I-Helicobacter Pylori (HP), esinye sezifo ezivame kakhulu ezithathelwanayo kubantu. Kuyisici esingozini yezifo eziningi, njengesilonda esingu-gastric, i-gastritis engamahlalakhona, i-gastric adenocarcinoma, kanye ne-lymphoid ehlobene ne-lymphoid (Malt) lymphoma. Ucwaningo lukhombisile ukuthi ukuqedwa kwe-HP kunganciphisa ubungozi bomdlavuza wesisu, kwandise izinga lokulapha izilonda, futhi njengamanje kudingeka ukuthi kuhlanganiswe nezidakamizwa kungaqeda ngokuqondile i-HP. Kunezinhlobonhlobo zezinketho zokuqedwa kwemitholampilo ezitholakalayo: Ukwelashwa komugqa wokuqala wokutheleleka kufaka ukwelashwa okujwayelekile, ukwelashwa okulindelekile, ukwelashwa okulandelanayo, kanye nokwelashwa okuhlangene. Ngo-2007, i-American College of Gastroenterology ihlanganise ukwelashwa kathathu nge -cacithromycin njengokwelashwa okuqala komugqa wokuqedwa kwabantu ababengatholanga i -cacithromycin futhi bekungenalo i-penicillin allergy. Kodwa-ke, emashumini eminyaka amuva nje, izinga lokuqedwa kokwelashwa okujwayelekile kukaTrivelies kube ≤80% emazweni amaningi. ECanada, izinga lokumelana ne -cacithromycin likhuphuke lisuka ku-1% ngonyaka we-1990 liye ku-11% ngonyaka we-2003. Phakathi kwabantu abaphathisiwe, izinga lokumelana nemithi labikwa ukuthi lidlula ama-60%. Ukumelana ne-Acacitrikycin kungaba imbangela eyinhloko yokwehluleka ukuqeda. Umbiko weMaastricht IV ngezindawo ezinokumelana okuphezulu ku -cacithromycin (isilinganiso sokumelana ngaphezulu kwe-15% kuya ku-20%), esikhundleni sokwelashwa okujwayelekile nge-quadruant noma / noma i-carat quadrum therapy nayo ingasetshenziswa njengokwelashwa okuqala I-Welapy ye--line ezindaweni ezinokumelana okuphansi kwi-MyCin. Ngaphezu kwezindlela ezingenhla, imithamo ephezulu ye-PPI plus amoxicillin noma enye i-antibiotic enjengeRifampicin, i-furazolidone, i-levofloxacin nayo iphakanyisiwe njengenye indlela yokwelashwa komugqa wokuqala.

Ukuphuculwa kokwelashwa okujwayelekile

1.1 I-Quadruple Therapy

Njengezinga lokuqedwa kokwelashwa okujwayelekile kokwelapha, njengekhambi, i-quadruple therapy inesilinganiso esiphakeme sokuqalisa. Shaikh et al. Iphathwe iziguli eziyi-175 ngokutheleleka nge-HP, kusetshenziswa ukuhlaziya nge-protocol (PP) nenhloso. Imiphumela yenhloso yokwelapha (ITT) Ukuhlaziya izinga lokuqedwa kokwelashwa okujwayelekile: I-PP = 66% (49/74% CI: 55-76 CI: 55-76), i-ITT = 62% (49/79 (49/79 Ci: 51-72); I-Quadruple Therapy inesilinganiso sokuqedwa okuphezulu: I-PP = 91% (102/112% (102/112, 95% CI: 84-95), ITT = 84%: (102/121, (102/121, 97 ~ 90). Yize inani lempumelelo lokuqedwa kwe-HP lincishiswe ngemuva kokwelashwa ngakunye okuhlulekile, ukwelashwa kwe-Quadruple kwe-tincture kwaba nezinga eliphakeme kakhulu (95%) njengekhambi ngemuva kokwehluleka kokwelashwa okujwayelekile. Olunye ucwaningo luphinde lwafinyelela esiphethweni esifanayo: Ngemuva kokwehluleka kokwelashwa okujwayelekile nokwelashwa okujwayelekile, izinga lokuqedwa kweBarium Quadruple Therapy lalingu-67% no-65%, ngokulandelana, kulabo ababengadli nge-penicillin noma batholile abakhulu ezigulini ezine I-cyclic lactone antibiotic, i-quadruple ye-quadruple eyakhekile nayo iyathandwa. Vele, ukusetshenziswa kweTincture Quadruple Therapy kunamathuba aphezulu emicimbi emibi, efana ne-nausea, isifo sohudo, ubuhlungu besisu, ukunambitheka kwekhanda, njll., Njll.) Kulula ukuyithola, futhi inesilinganiso sokuqedwa okuphezulu ingasetshenziswa njengokwelashwa kokulungiswa. Kufanelekile ukukhuthaza emtholampilo.

