ka mid ah shakhsiyaadka iska caabinta dawada, ayaa la soo sheegay in ay ka badan tahay 60%. Iskaas caabbinta ee Clarithromycin waxay noqon kartaa sababta ugu weyn ee ciribtirka ciribtirka. Maastricht iv IV-ga ayaa ka warbixiyay meelaha iska caabin sare u leh Staritromycin (heerka iska caabbinta in ka badan 20%), oo lagu beddelayo daweynta 'stepherap' ama zquums, halka daweynta daaweyntuna ay sidoo kale loo isticmaali karo marka hore -Waxaa lagu daaweeyaa aagagga leh iska caabin hoose ee Mycin. Ka sokow hababka kor ku xusan, qiyaasta sare ee PPI Plus amoxycillin ama antibiyootigyada kale ee antibiyootigyada sida Rifampicins, Flaflolidone, Levofloxacin ayaa sidoo kale loo soo jeediyay inuu yahay daaweyn safka koowaad ah.

Hagaajinta daaweynta caadiga ah ee caadiga ah

1.1 Dareenka Quadruple

Maaddaama heerka ciribtirka dawada caadiga ah ee daaweynta caadiga ah, sida daaweynta, daaweyn labajibbaarane ah ayaa leh heerka darafeeca sare. Shaikh et al. Waxaa loola dhaqmay 175 bukaan oo qaba cudurka HP, iyagoo adeegsanaya falanqaynta POSOCOCOL (PP) iyo ujeedka. Natiijooyinka dawada lagu daweynayo (ITT) waxay qiimeysay heerka ciribtirka dawada caadiga ah ee dawada caadiga ah: pp = 66% (49/74, 95-76), waa 62% (49/79, 95%, 95%. CI: 51-72); Daaweynta laf-dhabarta ah waxay leedahay qiimeyn ka-saarid sare: PP = 91% (102/112, 95% CI: 84-95), ITT = 84/121, 95% CI: 77 ~ 90). In kasta oo heerka guusha ee ciribtirka HP la yareeyay ka dib markii daaweyn kasta oo fashilmay ka dib, daaweynta rugta ah ee tincture waxay cadeysay inay sicirka ciribtirka sare (95%) daaweyn ka dib markii la daaweeyay dawada caadiga ah ee dawada caadiga ah. Daraasad kale ayaa sidoo kale gaadhay gabagabada la midka ah: ka dib markii ay ku guuldaraysteen dawada caadiga ah ee dawada iyo daaweynta the levoxcin shprapy-ga, ciribtirka ka-hortagga barium Quadruluple wuxuu ahaa 67% iyo kuwa xasaasiyad u leh penicillin ama ka helay bukaannada Daawada dawada la canaa ee canaanada ee baastada ka ah, daweynta ka hortagga ah ee bannaan ayaa sidoo kale la door bidaa. Dabcan, isticmaalka daaweyn tincture ruburuple waxay leedahay itimaal sare oo ah dhacdooyin xun, sida lallabbo, caloosha, dhagaxa, qadhaadhka, iwm, sababtoo ah iwm, sababtoo ah exchether-ka ayaa si weyn loogu isticmaalaa Shiinaha, waa Si fudud ayaa loo heli karaa, waxaana loo isticmaali karaa sicirka ciribtirka sare loo isticmaali karo sida daaweynta sixitaanka. Waxaa mudan in lagu dhiirrigeliyo rugta caafimaadka.

1.2 sqt

SQT waxaa lagu daaweeyay PPI + amoxycillin muddo 5 maalmood ah, ka dibna lagu daweeyay PPI + Chitromromycin + Metronazole 5 maalmood. SQT waxaa hada lagula talinayaa inay tahay daaweynta ciribtirka safka koowaad ee loogu talagalay HP. Falanqaynta Meta-ka-eega ah ee lix maxkamadood oo la xakameeyay (RCTS) ee Kuuriya oo ku saleysan SQT waa 79.4% (ITT) iyo 86.4% (PP), iyo 8 %% (PP), 95.4% ~ 2.209), farsamaynta ayaa noqon kara in 5D ugu horreysay (ama 7D) u isticmaal amoxycillin si loo burburiyo kanaalka emplomromycin eftlux derbiga loo yaqaan 'Chritromycin efflux', taasoo saameyn ku yeelata saameynta Claritromycincin. SQT waxaa badanaa loo isticmaalaa sidii dawayn loogu talagalay guuldaradii daaweynta caadiga ah ee dibedda dibedda. Si kastaba ha noqotee, daraasadaha ayaa muujiyay in heerka ciribtirka dawada (82.8%) waqti dheeri ah (14D) ayaa ka sarreeya kan taranka taxanaha sequatical (76.5%). Hal daraasad ayaa sidoo kale lagu ogaaday inaysan jirin wax farqi weyn ah oo ku saabsan sicirka qarashka HP-ga ee u dhexeeya SQT iyo dawada caadiga ah ee caadiga ah, oo laga yaabo inay la xiriiraan heerka sare ee caabbinta Clarithromycin. SQT waxay leedahay deg-deg ah oo lagu daaweeyo, oo yareyn kara u hoggaansanaanta bukaanka isla markaana aan ku habooneyn meelaha ay iska caabin sare u yihiin Clarithromycin, sidaa darteed SQT waa la tixgelin karaa marka waxyaabaha loo yaqaan 'Tinctute'.

