I-Helicobacter pylori (Hp), esinye sezifo ezithathelwanayo ezivame kakhulu kubantu. Kuyingozi ezifweni eziningi, njengesilonda esiswini, isifo sofuba esingamahlalakhona, i-gastric adenocarcinoma, kanye nezicubu ze-lymphoid ezihambisana ne-mucosa (MALT) lymphoma. Ucwaningo luye lwabonisa ukuthi ukuqedwa kwe-Hp kunganciphisa ingozi yomdlavuza wesisu, kwandise izinga lokwelapha izilonda, futhi okwamanje kudingeka kuhlanganiswe nezidakamizwa kungaqeda i-Hp ngokuqondile. Kunezinhlobonhlobo zezinketho zokuqeda umtholampilo ezitholakalayo: ukwelashwa komugqa wokuqala kokutheleleka kubandakanya ukwelashwa okujwayelekile okuphindwe kathathu, ukwelashwa okuphindwe kane kwe-expectorant, ukwelashwa okulandelanayo, kanye nokwelashwa okuhambisanayo. Ngo-2007, i-American College of Gastroenterology yahlanganisa ukwelashwa okuphindwe kathathu ne-clarithromycin njengendlela yokwelapha yomugqa wokuqala yokuqeda abantu ababengayitholanga i-clarithromycin futhi ababengenayo i-penicillin yokungezwani komzimba. Kodwa-ke, emashumini eminyaka amuva nje, izinga lokuqedwa lokwelashwa okuphindwe kathathu libe ngu-≤80% emazweni amaningi. E-Canada, izinga lokungazweli kwe-clarithromycin lenyuke lisuka ku-1% ngo-1990 laya ku-11% ngo-2003. Phakathi kwabantu abalashwayo, izinga lokumelana nomuthi kwaze kwabikwa ukuthi ledlula ama-60%. Ukumelana ne-Clarithromycin kungase kube imbangela enkulu yokwehluleka ukuqeda. Umbiko wokuvumelana kwe-Maastricht IV ezindaweni ezinokumelana okuphezulu ne-clarithromycin (izinga lokumelana ne-clarithromycin elingaphezu kuka-15% kuya ku-20%), esikhundleni sokwelashwa okuphindwe kathathu ngokwelashwa okuphindwe kane noma okulandelanayo nge-expectorant kanye/noma engenaso isikhwehlela, kuyilapho i-carat Quadruple therapy ingasetshenziswa njengokuqala. -ukwelashwa ngomugqa ezindaweni ezinokumelana okuphansi kwe-mycin. Ngaphezu kwalezi zindlela ezingenhla, imithamo ephezulu ye-PPI kanye ne-amoxicillin noma amanye ama-antibiotic afana ne-rifampicin, i-furazolidone, i-levofloxacin nawo aphakanyiswe njengenye indlela yokwelapha yomugqa wokuqala.

Ukuthuthukiswa kokwelashwa okuphindwe kathathu okujwayelekile

1.1 Ukwelashwa okuphindwe kane

Njengoba izinga lokuqeda lokwelashwa okuphindwe kathathu lehla, njengekhambi, ukwelashwa okuphindwe kane kunezinga eliphezulu lokuqeda. Shaikh et al. belaphe iziguli eziyi-175 ezinokutheleleka nge-Hp, kusetshenziswa ukuhlaziywa kwephrothokholi ngayinye (PP) kanye nenhloso. Imiphumela yenhloso yokwelapha (ITT) ukuhlaziywa ihlole izinga lokuqedwa kokwelashwa okuphindwe kathathu: PP=66% (49/74, 95% CI: 55-76), ITT=62% (49/79, 95% CI: 51-72); Ukwelapha okuphindwe kane kunezinga eliphakeme lokuqeda: PP = 91% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, 95% CI : 77 ~ 90). Nakuba izinga lempumelelo lokuqedwa kwe-Hp lehliswa ngemva kokwelashwa ngakunye okuhlulekile, ukwelashwa okuphindwe kane kwe-tincture kubonakale kunezinga eliphezulu lokuqeda (95%) njengekhambi ngemva kokwehluleka kokwelashwa okuphindwe kathathu. Olunye ucwaningo nalo lwafinyelela esiphethweni esifanayo: ngemva kokwehluleka kokwelashwa okujwayelekile okuphindwe kathathu kanye ne-levofloxacin yokwelashwa okuphindwe kathathu, izinga lokuqedwa kwe-barium quadruple therapy lalingu-67% no-65%, ngokulandelana, kulabo ababengezwani ne-penicillin noma ababethole i-penicillin enkulu Ezigulini ezinesifo sikashukela. I-cyclic lactone antibiotics, i-expectorant quadruple therapy nayo iyakhethwa. Yiqiniso, ukusetshenziswa kwe-tincture therapy quadruple kunamathuba aphezulu okuba nezenzakalo ezimbi, ezifana nesicanucanu, isifo sohudo, ubuhlungu besisu, i-melena, isiyezi, ikhanda elibuhlungu, ukunambitheka kwensimbi, njll., kodwa ngenxa yokuthi i-expectorant isetshenziswa kabanzi e-China, kulula ukuyithola, futhi inezinga eliphezulu lokuqeda lingasetshenziswa njengendlela yokwelapha. Kuyafaneleka ukukhushulwa emtholampilo.