1.2 Sqt

I-SQT iphathwe nge-PPI + Amoxicillin izinsuku ezi-5, yabe iphathwe nge-PPI + Ecacitri + Metronidazole izinsuku ezi-5. I-SQT njengamanje inconyelwe njengokwelashwa kokuqalwa komugqa wokuqala we-HP. Ukuhlaziywa kwe-meta kwezilingo eziyisithupha ezilawulwa ngokungahleliwe (i-RCT) eKorea ezisuselwa ku-Sqt zingama-79.4% (i-PP) kanye ne-86.4% (PP) ne-HQ% (pp% ~ 2.209), inqubo kungenzeka ukuthi i-5D yokuqala (noma i-7D) isebenzisa i-amoxicillin ukucekela phansi isiteshi se-Acacitromycin Effact kuWall Cell, okwenza umphumela we -cacithromycin uphumelele kakhudlwana. I-SQT ivame ukusetshenziswa njengekhambi yokwehluleka ukwelashwa okujwayelekile kwamanye amazwe. Kodwa-ke, izifundo zikhombisile ukuthi isilinganiso sokwelashwa okuphezulu (82.8%) isikhathi esandisiwe (14D) siphakeme kunaleso sokwelashwa ngokulandelana kwakudala (76,5%). Olunye ucwaningo luphinde lwathola ukuthi akukho mehluko obalulekile kumanani akwa-HP aradication phakathi kwe-Sqt ne-Triple Therapy, engahle ihlobene nesilinganiso esiphakeme sokuphikiswa kwe -cacithycin. I-SQT inenkambo yendlela ende yokwelashwa, enganciphisa ukulandelwa kweziguli futhi ayilungele izindawo ezinokumelana okuphezulu ku -cacithromycin, ngakho-ke i-SQT ingahle ibhekwe lapho i-contraincow.

1.3 Ukwelapha umngane

Ukwelashwa okuhambisana nakho yi-PPI kuhlangene ne-amooxicazole kanye neMetronidazole ne -cacidromycin. Ukuhlaziywa kwe-meta kuveze ukuthi isilinganiso sokuqalisa sasiphakeme kunokwelashwa okujwayelekile. Okunye ukuhlaziywa kwe-meta kubuye kutholakale ukuthi isilinganiso sokuqalisa (90%) sasiphakeme kakhulu kunalokho kwezokwelapha ezintathu (78%). Ukuvumelana kwe-Maastricht IV kubonisa ukuthi ukwelashwa kwe-SQT noma okuhlangenwe nakho kungasetshenziswa lapho kungekho okulindelwe, futhi amanani okuqothula kwalapha amabili afanayo. Kodwa-ke, ezindaweni lapho ama-Acacitromycin engamelana khona ne-metronidazole, inzuzo ngokwengeziwe ngezokwelapha ezihlangene. Kodwa-ke, ngoba ukwelashwa okuhambisana nalokhu kuqukethe izinhlobo ezintathu zemithi elwa namagciwane, ukukhethwa kwama-antibiotic kuzoncishiswa ngemuva kokwehluleka ukwelashwa, ngakho-ke akunconywa njengohlelo lokuqala lokwelashwa ngaphandle kwezindawo lapho kuvela khona izindawo. Isetshenziswa kakhulu ezindaweni ezinokumelana okuphansi ku -cacithromycin kanye ne-metronidazole.

