Integrated treatment of refractory Helicobacter pylori infection with Traditional Chinese and Western Medicine——the coordination and unity of "consensus plan" and "personalized treatment"
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摘要: 幽门螺杆菌(Helicobacter pylori，HP)是胃癌的独立危险因素，根除HP可显著降低胃癌的发生率，但根除成功率始终不能令人满意，根除方案不断更迭。遗憾的是，随着抗生素的应用越来越多，疗程越来越长，HP对抗生素的耐药性也在逐年升高，难治性HP感染(refractory Helicobacter pylori infection，RHPI)应运而生，成为当前亟需攻克的严峻课题。在此背景下，国内学者逐渐探索出中西医整合治疗RHPI的新路径。笔者试梳理RHPI的治疗难点，解析相关共识处理方案，汇总中西医结合治疗RHPI的研究进展，寻找中医药治疗RHPI的优势环节与作用机制，以期为中西医整合治疗RHPI的相关临床与科研工作提供发展方向与思路。
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关键词:
- 难治性幽门螺杆菌感染 /
- 中西医整合 /
- 共识方案 /
- 个体化治疗
Abstract: Helicobacter pylori(H.pylori) is an independent risk factor for gastric cancer. Eradicating H.pylori can significantly reduce the incidence of gastric cancer, but the success rate of eradication remains unsatisfactory, and eradication plans continue to change. Unfortunately, with the increasing use of antibiotics and longer treatment courses, the resistance of H.pylori to antibiotics is increasing year by year. Refractory H.pylori infection(RHPI) has emerged, becoming a serious issue that urgently needs to be overcome. In this context, domestic scholars have gradually explored a new path of integrating Traditional Chinese and Western Medicine to treat RHPI. The author attempts to sort out the treatment difficulties of RHPI, analyze relevant consensus treatment plans, summarize relevant research progress, search for the advantages and mechanisms of Traditional Chinese Medicine in treating RHPI, in order to provide development direction and ideas for the clinical and scientific research work of integrating Traditional Chinese and Western Medicine in the treatment of RHPI. -
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表 1 RHPI的定义
时间 共识标题 国家及机构 定义 1999 A practical approach to patients with refractory Helicobacter pylori infection，or who are re-infected after standard therapy[7] 德国，马格德堡大学医院 经根除治疗后HP仍持续存在或复发 2018 全国中西医整合治疗幽门螺杆菌相关“病-证”共识[8] 中国，全国中西医整合幽门螺杆菌处理共识专家组 ①在3年内连续按“共识”中的“铋剂四联疗法”治疗失败≥3次；②每次疗程10~14 d(其中14 d疗程≥1次)；③每次治疗都按共识要求完成全疗程；④符合治疗适应证。 2021 AGA clinical practice update on the management of refractory Helicobacter pylori infection：expert review[9] 美国，美国胃肠病学会 按照共识方案治疗失败1次 2022 2022中国幽门螺杆菌感染治疗指南[10] 中国，中华医学会消化病学分会幽门螺杆菌学组 连续规范的不同药物组合方案根除治疗≥2次仍未成功 
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