1.2 SQT

I-SQT yelashwa nge-PPI + i-amoxicillin izinsuku ezi-5, yase iphathwa nge-PPI + i-clarithromycin + ne-metronidazole izinsuku ezi-5. I-SQT okwamanje iyanconywa njengokwelashwa kokuqeda umugqa wokuqala we-Hp. Ukuhlaziywa kwe-meta yezilingo eziyisithupha ezilawulwa ngokungahleliwe (RCTs) e-Korea ngokusekelwe ku-SQT ngu-79.4% (ITT) no-86.4% (PP), kanye nokuqedwa kwe-HQ kwe-SQT Izinga liphakeme kunokwelashwa okuphindwe kathathu okujwayelekile, 95% CI: 1.403 ~ 2.209), umshini kungenzeka ukuthi owokuqala ongu-5d (noma u-7d) usebenzise i-amoxicillin ukucekela phansi umzila we-clarithromycin efflux odongeni lweseli, okwenza umphumela we-clarithromycin usebenze kakhulu. I-SQT ivame ukusetshenziswa njengekhambi lokwehluleka kokwelashwa okuphindwe kathathu phesheya. Kodwa-ke, ucwaningo luye lwabonisa ukuthi izinga lokuqeda ukwelashwa okuphindwe kathathu (82.8%) esikhathini esinwetshiwe (14d) liphakeme kunalelo lokwelapha okulandelanayo kwakudala (76.5%). Olunye ucwaningo luphinde lwathola ukuthi kwakungekho umehluko ophawulekayo kumazinga okuqeda i-Hp phakathi kwe-SQT kanye nokwelashwa okuphindwe kathathu okujwayelekile, okungase kuhlotshaniswe nezinga eliphezulu lokumelana ne-clarithromycin. I-SQT inenkambo ende yokwelapha, enganciphisa ukuthobela kwesiguli futhi ayifanele izindawo ezinokumelana okuphezulu ne-clarithromycin, ngakho-ke i-SQT ingacatshangelwa lapho ukuphikisana nokusetshenziswa kwe-tincture.

1.3 Ukwelashwa okuhambisanayo

Ukwelashwa okuhambisanayo yi-PPI ehlanganiswe ne-amoxicillin, i-metronidazole ne-clarithromycin. Ukuhlaziywa kwe-meta kubonise ukuthi izinga lokuqeda laliphezulu kunokwelashwa okuphindwe kathathu. Okunye ukuhlaziywa kwe-meta kuphinde kwathola ukuthi izinga lokuqeda (90%) laliphezulu kakhulu kunalelo lokwelapha okuphindwe kathathu (78%). I-Maastricht IV Consensus iphakamisa ukuthi i-SQT noma i-concomitant therapy ingasetshenziswa uma kungekho ama-expectorants, futhi amazinga okuqedwa kwezindlela zokwelapha ezimbili ezifanayo. Kodwa-ke, ezindaweni lapho i-clarithromycin imelana ne-metronidazole, kunenzuzo enkulu ngokwelashwa okuhambisanayo. Kodwa-ke, ngenxa yokuthi ukwelapha okuhambisana nalokhu kuhlanganisa izinhlobo ezintathu zemithi elwa namagciwane, ukukhethwa kwemithi elwa namagciwane kuzoncishiswa ngemva kokwehluleka kokwelashwa, ngakho-ke akunconywa njengohlelo lokuqala lokwelapha ngaphandle kwezindawo lapho i-clarithromycin ne-metronidazole ingazweli. Isetshenziswa kakhulu ezindaweni ezinokumelana okuphansi kwe-clarithromycin ne-metronidazole.