1.4 Ukwelapha okuphezulu kwedosi

Ucwaningo luthole ukuthi ukukhuphula umthamo kanye / noma imvamisa yokuphathwa kwe-PPI ne-amoxicillin inkulu kune-90%. Umphumela we-bactericidal we-amoxicillin ku-HP kubhekwa njengokuncika isikhathi, ngakho-ke, kusebenza kakhulu ukukhulisa imvamisa yokuphatha. Okwesibili, lapho i-PH esiswini igcinwa phakathi kuka-3 no-6, ukuphindaphinda kungavinjelwa ngempumelelo. Lapho i-PH esiswini idlula ama-6, i-HP ngeke isaphinda futhi inandelele ku-amoxicillin. URen et al waqhuba izivivinyo ezilawulwa ngokungahleliwe ezigulini eziyi-117 ezineziguli ezinhle ze-HP. Iqembu eliphakeme lethamo eliphakeme lanikezwa i-amoxicillin 1g, i-TID ne-rabeprazole 20mg, ibhidi, futhi iqembu lokulawula linikezwe i-amooticillin 1g, i-TID neRabeprazole. I-10mg, ibhidi, ngemuva kwamasonto amabili ukwelashwa, isilinganiso sokuqedwa kwe-HP yeqembu eliphakeme sethamo langama-89.8% (i-93.0% (pp), liphakeme kakhulu kuneqembu elilawulayo: 85.0% (i-PP), P <0.05. Isifundo esivela e-United States sabonisa ukuthi sisebenzisa i-Esomeprazole 40 MG, LD + Amoxicillin 750 mg, izinsuku ezintathu, i-72.2% ngemuva kwezinsuku eziyi-14 zokwelashwa, i-PP = 74.2%. UFranceschi et al. kuhlaziye emuva ngempumelelo ukwelashwa okuthathu: I-1 standard Triple Trapy: I-Lansoola 30mg, ibhidi, i -cacithromycin 500mg, ibhidi, i-amoxIlillin 1000mg, ibhidi, 7d; 2 Ukwelashwa okuphezulu okuphezulu I-3SQT: I-LansopPole 30MG, BID + Amoxicillin 1000mg, Ukwelashwa kwe-BID kwe-5D, i-lansoplere 30mg BID, i-carat the 500mg ibhidi ye-500mg ye-tinidazole kanti ibhidi le-tinidazole 500mg liphathwa izinsuku ezi-5. Izilinganiso zokuqedwa kwama-regimons amathathu ukwelashwa kwakuyi: 55%, 75%, no-73%. Umehluko phakathi kwezokwelapha eziphakeme kanye nokwelashwa okujwayelekile kwezibalo kwakubaluleke kakhulu ngokwezibalo, futhi umehluko waqhathaniswa ne-SQT. Akubalulekile ngokwezibalo. Kuyiqiniso, ucwaningo luye lwabonisa ukuthi ukwelashwa kwe-omeprazole ephezulu ne-amoxicillin akuzange kuthuthukise ngempumelelo amanani okuqothula, mhlawumbe ngenxa ye-CYP2C19 genetype. Iningi le-PPIS lihlaselwe yi-CYP2C19 Enzyme, ngakho-ke amandla e-CYP2C19 gene Metabolite angathinta imetabolism ye-PPI. I-EsomePrazole ikakhulukazi i-Cytochrome P450 3 A4 Enzyme, enganciphisa ithonya le-CYP2C19 gene ngezinga elithile. Ngaphezu kwalokho, ngaphezu kwe-PPI, i-Amoxicillin, i-Rifampicin, i-Furazolidone, i-levefloxacin, nayo inconywa njengenye indlela yokwelashwa kwethamo eliphakeme.

