I-Helicobacter pylori (Hp), esinye sezifo ezithathelwanayo eziqhelekileyo kubantu. Ingumngcipheko wezifo ezininzi, ezifana ne-gastric ulcer, i-gastritis engapheliyo, i-gastric adenocarcinoma, kunye ne-mucosa-associated lymphoid tissue (MALT) lymphoma. Uphononongo lubonise ukuba ukupheliswa kwe-Hp kunokunciphisa umngcipheko womhlaza wesisu, ukwandisa izinga lokunyanga izilonda, kwaye ngoku kufuneka kudityaniswe namachiza kunokuphelisa ngokuthe ngqo i-Hp. Kukho iintlobo ngeentlobo zokhetho lwezonyango olukhoyo olukhoyo: unyango lodidi lokuqala losulelo lubandakanya unyango oluqhelekileyo oluphindwe kathathu, unyango lwe-expectorant quadruple therapy, unyango olulandelelanayo, kunye nonyango oluhambisanayo. Ngo-2007, i-American College of Gastroenterology yadibanisa unyango oluphindwe kathathu kunye ne-clarithromycin njengonyango lokuqala lokuphelisa abantu abangazange bafumane i-clarithromycin kwaye bangenayo i-penicillin allergy. Nangona kunjalo, kumashumi eminyaka akutshanje, izinga lokuphelisa unyango oluqhelekileyo oluphindwe kathathu lube ngu-≤80% kumazwe amaninzi. EKhanada, izinga loxhathiso lwe-clarithromycin linyukile ukusuka kwi-1% ngo-1990 ukuya kwi-11% ngo-2003. Ukunganyangeki kwe-Clarithromycin kunokuba ngoyena nobangela wokusilela kokuphelisa. Ingxelo yemvumelwano kaMaastricht IV kwimimandla enokuxhathisa okuphezulu kwe-clarithromycin (izinga loxhathiso ngaphezu kwe-15% ukuya kwi-20%), ibuyisela unyango oluqhelekileyo oluphindwe kathathu ngonyango lwe-quadruple okanye olulandelelanayo kunye ne-expectorant kunye/okanye akukho sputum, ngelixa unyango lwe-carat Quadruple lungasetyenziswa njengonyango lokuqala. -unyango lomgca kwiindawo ezinokumelana okuphantsi kwe-mycin. Ukongeza kwezi ndlela zingasentla, iidosi eziphezulu zePPI kunye ne-amoxicillin okanye ezinye izibulala-ntsholongwane ezifana ne-rifampicin, i-furazolidone, i-levofloxacin nazo ziye zacetyiswa njengolunye unyango lodidi lokuqala.

Ukuphuculwa konyango oluqhelekileyo lwesithathu

1.1 Unyango oluphindwe kabini

Njengoko umyinge wokuphelisa unyango oluqhelekileyo oluphindwe kathathu uhla, njengonyango, unyango oluphindwe kane lunezinga eliphezulu lokuphelisa. USheikh et al. uphathwe izigulane ze-175 ezinosulelo lwe-Hp, usebenzisa uhlalutyo lwe-protocol (PP) kunye nenjongo. Iziphumo zenjongo yokunyanga (ITT) uhlalutyo luvavanya izinga lokuphelisa unyango oluqhelekileyo lwe-triple: PP = 66% (49/74, 95% CI: 55-76), ITT = 62% (49/79, 95% CI: 51-72); unyango lwe-quadruple lunezinga eliphezulu lokuphelisa: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI: 77 ~ 90). Nangona izinga lempumelelo yokupheliswa kwe-Hp liye lancitshiswa emva konyango ngalunye olungaphumeleliyo, unyango oluphindwe kane lwe-tincture lubonakalise ukuba linezinga eliphezulu lokuphelisa (95%) njengeyeza emva kokusilela konyango oluphindwe kathathu. Olunye uphononongo luye lwafikelela kwisigqibo esifanayo: emva kokungaphumeleli konyango oluqhelekileyo lwe-triple kunye ne-levofloxacin yonyango oluphindwe kathathu, izinga lokupheliswa kwe-barium quadruple therapy yayingama-67% kunye nama-65%, ngokulandelanayo, kwabo bangenayo i-penicillin okanye bafumene i-penicillin enkulu. I-cyclic lactone antibiotics, unyango lwe-expectorant quadruple luyakhethwa. Ewe kunjalo, ukusetyenziswa kwe-tincture yonyango lwe-quadruple kunamathuba aphezulu okuba neziganeko ezimbi, ezifana nesicaphucaphu, urhudo, iintlungu zesisu, i-melena, isiyezi, intloko ebuhlungu, incasa yesinyithi, njl., kodwa ngenxa yokuba i-expectorant isetyenziswa kakhulu eTshayina kulula ukuyifumana, kwaye inezinga eliphezulu lokuphelisa lingasetyenziswa njengonyango lolungiso. Kufanelekile ukukhuthazwa eklinikhi.

