治疗Helicobacter pylori治疗失败的管理:一项基于人口的大型研究 (HP治疗失败试验)
Natsuda Aumpan1,2, Navapan Issariyakulkarn1, Varocha Mahachai2
1Center of Excellence in Digestive Diseases and Gastroenterology Unit, Department of Medicine, Thammasat University, Pathumthani, Thailand.
PloS one
|November 30, 2023
概括
抗微生物敏感性测试 (AST) 提高了Helicobacter pylori根除率,特别是当在治疗失败之前或之后使用时. 不坚持和多重耐药性 (MDR) 预测治疗失败,而量身定制的治疗和特定的阿莫西西林剂量可以提高成功率.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
背景情况:
- 杆菌 (H. pylori) 根除失败是一个重大的临床挑战.
- 确定预测H. pylori治疗成功的因素对于患者的治疗结果至关重要.
研究的目的:
- 确定先前治疗失败的患者中成功根除H. pylori的预测因素.
- 分析抗微生物敏感性测试 (AST) 对治疗结果的影响.
主要方法:
- 对1050名患有H.pylori感染的消化不良患者进行了回顾性队列研究.
- 对人口统计数据,内镜检查结果,H. pylori培养,AST,治疗方案和结果的分析.
- 对治疗成功和失败组进行比较,重点关注抵抗模式和坚持.
主要成果:
- 治疗失败发生在28.7%的患者中.
- 对甲尼达 (43.2%),勒沃素 (33.9%) 和澄胺素 (24%) 观察到高耐药率.
- 多药耐药性 (MDR) 在治疗失败率 (45.5%对15.7%) 中显著较高.
- 药物不服药 (OR 36.6) 和MDR (OR 4.49) 与治疗失败有关.
- 量身定制的抗生素治疗 (OR 4.92) 和高剂量的阿莫西林 (OR 3.05) 改善了成功率.
- 在一线治疗前的AST产生了最高的治愈率 (94.4%vs50%没有AST).
结论:
- 在治疗失败之前或之后进行的AST与更高的根除成功相关.
- 药物不服药和MDR感染是H. pylori治疗失败的关键预测因素.
- 在治疗失败后,量身定制的治疗和特定的阿莫西西林剂量方案是有效的策略.
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