Ukulungiswa kwe-microbial okuhlangene

Ukungeza ama-microbial Ezemvelo Agents (Mea) kuya kokwelashwa okujwayelekile kunganciphisa ukusabela okuhlukile, kepha kusalokhu kuyimpikiswano ukuthi isilinganiso sokuqedwa kwe-HP singandiswa. Ukuhlaziywa kwe-meta kutholwe ukuthi ukwelashwa kathathu kukaB. SPhaeoides kuhlanganiswe nokwelashwa kathathu kuphela kwandise isilinganiso sokuqedwa kwe-HP (4.30, i-RR = L.11), futhi Ukuphendula okunamandla okubandakanya uhudo. UZhao Baomin et al. Kuphinde kwabonisa ukuthi ukuhlanganiswa kwama-probiotics kungathuthukisa kakhulu isilinganiso sokuqalisa, noma ngemuva kokunciphisa inkambo yokwelashwa, kusekhona isilinganiso esiphakeme kakhulu. Ucwaningo lweziguli ezingama-85 ezineziguli ezine-HP-Positives zazingahlelwanga zibe ngamaqembu ama-4 we-lactobacillus 20 MG BID, ecacisiwe 500 mg Bid, kanye ne-Tinidazole 500 mg Bid. , B. CerevisIae, i-lactobacillus ihlanganiswe ne-bifidoobacteria, gcwalisa iphepha eli-1 ocwaningweni olungamaviki ama-4, ucwaningo olutholakele kamuva: Ucwaningo lutholakele Umehluko ngezinga lokuqedwa phakathi kwamaqembu, kepha wonke amaqembu ama-probiotic ayenenzuzo kakhulu ekuvikeleni ukusabela okuphikisayo kuneqembu elilawulayo, futhi kwakungekho mehluko omkhulu ezigabeni ezingezezelwa phakathi kwamaqembu ama-probiotic. Indlela yokuqeda i-HP emangalo ayicaci, futhi ingavimba noma ingasebenzi ngamasayithi anama-adhesion ancintisanayo nezinto ezahlukahlukene ezifana nama-organic acid nama-bacteriopeptides. Kodwa-ke, ezinye izifundo zithole ukuthi ukuhlanganiswa kwama-probiotics akulungiselele isilinganiso sokuqalisa, okungahle kuhlobane nomphumela owengeziwe we-probiotic kuphela lapho ama-antibiotic engasebenzi kuphela. Kusekhona isikhala esihle socwaningo kwizinto ezihlanganyelwe ama-probitootic, futhi ucwaningo olwengeziwe luyadingeka ezinhlotsheni, ezifundweni zokwelashwa, izinkomba kanye nesikhathi sokulungiselela ama-probiotic.

Izici ezithinta isilinganiso sokuqedwa kwe-HP

Izici eziningana ezithinta ukuqedwa kwe-HP zifaka ukumelana namagciwane, isifunda sendawo, iminyaka yokugula, isimo sokubhema, ukuhambisana kwe-atrophic, ukuphendula kwe-PPI, ne-CYP2C19 gene polymorphism. Ukuba khona. Ucwaningo luye lwabika ukuthi ukuhlaziywa okungapheli, ubudala, indawo yokuhlala, umuthi, isifo se-gastrointestinal, i-comorbidity, umlando wokuqothula, i-PPI, inkambo yokwelashwa, kanye nokunamathela ekwelashweni kuhlotshaniswa namanani okuqothula. Ngaphezu kwalokho, ezinye izifo ezingaba khona ezingapheli, ezinjengesifo sikashukela, isifo segazi, isifo sezisongo ezingamahlalakhona, isifo seziguli ezingamahlalakhona, nesifo samaphaphu esingamahlalakhona, nesifo samaphaphu esingamahlalakhona kungahle kuhlobane nokuqedwa kwezinga lokuqedwa kwe-HP. Kodwa-ke, imiphumela yocwaningo lwamanje ayifani, futhi ezinye izifundo ezinkulu ezidingekayo.