1.2 SQT

I-SQT yaphathwa ngePPI + i-amoxicillin iintsuku ezi-5, emva koko iphathwa ngePPI + i-clarithromycin + metronidazole iintsuku ezi-5. I-SQT ngoku iyacetyiswa njengonyango lokuphelisa lodidi lokuqala lwe-Hp. Uhlalutyo lwe-meta lwezilingo ezithandathu ezilawulwa ngokungahleliwe (RCTs) eKorea ngokusekelwe kwi-SQT yi-79.4% (ITT) kunye ne-86.4% (PP), kunye ne-HQ yokupheliswa kwe-SQT Izinga liphezulu kunonyango oluqhelekileyo lwe-triple, 95% CI: 1.403 ~ 2.209), umatshini unokuthi i-5d yokuqala (okanye i-7d) isebenzise i-amoxicillin ukutshabalalisa umjelo we-clarithromycin efflux kudonga lweseli, okwenza umphumo we-clarithromycin usebenze ngakumbi. I-SQT isoloko isetyenziswa njengeyeza lokusilela kunyango oluqhelekileyo oluphindwe kathathu phesheya. Nangona kunjalo, uphando lubonise ukuba izinga lokuphelisa unyango oluphindwe kathathu (82.8%) kwixesha elongeziweyo (14d) liphezulu kunonyango lwe-classical sequential (76.5%). Olunye uphando luye lwafumanisa ukuba akukho mmahluko obalulekileyo kumazinga okuphelisa i-Hp phakathi kwe-SQT kunye nonyango oluqhelekileyo lwe-triple, enokuthi inxulumene nezinga eliphezulu lokuchasana kwe-clarithromycin. I-SQT inonyango olude lonyango, olunokunciphisa ukuthotyelwa kwesigulane kwaye alufanelekanga kwiindawo ezinokumelana okuphezulu ne-clarithromycin, ngoko ke i-SQT inokuqwalaselwa xa i-contraindications yokusetyenziswa kwe-tincture.

1.3 Unyango lweqabane

Unyango olukhaphayo yiPPI edityaniswe ne-amoxicillin, i-metronidazole kunye ne-clarithromycin. Uhlalutyo lwe-meta lubonise ukuba izinga lokuphelisa laliphezulu kunonyango oluqhelekileyo oluphindwe kathathu. Olunye uhlalutyo lwe-meta luphinde lwafumanisa ukuba izinga lokuphelisa (90%) laliphezulu kakhulu kunonyango oluqhelekileyo lwe-triple (78%). I-Maastricht IV Consensus iphakamisa ukuba i-SQT okanye unyango oluhambelanayo lunokusetyenziswa ngokungabikho kwe-expectorants, kunye namazinga okupheliswa kweendlela ezimbini zonyango ziyafana. Nangona kunjalo, kwiindawo apho i-clarithromycin inganyangekiyo kwi-metronidazole, iluncedo ngakumbi ngonyango oluhambelanayo. Nangona kunjalo, ngenxa yokuba unyango olukhaphayo luneentlobo ezintathu zamayeza okubulala iintsholongwane, ukhetho lwamayeza okubulala iintsholongwane luya kuncitshiswa emva kokungaphumeleli kwonyango, ngoko ke akukhuthazwa njengesicwangciso sokuqala sonyango ngaphandle kweendawo apho i-clarithromycin kunye ne-metronidazole zixhathisa. Isetyenziswa kakhulu kwiindawo ezinokumelana okuphantsi kwe-clarithromycin kunye ne-metronidazole.

