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幽门螺杆菌感染的治疗:当前见解与未来展望

Treatment of Helicobacter pylori infection: Current and future insights.

作者信息

Safavi Maliheh, Sabourian Reyhaneh, Foroumadi Alireza

机构信息

Maliheh Safavi, Department of Biotechnology, Iranian Research Organization for Science and Technology, Tehran 13353-5111, Iran.

出版信息

World J Clin Cases. 2016 Jan 16;4(1):5-19. doi: 10.12998/wjcc.v4.i1.5.

Abstract

Helicobacter pylori (H. pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide. H. pylori treatment still remains a challenge, since many determinants for successful therapy are involved such as individual primary or secondary antibiotics resistance, mucosal drug concentration, patient compliance, side-effect profile and cost. While no new drug has been developed, current therapy still relies on different mixture of known antibiotics and anti-secretory agents. A standard triple therapy consisting of two antibiotics and a proton-pump inhibitor proposed as the first-line regimen. Bismuth-containing quadruple treatment, sequential treatment or a non-bismuth quadruple treatment (concomitant) are also an alternative therapy. Levofloxacin containing triple treatment are recommended as rescue treatment for infection of H. pylori after defeat of first-line therapy. The rapid acquisition of antibiotic resistance reduces the effectiveness of any regimens involving these remedies. Therefore, adding probiotic to the medications, developing anti-H. pylori photodynamic or phytomedicine therapy, and achieving a successful H. pylori vaccine may have the promising to present synergistic or additive consequence against H. pylori, because each of them exert different effects.

摘要

幽门螺杆菌(H. pylori)是全球范围内消化性溃疡疾病以及胃恶性肿瘤(如黏膜相关淋巴组织淋巴瘤和胃腺癌)的重要主要病因。幽门螺杆菌治疗仍然是一项挑战,因为成功治疗涉及许多决定因素,如个体对一线或二线抗生素的耐药性、黏膜药物浓度、患者依从性、副作用情况和成本。虽然尚未开发出新药物,但目前的治疗仍依赖于已知抗生素和抗分泌剂的不同组合。一种由两种抗生素和一种质子泵抑制剂组成的标准三联疗法被提议作为一线治疗方案。含铋四联疗法、序贯疗法或非铋四联疗法(联合疗法)也是替代疗法。含左氧氟沙星三联疗法被推荐作为一线治疗失败后幽门螺杆菌感染的挽救治疗。抗生素耐药性的迅速产生降低了任何涉及这些药物的治疗方案的有效性。因此,在药物中添加益生菌、开发抗幽门螺杆菌光动力疗法或植物医学疗法以及成功研发幽门螺杆菌疫苗可能有望对幽门螺杆菌产生协同或相加作用,因为它们各自发挥不同的作用。

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