1.4 ukwelashwa ngethamo eliphezulu

Ucwaningo luthole ukuthi ukwandisa umthamo kanye/noma imvamisa yokuphatha i-PPI ne-amoxicillin kungaphezu kwama-90%. Umphumela we-bactericidal we-amoxicillin ku-Hp uthathwa njengokuncika kwesikhathi, ngakho-ke, kusebenza kahle kakhulu ukukhulisa imvamisa yokuphatha. Okwesibili, lapho i-pH esiswini igcinwa phakathi kuka-3 no-6, ukuphindaphinda kungavinjelwa ngempumelelo. Lapho i-pH esiswini idlula ku-6, i-Hp ngeke isakwazi ukuphindaphinda futhi izwela i-amoxicillin. U-Ren et al wenze izivivinyo ezilawulwa ngokungahleliwe ezigulini eziyi-117 ezineziguli ezine-Hp-positive. Iqembu lomthamo omkhulu lanikezwa i-amoxicillin 1g, tid ne-rabeprazole 20mg, ibhidi, futhi iqembu lokulawula lanikezwa i-amoxicillin 1g, tid ne-rabeprazole. I-10mg, ibhidi, ngemva kwamaviki angu-2 wokwelashwa, izinga lokuqedwa kwe-Hp leqembu le-dose ephezulu lalingu-89.8% (ITT), 93.0% (PP), liphakeme kakhulu kuneqembu lokulawula: 75.9% (ITT), 80.0% (PP), P <0.05. Ucwaningo oluvela e-United States lubonise ukuthi ukusebenzisa i-esomeprazole 40 mg, ld + amoxicillin 750 mg, izinsuku ezingu-3, ​​ITT = 72.2% ngemva kwezinsuku ezingu-14 zokwelashwa, PP = 74.2%. Franceschi et al. ihlaziye kabusha izindlela zokwelapha ezintathu: 1 ukwelashwa okuphindwe kathathu okujwayelekile: i-lansoola 30mg, ibhidi, i-clarithromycin 500mg, ibhidi, i-amoxicillin 1000mg, ibhidi, i-7d; 2 ukwelapha umthamo omkhulu: Lansuo Carbazole 30mg, bid, clarithromycin 500mg, bid, amoxicillin 1000mg, tid, inkambo yokwelashwa 7d; 3SQT: i-lansoprazole 30mg, ibhidi + i-amoxicillin 1000mg, ibhidi yokwelashwa kwe-5d, ibhidi ye-lansoprazole 30mg, i-carat Ibhidi ye-500mg kanye nebhidi ye-tinidazole 500mg zelashwe izinsuku ezi-5. Amazinga okuqedwa kwezinhlobo ezintathu zokwelashwa kube: 55%, 75%, kanye nama-73%. Umehluko phakathi kokwelashwa kwedosi ephezulu kanye nokwelashwa okuphindwe kathathu kwakubalulekile ngokwezibalo, futhi umehluko wawuqhathaniswa ne-SQT. Akubalulekile ngokwezibalo. Vele, ucwaningo selukhombisile ukuthi i-omeprazole yomthamo omkhulu kanye nokwelashwa kwe-amoxicillin akuzange kuwathuthukise ngempumelelo amazinga okuqeda, mhlawumbe ngenxa ye-CYP2C19 genotype. Ama-PPI amaningi ahlanganiswa yi-enzyme ye-CYP2C19, ngakho-ke amandla e-CYP2C19 gene metabolite angase athinte ukuguqulwa kwe-PPI. I-Esomeprazole igaywe ngokuyinhloko yi-cytochrome P450 3 A4 enzyme, enganciphisa umthelela wofuzo lwe-CYP2C19 ngezinga elithile. Ngaphezu kwalokho, ngaphezu kwe-PPI, i-amoxicillin, i-rifampicin, i-furazolidone, i-levofloxacin, nayo iyanconywa njengenye indlela yokwelapha umthamo ophezulu.