1.4 unyango lwedosi ephezulu

Uphononongo lufumanise ukuba ukonyusa idosi kunye/okanye ukuphindaphindwa kolawulo lwePPI kunye ne-amoxicillin likhulu kune-90%. Impembelelo ye-bactericidal ye-amoxicillin kwi-Hp ithathwa njengento exhomekeke kwixesha, kwaye ngoko ke, kusebenza ngakumbi ukwandisa ukuphindaphinda kolawulo. Okwesibini, xa i-pH esiswini igcinwa phakathi kwe-3 kunye ne-6, ukuphindaphinda kunokuvinjelwa ngokufanelekileyo. Xa i-pH esiswini idlula i-6, i-Hp ayisayi kuphinda iphindaphinde kwaye ivakalelwa kwi-amoxicillin. U-Ren et al wenza izilingo ezilawulwa ngokungenamkhethe kwizigulane ze-117 ezinezigulane ezine-Hp. Iqela le-high-dose lanikwa i-amoxicillin 1g, i-tid kunye ne-rabeprazole i-20mg, i-bid, kunye neqela lokulawula lanikwa i-amoxicillin 1g, i-tid kunye ne-rabeprazole. I-10mg, ibhidi, emva kweeveki ze-2 zonyango, izinga lokuphelisa i-Hp yeqela le-dose ephezulu yayiyi-89.8% (ITT), 93.0% (PP), iphezulu kakhulu kuneqela lokulawula: 75.9% (ITT), 80.0% (PP), P <0.05. Uphononongo oluvela eUnited States lubonise ukuba ukusebenzisa i-esomeprazole 40 mg, ld + amoxicillin 750 mg, iintsuku ze-3, ITT = 72.2% emva kweentsuku ze-14 zonyango, PP = 74.2%. Franceschi et al. ihlalutywe ngokuphindaphindiweyo unyango oluthathu: 1 unyango oluqhelekileyo kathathu: lansoola 30mg, ibhidi, i-clarithromycin 500mg, i-bid, i-amoxicillin 1000mg, ibhidi, i-7d; 2 unyango lwedosi ephezulu: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, ikhosi unyango 7d; I-3SQT: i-lansoprazole 30mg, ibhidi + i-amoxicillin 1000mg, ibhidi yonyango ye-5d, i-lansoprazole 30mg ibhidi, i-carat I-500mg ye-bid kunye ne-tinidazole 500mg yaphathwa iintsuku ze-5. Amazinga okupheliswa kweerejimeni ezintathu zonyango ibe: 55%, 75%, kunye nama-73%. Umahluko phakathi konyango lwe-dose ephezulu kunye nonyango oluqhelekileyo lwe-triple lwalubalulekile ngokwezibalo, kwaye umahluko wawuthelekiswa ne-SQT. Ayibalulekanga ngokwezibalo. Ewe kunjalo, izifundo zibonise ukuba idosi ephezulu ye-omeprazole kunye ne-amoxicillin unyango aluzange luphucule ngokufanelekileyo amazinga okuphelisa, mhlawumbi ngenxa ye-CYP2C19 genotype. Uninzi lwe-PPI luxutywe yi-enzyme ye-CYP2C19, ngoko amandla e-CYP2C19 gene metabolite inokuchaphazela i-metabolism ye-PPI. I-Esomeprazole ikakhulu i-metabolized yi-cytochrome P450 3 A4 enzyme, enokunciphisa impembelelo ye-CYP2C19 gene ukuya kwinqanaba elithile. Ukongeza, ukongeza kwi-PPI, i-amoxicillin, i-rifampicin, i-furazolidone, i-levofloxacin, nayo iyacetyiswa njengenye indlela yonyango ephezulu.

