抗幽门螺杆菌感染的研究进展

Advancements in studies on combatting Helicobacter pylori infection

幽门螺杆菌(Hp)是胃炎、消化性溃疡病原菌,其感染遍及全球,感染率居高不下。抗菌药在胃的酸性环境中效果差,因而需同时针对细菌和胃酸进行治疗。奥美拉唑和阿莫西林曾是经典的杀菌和抗酸二联疗法,随后发展成三联疗法,即铋剂或质子泵抑制剂+2种抗菌药;随着抗菌药物耐药性的增加,开始使用新型钾离子竞争性酸阻断剂沃诺拉赞(VPZ)替代的三联疗法,在克拉霉素耐药率高的地区采用铋四联疗法,但仍难以阻挡根除率下降的趋势。科学家在继续深入研究耐药机制的同时,也在寻找非抗菌药物的策略。益生菌辅助疗法和Hp疫苗有望提高根除率,刺激响应材料也显示出根除Hp的潜力,特别是改变胃液中的氧环境使Hp无法存活的思路为根除提供了新的策略。

Helicobacter pylori(Hp)is the causative agent of gastritis and peptic ulcers,and its infection is worldwide,with a high rate of infection.Antimicrobials are ineffective in the acidic environment of the stomach,thus requiring treatments that target both bacteria and stomach acid.Omeprazole and amoxicillin were the classic bactericidal and antacid combination therapy,and then developed into triple therapy,i.e.,bismuth or proton pump inhibitor+2 antimicrobials.With the increase of antimicrobial drug resistance,the triple therapy replaced by the new potassium-competitive acid-blocking agent started to be used,and bismuth quadruple therapy was adopted in areas with high rate of clarithromycin resistance,but it was still difficult to stop the declining trend of the eradication rate.Scientists are searching for strategies with non-antimicrobial drugs while continuing to delve into the mechanisms of resistance.Probiotic-assisted therapies and Hp vaccines are expected to improve eradication rates,and stimuli-responsive materials also show potential for eradicating Hp,especially the idea of altering the oxygen environment in the gastric juice so that Hp cannot survive offers a new strategy for eradication.