Ukulungiswa kwe-microbial okuhlanganisiwe

Ukwengeza ama-microbial ecological agents (MEA) ekwelashweni okujwayelekile kunganciphisa ukusabela okubi, kodwa kuseyimpikiswano ukuthi izinga lokuqeda i-Hp linganyuswa yini. Ukuhlaziywa kwe-meta kutholwe ukuthi ukwelashwa okuphindwe kathathu kwe-B. sphaeroides okuhlanganiswe nokwelashwa okuphindwe kathathu kukodwa kukhuphule izinga lokuqedwa kwe-Hp (izilingo ezilawulwa ngokungahleliwe ezi-4, n=915, RR=l.13, 95% CI: 1.05) ~1.21), nakho kunciphisa ukusabela okubi okuhlanganisa nesifo sohudo. UZhao Baomin et al. iphinde yabonisa ukuthi inhlanganisela yama-probiotics ingathuthukisa kakhulu izinga lokuqeda, ngisho nangemva kokunciphisa inkambo yokwelashwa, kusekhona izinga eliphezulu lokuqeda. Ucwaningo lweziguli ezingama-85 ezineziguli ezine-Hp lwenziwa ngokungahleliwe lwaba ngamaqembu angu-4 ebhidi ye-Lactobacillus 20 mg, i-clarithromycin 500 mg bid, ne-tinidazole 500 mg bid. , B. cerevisiae, i-Lactobacillus ehlangene ne-bifidobacteria, i-placebo yeviki le-1, gcwalisa uhlu lwemibuzo ocwaningweni lwezimpawu masonto onke amaviki angu-4, amaviki angu-5 kuya kwangu-7 kamuva ukuhlola ukutheleleka, ucwaningo lwathola: iqembu le-probiotics nenduduzo Kwakungekho okuphawulekayo umehluko wezinga lokuqeda phakathi kwamaqembu, kodwa wonke amaqembu e-probiotic ayenenzuzo kakhulu ekuvimbeleni ukusabela okubi kuneqembu elilawulayo, futhi kwakungekho umehluko obalulekile ezenzakalweni zokusabela okubi phakathi kwamaqembu e-probiotic. Indlela ama-probiotics aqeda ngayo i-Hp ayikacaci, futhi ingase ivimbele noma ingasebenzi ngezingosi zokunamathela ezincintisanayo nezinto ezihlukahlukene ezifana nama-acids ephilayo nama-bacteriopeptides. Kodwa-ke, ezinye izifundo zithole ukuthi inhlanganisela yama-probiotics ayithuthukisi izinga lokuqeda, okungenzeka lihlobene nomphumela owengeziwe wama-probiotics kuphela lapho ama-antibiotics engasebenzi kahle. Kusenendawo enkulu yocwaningo kuma-probiotics ahlangene, futhi ucwaningo olwengeziwe luyadingeka ngezinhlobo, izifundo zokwelapha, izinkomba kanye nesikhathi sokulungiselela ama-probiotic.

Izinto ezithinta izinga lokuqedwa kwe-Hp

Izici eziningana ezithinta ukuqedwa kwe-Hp zihlanganisa ukumelana nama-antibiotic, isifunda sendawo, iminyaka yesiguli, isimo sokubhema, ukuthobela, isikhathi sokwelashwa, ukuminyana kwebhaktheriya, i-atrophic gastritis engapheli, ukuhlushwa kwe-acid esiswini, ukuphendula komuntu ngamunye ku-PPI, kanye ne-CYP2C19 gene polymorphism. Ubukhona. Ucwaningo luye lwabika ukuthi ekuhlaziyweni okungaguquki, ubudala, indawo yokuhlala, imithi, izifo zesisu, ukugula, umlando wokuqeda, i-PPI, inkambo yokwelashwa, nokubambelela ekwelashweni kuhlotshaniswa namazinga okuqeda. Ngaphezu kwalokho, ezinye izifo ezingalapheki ezingase zibe khona, njengesifo sikashukela, umfutho wegazi ophakeme, isifo sezinso esingamahlalakhona, isifo sesibindi esingamahlalakhona, nesifo samaphaphu esingamahlalakhona kungase kuhlotshaniswe nezinga lokuqedwa kwe-Hp. Kodwa-ke, imiphumela yocwaningo lwamanje ayifani, futhi ezinye izifundo ezinkulu ziyadingeka.