Ukulungiselela i-microbial edibeneyo

Ukongeza i-microbial ecological agents (MEA) kunyango olusemgangathweni kunokunciphisa ukusabela okungathandekiyo, kodwa kusaphikiswana ukuba ingaba izinga lokuphelisa i-Hp linganyuswa. Uhlalutyo lwe-meta lufumene ukuba unyango oluphindwe kathathu lwe-B. sphaeroides oludityaniswe ne-triple therapy yodwa yonyusa izinga lokuphelisa i-Hp (izilingo ezi-4 ezilawulwa ngokungahleliwe, n = 915, RR = l.13, 95% CI: 1.05) ~ 1.21), nazo zinciphisa ukusabela kakubi kuquka urhudo. UZhao Baomin et al. Kwakhona kwabonisa ukuba indibaniselwano yeprobiotics inokuphucula kakhulu izinga lokuphelisa, nangona emva kokunciphisa ixesha lonyango, kusekho izinga eliphezulu lokuphelisa. Uphononongo lwezigulane ze-85 ezinezigulane ezine-Hp-positive zifakwe kwi-4 amaqela e-Lactobacillus 20 mg bid, i-clarithromycin 500 mg bid, kunye ne-tinidazole 500 mg bid. , B. cerevisiae, iLactobacillus idibene ne-bifidobacteria, i-placebo ye-1 iveki, gcwalisa i-questionnaire malunga nophando lweempawu ngeveki nganye kwiiveki ze-4, ii-5 ukuya kwii-7 iiveki emva koko ukujonga ukusuleleka, uphando lufumene: iqela le-probiotics kunye nentuthuzelo Kwakungekho nto ebalulekileyo. Umahluko kwireyithi yokuphelisa phakathi kwamaqela, kodwa onke amaqela eprobiotic ayenenzuzo ngakumbi ekuthinteleni ukusabela okungalunganga kuneqela lolawulo, kwaye akukho mahluko ubalulekileyo kwizehlo zokusabela okubi phakathi kwamaqela eprobiotic. Indlela apho i-probiotics iphelisa i-Hp ayikacaci, kwaye inokuthintela okanye ingasebenzi kunye neendawo zokubambelela ezikhuphisanayo kunye nezinto ezahlukeneyo ezifana ne-organic acids kunye ne-bacteriopeptides. Nangona kunjalo, uphando oluthile lufumene ukuba indibaniselwano yeprobiotics ayiliphuculi izinga lokuphelisa, elinokuthi linxibelelene nesiphumo esongezelelweyo seprobiotics kuphela xa ii-antibiotics zingasebenzi. Kusekho indawo enkulu yophando kwi-probiotics edibeneyo, kwaye uphando olongezelelweyo luyafuneka kwiintlobo, izifundo zonyango, izibonakaliso kunye nexesha lamalungiselelo e-probiotic.

Izinto ezichaphazela izinga lokuphelisa i-Hp

Izinto ezininzi ezichaphazela ukupheliswa kwe-Hp zibandakanya ukuxhathisa i-antibiotic, ummandla wejografi, iminyaka yesigulane, isimo sokutshaya, ukuthotyelwa, ixesha lokunyanga, ubuninzi bebhaktheriya, i-atrophic gastritis engapheliyo, i-gastric acid concentration, impendulo yomntu ngamnye kwi-PPI, kunye ne-CYP2C19 gene polymorphism. Ubukho. Uphononongo luye lwaxela ukuba kuhlalutyo olungaguqukiyo, ubudala, indawo yokuhlala, amayeza, isifo sesisu, ukuxhatshazwa, imbali yokuphelisa, i-PPI, ikhosi yonyango, kunye nokubambelela kunyango kuhambelana namazinga okuphelisa. Ukongeza, ezinye izifo ezingapheliyo, ezifana nesifo seswekile, uxinzelelo lwegazi, isifo sezintso esinganyangekiyo, isifo sesibindi esingapheliyo, kunye nesifo semiphunga esinganyangekiyo sinokunxulumana nezinga lokuphelisa i-Hp. Nangona kunjalo, iziphumo zophononongo lwangoku azifani, kwaye ezinye izifundo ezinkulu ziyafuneka.