I-Hylobacter Pylori (HP), yenye yezona zifo zixhaphakileyo ebantwini. Yinto enomngcipheko kwizifo ezininzi, ezinje nge-gestric ulungelelwa, i-Gastritis, i-Gastric Adenocarcinoma, kunye ne-Lymphoid ye-Lymphoid ye-Lymphoid (Malt) i-lymphoma. Izifundo zibonakalisile ukuba ukupheliswa kwe-HP kungawunciphisa umngcipheko womhlaza we-gestric, ukwandisa izinga lokunyanga izilonda, kwaye okwangoku kufuneka kudityaniswe kunye neziyobisi. Kukho iindlela ezahlukeneyo zokupheliswa kweklinikhi: Unyango lomgca wokuqala wosulelo lubandakanya unyango kathathu kathathu, unyango lwe-quadrruction, unyango olulandelelana, kunye nonyango oluhle kakhulu. Ngo-2007, iKholeji yaseMelika yeGistroeroerology idibanisa unyango kathathu kunye ne-claritthromycin njengonyango lodidi lokuqala lokupheliswa kwabantu abangazange bafumane i-clarithromycin kwaye babengenalo ipenicillin. Nangona kunjalo, kumashumi eminyaka akutshanje, izinga lokupheliswa komgangatho oqhelekileyo kathathu lube ≤80% kumazwe amaninzi. ECanada, izinga lokuchasana kwe-ClarithroMycin inyuke ukusuka kwi-1% ngo-1990 ukuya kwi-11% ngo-2003. Phakathi kwabantu abaphathwayo, izinga lokuchasana neziyobisi lalikwaxelwa ukuba lingaphezulu kwe-60%. Ukunganyangeki kweClaritchromycin kunokuba yeyona nto iphambili yokupheliswa kokungaphumeleli. Ingxelo ye-maastricht iv iNgxelo yokuPhila ngokuxhathisa kakhulu kwi-clarithromycin (i-Paunting engaphezulu kwe-15%), i-Sputul Coupped okanye i-Sputum ePhezulu kunye ne-Sputum, ngelixa i-Cadrux enokusetyenziswa Unyango-sebenzisa unyango kwiindawo ezinokumelana nophantsi kwi-MyCin. Ukongeza kwezi ndlela zilapha ngasentla, iidosi eziphezulu ze-Amoxitistiki ezifana ne-rifampicin, i-firazolidone, levoflone, i-Levofloxacin iphakanyisiwe njengonyango lodidi lokuqala.

Ukuphuculwa konyango kathathu kathathu

1.1 Unyango lwe-quadrupple

Njengoko inqanaba lokupheliswa konyango olusemgangathweni olusemgangathweni liwa, njengonyango, unyango lwe-quadrrupp lunenqanaba eliphezulu lokucofa. I-shaikh et al. Baphathe izigulana ezili-175 ngosulelo lwe-HP, ukusebenzisa uhlalutyo lomgaqo-nkqubo (PP) kunye nenjongo. Iziphumo zenjongo yokunyanga (i-ITT) ihlolisise inqanaba lokupheliswa konyango oluqhelekileyo lonyango: i-PP = i-66% (49/74), i-ITT = 62% (49/79, i-42% I-CI: 51-72); Unyango lwe-quadrruppepple lunenqanaba eliphezulu lokuphelisa: i-91% (102/112, 95%), i-75/10), i-ITT = 78% ye-CI: (77 ~ 70). Nangona inqanaba lokuphumelela kwe-HP lokupheliswa kwe-HP lancitshiswa emva konyango ngalunye olungaphumelelanga, ukunyangwa okuthe kratya kungqineke kunexabiso eliphezulu (95%) njengonyango olusemgangathweni oqhelekileyo. Olunye uphononongo lufikelele kwisigqibo esifanayo: Emva kokusilela konyango olusemgangathweni kunye ne-levobloxacin ye-quadru quadruple yayingama-67%, kuba bafumene i-Pedrugn okanye abafumene izigulana nge I-Cycclic Lactone Antibiotics, unyango lwe-quadrucle quadruad lukhethwa. Ewe kunjalo, ukusetyenziswa konyango lwe-quadruple inamathuba aphezulu kwiziganeko ezimbi, ezinjenge-Nausea, i-Halena, isiyezi, kodwa ngenxa yokuba i-chielly isetyenziswe ngokubanzi eTshayina, kunjalo Kulula ukuyifumana, kwaye unexabiso eliphezulu lokuphelisa lingasetyenziswa njengonyango lokulungisa. Kufanelekile ukukhuthaza ekliniki.

