J Gastroenterology:基于Vonoprazan的三联疗法均可有效根除幽门螺杆菌

2020-09-22 MedSci原创 MedSci原创

已知幽门螺杆菌感染会引起上消化道疾病,例如慢性胃炎,消化性溃疡和胃癌。

        已知幽门螺杆菌感染会引起上消化道疾病,例如慢性胃炎,消化性溃疡和胃癌。胃癌患者中90%以上的患者均有幽门螺杆菌的感染,根除幽门螺杆菌有助于降低胃癌的风险。但是,近年来幽门螺杆菌根除率的下降已成为一个主要问题。克拉霉素(CAM)耐药是导致治疗失败的主要因素之一。由于根除率取决于耐药细菌的局部流行程度,因此尝试了多种治疗方法,包括序贯治疗,四联治疗,联合治疗和大剂量双重治疗,在日本,据报道,使用各种质子泵抑制剂(PPI)的基本疗法的根除率在71.9%至73.9%之间。日本最近报道了Vonoprazan(VPZ)疗法有效性的几项研究的结果。VPZ是一种新型的钾竞争酸阻滞剂,已于2015年在日本获得批准用于根除幽门螺杆菌。VPZ与常规PPI的不同之处在于,它通过抑制胃壁细胞中的H + / K + -ATPase活性来降低胃酸分泌。VPZ不需要酸活化,在中性pH下更稳定,并且对环境pH的敏感性较小,在一项随机双盲III期研究中,基于VPZ的一线三联疗法(使用阿莫西林[AMPC]和CAM)的根除率为92.6%,即使在CAM抵抗患者中,根除率也能达到82.0%,显着高于传统PPI处理的结果。因此,本项研究旨在评估基于VPZ的三联疗法作为根除幽门螺杆菌的一线方案的有效性和安全性,以及其与克拉霉素(CAM)敏感性的关系。

 

        研究人员在2015年5月至2017年9月间,前瞻性纳入接受食管胃十二指肠镜检查并接受CAM敏感性测试的幽门螺杆菌感染患者于本试验中。患者每天接受两次为期7天的三联疗法(VAC),分别为VPZ(20 mg),阿莫西林(750 mg)和CAM(200 mg)。最后研究人员评估了幽门螺杆菌根除率,CAM易感性和安全性之间的关系。

 

 

        结果显示:146例患者(中位年龄:63岁,范围:22-85岁)(其中60%为女性)接受VAC治疗,131例患者进行了13 C-尿素呼气试验以评估根除成功率。CAM抵抗的患病率为34.2%。每个方案(PP)和“治疗意图”(ITT)分析中VAC的总体根除率分别为90.8%(n  = 131)和81.5%(n  = 146)。在针对CAM敏感性的PP分析中,VAC的根除率在CAM敏感 株(91.6%,n  = 83)和CAM耐药株(89.4%,n = 47)之间是有统计学差异的。

 

        最后研究人员说道,日本三分之一的患者中普遍存在耐CAM的幽门螺杆菌菌株。不论CAM敏感性如何,基于VPZ的三联疗法均非常有效且耐受性良好。因此,它可能是幽门螺杆菌感染的有价值的一线治疗方案。

 

原始出处:

Hidetaka Okubo. Et al. Vonoprazan-based triple therapy is effective for Helicobacter pylori eradication irrespective of clarithromycin susceptibility. J Gastroenterology. 2020.

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24 00:22:59 CST 2020, time=2020-09-24, status=1, ipAttribution=)]
    2021-07-04 许安
  5. 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  7. 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    2020-09-24 言西早

    根除幽门螺旋杆菌是治疗根本。

    0

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