1.3 Daaweynta wejiga

Daaweynta la socda ayaa PPI isku darka amoxycillin, metronazole iyo Clarithromycin. Falanqaynta Meta-Conta waxay muujisay in heerka ciribtirka ay ka sarreysay dawaynta caadiga ah ee dawada. Falanqaynta kale ee Meta-kale ayaa sidoo kale lagu ogaaday in sicirka ciribtirka (90%) uu si weyn uga sarreeyay kii-shprapy-ga caadiga ah (78%). Isku xirnaanta Maastricht IV waxay soo jeedineysaa in daaweynta SQT ama daweynta quseeya ee loo adeegsan karo maqnaanshaha bannaanka, oo sicirka ciribtirka labada daaweyntu waa isku mid. Si kastaba ha noqotee, meelaha ay Claritromycin uu u adkaysto metarondazole, waxay ka faa iidaysan tahay daweynta chomithit. Si kastaba ha noqotee, sababta oo ah daaweynta la socota waxay ka kooban tahay seddex nooc oo antibiyootig ah, doorashada antibiyootigga waa la dhimi doonaa ka dib marka lagu daro qorshaha daaweynta ee ugu horreeya marka laga reebo meelaha ay ka hadlaan meelaha loo yaqaan 'Clithromycin' iyo metrokazole. Badanaa loo adeegsaday meelaha ay iska caabbinta hoose u leeyihiin Clarithromycin iyo Metronazole.

1.4 Daaweynta Qiyaasta Sare

Daraasaduhu waxay ogaadeen in kordhinta qiyaasta iyo / ama inta jeer ee maamulka PPI iyo Amoxicillin uu ka weyn yahay 90%. Saamaynta bakteeri-yada ee amoxycillin ee HP waxaa loo tixgeliyaa inay tahay waqti-waqti-waqti ah, sidaa darteedna, waxay sifiican waxtar u leedahay in la kordhiyo inta jeer ee maamulka. Marka labaad, markii PH caloosha lagu hayo inta u dhaxaysa 3 iyo 6, taranka ayaa si wax ku ool ah loo xakameyn karaa. Marka PH caloosha ka buuxsamo 6, HP ma soo saari doonto oo xasaasi u tahay amoxycillin. Ven et al At ee loo sameeyay tijaabooyin la xakameeyay oo la xakameeyay 117 bukaan oo qaba bukaannada hufan ee HP-Posital. Kooxda qaddarka sareysa ayaa la siiyay amoxycillin 1g, Tid iyo Raeprazole 20mg, oo ay soo gudbiyeen, oo kooxda gacanta lagu hayo ayaa la siiyay amoxhoxicillin 1g, Tid iyo Raepazole. 10mg, dalab, ka dib 2 toddobaad oo daaweyn ah, oo ah heerka dadaalka qaddarka ee HP wuxuu ahaa 89.8% (ITT), oo ah 90.0% (ITT), 80.0% (PP), P <0.05. Daraasad ka socota Mareykanka ayaa muujisay in adeegsiga ESOmePrazole 40 mg, ld + amoxycillin 750 mg, 32 maalmood ka dib markii la daaweynayo 14 maalmood ka dib 14 maalmood oo daaweyn ah, PP = 74.2%. Frackchi et al. Dib-u-habeyn ah seddex daaweyn: 1 Daaweynta caadiga ah ee caadiga ah 2 Daaweynta Qiyaasta Sare: Lansuo Carbazole 30mg, Bixinta, Chitromycin 500mg, dalab, amoxycillin 1000mg, tareenka, habka daaweynta waa 7d; 3SQT: Lansol -sion 30mg, dalab + amoxsicillin 1000mg, dalab 30 milyan oo ginni ah, oo ah dalabkii 500mg 500mg 500mg ah ayaa la daaweynayay 5 maalmood. Heerarka ciribtirka saddexda daaweyn ee daaweynta daaweynta ayaa ahaa: 55%, 75%, iyo 73%. Farqiga u dhexeeya daaweynta-qiyaasta-qaddarka iyo daaweynta caadiga ah ee caadiga ah waxay ahayd mid tirakoob ahaan muhiim ah, farqiga u dhexeeya ayaa la barbar dhigay SQT. Ma aha mid tirakoob ahaan muhiim ah. Dabcan, daraasadaha ayaa muujiyey in qaadashada-sare ee omeprazole iyo daaweynta amoxxicillin aysan si wax ku ool ah u wanaajin sicirka ciribtirka, laga yaabee inuu sabab u yahay CYP2C19 Genotype. Inta badan PPIs-ka waxaa ku dhajiya Cyp2c19 enzyme, sidaa darteed xoogga Cyp2c19 hiddo-wadaha ee TENE Metabolite ayaa saameyn ku yeelan kara dheef-shiid kiimikaadka PPI. Esomeprazole ayaa inta badan ka soo qaadaya by cytochrome p450 3 a4 enzyme, oo yareyn kara saameynta hiddaha Cyp2c19 illaa xad. Intaas waxaa sii dheer, marka lagu daro PPI, Amoxycillin, Rifampicin, Falasoobinne, sidoo kale waxaa lagula talinayaa inay tahay daaweyn daweyn sare leh.