1.2 SQT

I-SQT yayiphathwa nge-PPI + i-Amoxillin kwiintsuku ezi-5, emva koko yanyangwa nge-PPI + iCLARITHROMYCIN + + iMetrocazi-kwiintsuku ezi-5. I-SQT icetyiswa njengangoku njengonyango lodidi lokuqala lwe-HP. Uhlalutyo lwe-meta olwenziwe ngokungacwangciswanga (i-RCTs) eKorea esekwe kwi-SQT yi-79.4% (it) kunye ne-95% (i-ITT), kunye ne-95% (PP), i-95% ye-CI: 1.403 ~ 2.209), Indlela yokusebenzela inokuba yi-5D yokuqala (okanye i-7D) isebenzise i-africhillin yokutshabalalisa ijelo le-clarithromycin ye-efflux kwiseli yeseli, esenza isiphumo se-clarithromycin isebenza ngakumbi. I-SQT ihlala isetyenziswa njengonyango lokungaphumeleli konyango olusemgangathweni oqhelekileyo kwelinye ilizwe. Nangona kunjalo, izifundo zibonise ukuba inqanaba lokupheliswa konyango lonyango (i-82.8%) ngaphezulu kwexesha elide (i-14d) liphezulu kunelo nyango ilungelelwaniso lakudala (76.5%). Olunye uphononongo lufumanise ukuba akukho mahluko ubalulekileyo kwi-HP yokuphelisa i-SQT kunye nonyango olusemgangathweni, olunokuba lunxulumene nenqanaba eliphezulu lokunganyangeki kwe-clarithromycin. I-SQT inekhondo elide lonyango, elinokunciphisa ukuthotyelwa kwesiguli kwaye alifanelekanga kwiindawo ezinokuxhathisa kakhulu kwi-clarithromycin, ke sqt inokuthathwa xa isivumelwano sokuphumelela.

1.3 Unyango lweqabane

Ukuhamba nonyango yi-PPI edibene ne-Amoxillin, iMetrodolisole kunye neClarithromycin. Uhlalutyo lwe-meta lubonise ukuba inqanaba lokupheliswa liphezulu kunonyango olusemgangathweni oqhelekileyo. Olunye uhlalutyo lwe-meta lukwafumanise ukuba inqanaba lokupheliswa (iipesenti ezingama-90) laliphezulu kakhulu kunelo yonyango kathathu oPhezulu (78%). I-maastrichtus iv I-IV iphakamisa ukuba i-SQT okanye iPhicomi eDityani inokusetyenziswa ekungabikho kweengcali, kwaye amazinga asuswayo ale minyango zimbini ziyafana. Nangona kunjalo, kwiindawo apho i-clarithroMycin ichasa i-metronidole, iluncedo ngakumbi ngonyango olucekeceke. Nangona kunjalo, ngenxa yokuba ulupop ohamba nonyango luqukethe iintlobo ezintathu ze-antibatics, ukhetho lwe-antibiotics ziya kuncitshiswa emva kokusilela konyango, ke ngoko akucetyiswa njengesicwangciso sokuqala sonyango ngaphandle kweendawo apho iClatchromcin kunye ne-metrolidole ziyachasa. Uninzi lusetyenziswa kwiindawo ezinokuchasana nophantsi kwi-clarithromycin kunye ne-metronidole.

1.4 Unyango lweDose ephezulu

Izifundo zifumanise ukuba ukwandisa idosi kunye / okanye irenti yolawulo lwe-PPI kunye ne-amoxillin ingaphezulu kwe-90%. Iziphumo ze-bactercicididay kwi-HP ithathwa njengexesha lokuxhomekeka, kwaye ke, isebenza ngakumbi ukonyusa imva kolawulo. Okwesibini, xa i-PH esiswini igcinwa phakathi kwe-3 ne-6, ukuphindaphinda kunokuthintelwa ngokufanelekileyo. Xa i-PH esiswini idlula kwi-6, i-HP ayisayi kuphinda iphinde iphindwe kwaye inomdla kwi-amooxillin. I-Ren et Al iqhutywa luvavanyo olulawulwa ngokungacwangciswanga kwizigulana eziyi-117 ngezigulana ze-HP. Iqela eliphezulu le-Dous lanikwa i-Amoxillin 1G, i-tid kunye ne-rabiprazole 20MG, ibhidi yolawulo inikwe i-Amoxillin 1g, i-rabiprazole. I-10Mg, ibhidi, emva kweeveki ezimbini zonyango, izinga lokupheliswa kwe-HP lalingama-89.8% (it), i-75.9% (it), i-80.0% (PP), P <0.05. Isifundo esivela eUnited States sabonisa ukuba ukusebenzisa i-Elespprazole 40 MG, i-A-Amoxillin 750 MG, iintsuku ezi-3, i-ITT = 72.2% emva kweentsuku ezili-14 zonyango, i-PP = 74.2%. UFranceschi et al. Ukuhlalutywa kwakhona konyango ezintathu: I-1MOLA 30MG, iBid, i-CLARITHOMYCIN 500MG, iBid, iBid, iBid, ibhidi, ibhidi; I-2 i-Dose-Dose Coution: I-Lanssuo Carbazu-30mg, ibhidi, i-clarithroMycin 500mg, ibhidi, i-amocacillin 1000mg, ikhosi yonyango yi-7D; I-3sqt: I-Landoprazole 30MG, ibhidi + i-5000mg bid, i-bid ye-5Grazole i-5mg bid kunye ne-tinidalisog bid ye-5MG yeentsuku ezi-5. Amazinga okupheliswa kweerejista zontathu zonyango yayi: 55%, 75%, kunye ne-73%. Umahluko phakathi konyango lwedosi ephezulu kunye nonyango kathathu oqhelekileyo lwalubaluleke kakhulu, kwaye umahluko wathelekiswa ne-SQT. Ayibalulekanga ngokwezibalo. Ewe, izifundo zibonakalise ukuba i-Omeprazole ephezulu ye-omeprazole kunye ne-Amoxitistin ayizange iphucule ngokufanelekileyo amazinga okupheliswa, mhlawumbi ngenxa ye-cyp2cEpe. Uninzi lwe-PPIs lubhalwe yi-cyp2c19 i-enzyme, ngoko ke amandla e-cyp2c metabolite anokuchaphazela imetabolism ye-PPI. I-Enepprazole ikakhulu yi-cytochrome p450 3 enzyme, enokunciphisa impembelelo ye-cyp2c ukuya kuthi ga kwinqanaba elithile. Ukongeza, ukongeza kwi-PPI, i-AACITIPIN, RIFICINPIN, FIRAFZANONO, Levoflondone, kuyacetyiswa njengendlela ephakamileyo yonyango.

