Abdulkhakov S R, Bordin D S, Abdulkhakov R A, Safina D D, Gizdatullina A R, Gimadieva L Z, Safina G M, Ziyatdinov A I, Maturina A M, Nyssen O P, Megraud F, O'Morain C, Perez-Gisbert J
Kazan Federal University.
Kazan State Medical University.
Ter Arkh. 2020 Sep 3;92(8):52-59. doi: 10.26442/00403660.2020.08.000758.
As part of an observational multicenter prospective study European Registry on the management of Helicobacter pylori infection, conducted on the initiative of the European H. pylori and Microbiota Study Group, the compliance of clinical practice in the management of patients with Helicobacter pylori infection in Kazan with clinical guidelines was assessed.
The data of 437 patients included into the register by clinical sites in Kazan in 20132019 were analyzed. The methods used for the initial diagnosis of H. pylori infection and eradication control were evaluated. The frequency of various eradication therapy regimens prescription was analyzed in 379 cases. Data regarding the effectiveness of eradication therapy was analyzed in 173 patients.
The rapid urease test (44.2% of cases) and cytology/histology (60% of cases) were most often used for the initial diagnosis of H. pylori infection; however non-invasive methods such as 13C-urea breath (9.2%), serology (6.2%), H. pylori stool antigen test (2.3%) were less common. In 21.7% of patients two methods of H. pylori detection were used for primary diagnosis. The control test to evaluate the effectiveness of eradication therapy at the recommended timepoint was performed in 46.2% of patients. 13C-urea breath test (31.7%), stool PCR/stool antigen test (28.7%), rapid urease test (22.3%), cytology/histology (26.2% of cases) prevailed in the assessment of eradication rate. Standard triple therapy, including proton pump inhibitor, clarithromycin and amoxicillin was most commonly prescribed as first-line therapy (64.6% of cases). The duration of eradication therapy was 14 days in the majority of cases with pantoprazole as the most common proton pump inhibitor in standard triple therapy regimens (84.8%). The efficacy of 14-day standard triple therapy (mITT) was 87.0%.
The results indicate a high frequency of non-invasive methods use for assessing the effectiveness of eradication therapy; however, the overall rate of eradication efficacy assessment is low, limiting the possibility of analyzing the eradication results. The effectiveness of the most common 14-day standard triple first-line therapy in Kazan doesnt reach the recommended 90% eradication level. This could be explained by high rate of pantoprazole use, which is not an optimal proton pump inhibitor in eradication therapy regimens.
作为一项观察性多中心前瞻性研究——欧洲幽门螺杆菌感染管理登记研究（由欧洲幽门螺杆菌与微生物群研究组发起）的一部分，评估了喀山地区幽门螺杆菌感染患者管理的临床实践与临床指南的符合情况。
分析了2013年至2019年喀山临床站点纳入登记册的437例患者的数据。评估了用于幽门螺杆菌感染初始诊断和根除控制的方法。分析了379例患者中各种根除治疗方案的处方频率。分析了173例患者根除治疗有效性的数据。
快速尿素酶试验（44.2%的病例）和细胞学/组织学检查（60%的病例）最常用于幽门螺杆菌感染的初始诊断；然而，非侵入性方法如¹³C尿素呼气试验（9.2%）、血清学检查（6.2%）、幽门螺杆菌粪便抗原检测（2.3%）使用较少。21.7%的患者使用两种幽门螺杆菌检测方法进行初步诊断。46.2%的患者在推荐时间点进行了评估根除治疗有效性的对照试验。¹³C尿素呼气试验（31.7%）、粪便PCR/粪便抗原检测（28.7%）、快速尿素酶试验（22.3%）、细胞学/组织学检查（26.2%的病例）在根除率评估中占主导地位。标准三联疗法，包括质子泵抑制剂、克拉霉素和阿莫西林，最常被作为一线疗法处方（64.6%的病例）。大多数病例中根除治疗的持续时间为14天，泮托拉唑是标准三联疗法方案中最常用的质子泵抑制剂（84.8%）。14天标准三联疗法（意向性分析）的疗效为87.0%。
结果表明用于评估根除治疗有效性的非侵入性方法使用频率较高；然而，根除疗效评估的总体比例较低，限制了分析根除结果的可能性。喀山地区最常见的14天标准三联一线疗法的有效性未达到推荐的90%根除水平。这可能是由于泮托拉唑的高使用率，它在根除治疗方案中不是最佳的质子泵抑制剂。