Isku diyaarinta microbial-ka microbial

Ku darista wakiilada dabiiciga ah ee microbial (MEA) ee daaweynta caadiga ah waxay yareyn kartaa jawaabcelinta xumaanta, laakiin wali waa mid muran badan dhaliyay in heerka dawada ee HP la kordhin karo. Falanqaynta Meta-Conta waxay ogaatay in dawada sedex-geesoodka ah ee B. SPhaeroids oo ay weheliso daweynta sedex-geesoodka oo keliya kor u kacay heerka dawada HP, 4 jir, 95% CI: ~ 1.21), ayaa sidoo kale yareynaya falcelin kacsan oo ay ka mid yihiin shuban. Zhao Baimin et al. Sidoo kale waxay muujisay in isku-darka mudittics uu si weyn u wanaajin karo qiimeynta waxyeelada, xitaa ka dib soo gaabiska koorsada daaweynta, waxaa wali jira heerka darafeeca sare. Daraasad ah 85 bukaan oo qaba bukaannada hufan ee cudurka HP-ka ayaa lagu kala soocay 4 kooxood oo Lactobacillus 20 MG dalab, Chitromycin 500 mg, iyo Tindazy 500 mg dalabka 500 mg. , B. Cevisiae, lactobaciallus oo ay weheliso bifobabobarccy, placebo muddo 1 toddobaad ah, buuxi su'aalo-weydiimaha cilmi baarista calaamadaha muddo 4 toddobaad ah, 5 illaa 7 toddobaad ka dib si aad u hubiso infekshanka: daraasadda waxaa lagu helay: kooxda cilmiga ah Farqiga u dhexeeya ciribtirka ka dhex dhaca kooxaha, laakiin dhammaan kooxaha cilmiga ay ka faa'iideysteen ka hortagga falcelinta kacsan ee ka dhanka ah kooxda kantaroolka ah ee falcelinta xun ee ka dhex jira kooxaha ka mid ah kooxaha cilmiga badan. Farsamadaas oo ay tahay cilmigaada ciribtirka HP wali ma cadda, oo laga yaabo inuu xakameeyo ama ka hortago goobaha adag ee adhesion iyo walxaha kaladuwan sida acids dabiiciga ah iyo bakteeriyada. Si kastaba ha noqotee, daraasadaha qaarkood waxay ogaadeen in isku-darka mugga ee muhaajiriinta aysan hagaajinin heerka dajinta daminta, kaas oo laga yaabo inay la xiriiraan saameynta dheeraadka ah ee tijaabada kaliya marka antibiyootigyadu ay yihiin kuwa aan waxtar lahayn. Weli waxaa jira goob cilmi baaris oo weyn oo ku yaal wadajirka ah ee loo yaqaan 'cotiotics', iyo cilmi-baaris dheeraad ah ayaa looga baahan yahay noocyada, koorsooyinka daaweynta, tilmaamayaasha iyo waqtiga diyaarinta cilmiga.

Qodobo saameeya heerka ciribtirka HP

Dhowr arrimood oo saameeya ka-hortagga HP waxaa ka mid ah iska caabbinta antibiyootigga, gobolka juqraafiyeed, da'da bukaanka, waqtiga loo yaqaan 'atrophopholic-ka', ee loo yaqaan 'bakteeriyada', ka-hortagga cudurka ppi, iyo cyp2c1c polmymorphism-ka. Jiritaanka. Daraasadaha ayaa lagu soo sheegay in falanqaynta aan la-falanqeyn, da ', deganaanshaha, cudurka caloosha, cudurka caloosha, comboridity, taarikhda, daaweynta PPI, iyo adkeynta daaweynta ayaa la xiriirta sicirka ciribtirka. Intaas waxaa sii dheer, qaar ka mid ah cudurrada daba-dheeraada, sida cudurka macaanka, cudurka kelyaha ee daba-dheeraada, cudurka kelyaha ee daba-dheeraada, iyo cudurka sambabka ee daba-dheeraada, iyo cudurka sambabka ee daba-dheeraada ayaa sidoo kale laxiriira heerka daminta ee HP. Si kastaba ha noqotee, natiijooyinka daraasadda hadda jira isku mid ma aha, daraasado dheeri ahna waa loo baahan yahay.