Ukulungiswa kwe-rocial edityanisiweyo

Ukongeza ii-Agents ze-Microfilial yendalo (i-MEA) kunyango olusemgangathweni lunokunciphisa izinto ezimbi, kodwa isambathisela ukuba i-HP yokupheliswa kwe-HP inyuswe. Uhlalutyo lwe-meta lufumanise ukuba unyango kathathu lwe-B. Sphaeroides edibene nonyango kathathu lodwa inyuka i-HP yokuphelisa i-HP yokupheliswa kwe-HP (N = 1.05), ikwanciphise Ukuphendula okungaphambili kubandakanya norhudo. Zhao Baomin et al. Ikwabonisa ukuba indibaniselwano yezicelo ezinokuphucula umgangatho wokupheliswa, kwanasemva kokunqulala ikhosi yonyango, kusekho izinga lokupheliswa. Ukufundisisa izigulana ezingama-85 ezinesigulana esine-HP-ne-HP-I-HP-I-4 ye-Lactobacils 20 MG Bid, i-clarithroMycin 500 MG Bid, kunye ne-tinidalisole 500 MG Bid. . Umahluko kwiqondo lokupheliswa phakathi kwamaqela, kodwa onke amaqela e-alcioticiotion ayeyinto efanelekileyo ukuthintela ukuphendula okuchaseneyo kuneqela elinolawulo, kwaye kwakungekho mahluko ubalulekileyo kwiqela elisebenzayo. Indlela yokuphelisa i-HP i-HP engacacanga, kwaye inokuthintela okanye isebenze ngokukhuphisana kunye nezinto ezinokhuphiswano kunye ne-acids. Nangona kunjalo, ezinye izifundo zifumanise ukuba indibaniselwano ye-piriotics ayiphuculi iqondo lokupheliswa, elinokuhambelana nefuthe elongezelelweyo le-fibiotics kuphela xa intsholongwane ingekho. Kusekho indawo enkulu yophando kwi-stiticis ye-fiotics, kwaye ufuneka ngakumbi kufuna uphando, iikhosi zonyango, iimpawu kunye nexesha lamalungiselelo endlela.

Izinto ezichaphazela i-HP yokupheliswa kwe-HP

Iinxalenye ezininzi ezichaphazela i-HP Ukupheliswa kwe-HP kubandakanya ukuchasana nokuchasa, iminyaka yobudala, imeko yokutshaya, i-binch geritis, i-binch geritis, impendulo ye-bictoric ges, i-Gepricic Geads, kunye ne-cyp2c19 ye-gep2c polymorphism. Ubukho. Izifundo zinike ingxelo yokuba kuhlalutyo olungacacanga, ubudala, indawo yokuhlala, isifo, isifo se-gustroidinal, imbali, imbali, i-PPI, i-Ahlethi yonyango, kunye nokunamathela kunyango zinxulunyaniswa namazinga okupheliswa. Ukongeza, ezinye izifo ezingapheliyo, ezinjengeswekile, i-hypertertered, isifo esingesifo singenasifo, kunye nesifo se-PHIFO ZESIFUNDO, kunye nesifo esinganyangekiyo, kunye nesifo esinganyangekiyo sinokuhambelana nenqanaba lokupheliswa kwe-HP. Nangona kunjalo, iziphumo zofundo lwangoku azifani, kwaye ezinye izifundo ezikhulu ziyafuneka.