3.影响Hp感染根除率的若干问题探讨.pptVIP

我们先来看一下PPI的代谢途径：大多数PPI主要经肝脏的细胞色素P450酶系统代谢，其中主要的有赖于CYP2C19酶代谢，包括埃索美拉唑，其代谢仍然依赖于CYP2C19酶。而雷贝拉唑与这些PPI相比，其代谢途径有本质的不同，主要为非酶代谢，较少依赖于细胞色素2C19酶，血浆中的主要代谢产物主要是通过非酶还原反应而产生的硫醚结合体。带来的临床意义:因PPI要与NSAID/抗凝药物同用,以预防NSAIDs引起的消化道损伤,雷因主要非酶代谢,与通过P450酶代谢的药物的相互作用小.*第一代PPIs受CYP2C19基因型影响，其临床疗效存在个体间差异及不稳定性。RAB和ESO的代谢与CYP2C19基因型无明显相关性，因此抑酸效应优于以往PPIs。*低，高剂量的雷贝拉唑与奥美拉唑幽门螺杆菌感染的治疗。*希腊研究7,10and14-daysrabeprazole-basedstandardtripletherapiesforH.pylorieradication:aretheystilleffective?Arandomizedtrial*左：Median24-hintragastricpHprofileswithdifferentdosingtimesofrabeprazole40mgdaily右：median24-hpHvalueswithonce,twiceandfourtimesdailydosing(o.m.,b.d.,q.d.s.).*Hepatogastroenterology2003Nov-Dec;50(54):2274-8*Background:InsufficientacidinhibitionduringHelicobacterpylorieradicationtreatmentandbacterialresistancetoantibioticsoftencauseseradicationfailure.Fourtimesdailydosing(q.i.d.)ofaproton-pumpinhibitor(PPI)achievespotentacidinhibition,suggestingitspotentialusefulnessasaregimenforeradicatingH.pyloriinfection.Therefore,atailorederadicationregimenbasedonantibioticsusceptibilityandmaintenanceofacidinhibitionshouldhaveahighsuccessrate.Weinvestigatedtheefficacyofsuchtreatmentbasedonclarithromycin(CAM)susceptibility.Methods:Using153H.pylori-positiveJapanesepatients,weinvestigatedtheefficacyoftailorederadicationstrategy:(1)PatientsinfectedwithCAM-sensitiveH.pyloriweretreatedwithaPPI(rabeprazole10mgq.i.d.),amoxicillin500mgq.i.d.,andCAM200mgb.i.d.(n=89),and(2)patientsinfectedwithCAM-resistantweregiventhesamedosesofrabeprazoleandamoxicillinandmetronidazole250mgb.i.d.(n=64)for1week.Results:Inthetailoredregimengroup,theoveralleradicationratewas96.7%(95%CI:92.5–98.9%,148/153)intheintention-to-treat(ITT)analysisand97.4%(93.4–99.3%,148/152)inthePPanalysis.Theeradicationratesfort