更新的第二线治疗的Helicobacter pylori感染:一个叙事审查
Chih-An Shih1,2, Chang-Bih Shie3, Wei-Chen Tai4
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Pingtung County.
由于勒沃素耐药性增加,Helicobacter pylori感染的二线治疗正在发展. 新的四重疗法和高剂量双重疗法现在提供比旧疗法更高的根除率.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 微生物学 微生物学
背景情况:
- 马斯特里赫特六号/佛罗伦萨共识报告建议在二线H.pylori治疗中采用标准的比斯木四倍疗法,含诺的三倍/四倍疗法或质子抑制剂 (PPI) -氨基双疗法.
- 列沃素 - 氨基素三重疗法显示,对抗抗勒沃素耐药的H. pylori菌株的疗效降低,需要采用替代策略.
研究的目的:
- 审查当前的二线H. pylori根除方案,每项协议的根除率超过全球85%.
- 为突出H. pylori救援治疗的新和有效疗法.
主要方法:
- 关于二线H. pylori根除疗法的当前文献的综述.
- 对随机对照试验和对不同治疗方案进行比较的元分析的分析.
- 专注于实现 >85% 根除率的疗法.
主要成果:
- 一种新型的四重疗法显示,每项方案的根除率为98%,明显高于三重疗法 (69%).
- 高剂量的PPI-阿莫西西林双疗法在台湾实现了89%的根除率.
- 基于诺普拉桑的疗法在二线H. pylori根除方面表现优于基于PPI的疗法.
结论:
- 由于耐药性,利沃素-氨基西林三重治疗对于二线H. pylori治疗是不理想的.
- 推的二线疗法包括标准的比斯木斯四倍疗法,四环素-莱沃弗洛克萨四倍疗法,阿莫西林-莱沃弗洛克萨四倍疗法,基于莱沃弗洛克萨的顺序四倍疗法,以及高剂量PPI-阿莫西林双疗法.
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