Nghiên cứu tỷ lệ kháng clarithromycin, levofloxacin của helicobacter pylori bằng epsilometer và hiệu quả của phác đồ EBMT ở bệnh nhân viêm dạ dày mạn tt

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Ngày đăng: 17/04/2018, 22:51

BỘ GIÁO DỤC ĐÀO TẠO ĐẠI HỌC HUẾ TRƯỜNG ĐẠI HỌC Y DƯỢC ĐẶNG NGỌC QUÝ HUỆ NGHIÊN CỨU TỶ LỆ KHÁNG CLARITHROMYCIN, LEVOFLOXACIN CỦA HELICOBACTER PYLORI BẰNG EPSILOMETER HIỆU QUẢ CỦA PHÁC ĐỒ EBMT BỆNH NHÂN VIÊM DẠ DÀY MẠN Chuyên ngành: NỘI TIÊU HOÁ Mã số: 62 72 01 43 TÓM TẮT LUẬN ÁN TIẾN SĨ Y HỌC HUẾ - NĂM 2018 Cơng trình nghiên cứu hoàn thành tại: Đại học Huế Trường Đại học Y Dược Huế Người hướng dẫn khoa học: PGS TS TRẦN VĂN HUY Phản biện 1: ……………………………………………… Phản biện 2: ……………………………………………… Phản biện 3:……………………………………………… Luận án bảo vệ trước Hội đồng chấm luận án cấp Đại học Huế, họp tại: số 3, Lợi, Thành phố Huế vào lúc: … …, ngày … tháng … năm 201… Có thể tìm hiểu luận án tại: Thư viện Quốc gia Việt Nam Trung tâm học liệu Huế Thư viện Trường Đại học Y Dược Huế ĐẶT VẤN ĐỀ Tính cấp thiết đề tài Viêm dày mạnHelicobacter pylori (H pylori) yếu tố nguy quan trọng với ung thư dày Tổ chức Y tế giới xác định điều trị tiệt trừ H pylori biện pháp chủ yếu ngăn ngừa ung thư dày Trong điều trị tiệt trừ H pylori, clarithromycin (CLR) kháng sinh quan trọng phác đồ ba thuốc chuẩn theo kinh nghiệm lần đầu levofloxacin (LVX) kháng sinh quan trọng phác đồ lần hai Phác đồ ba thuốc có CLR có hiệu cao tỷ lệ H pylori đề kháng CLR 40 years old was higher in the age group < 40, with OR= 2.23 (95%CI 1.214.12) However in our study, the age group that was likely to be infected with H pylori resistance to CLR started at a lower age (≥ 30 years old) Increasing use of macrolides for the treatment of respiratory and urinary infections increasing the exposure of H pylori infection with this drug It is reason why resistance to CLR is higher in the older adults 4.2.4.3 History of treatment H pylori and CLR resistance Our results indicated that a history of treatment H pylori was an independent risk factor to CLR resistance H pylori (Table 3.8) This finding was consistent with the findings that patients with eradication therapy failure have a higher risk of resistance to CLR than those without treatment by Shiota, Wuppenhorst and Lee 21 4.2.5 Characteristic analysis of patients with LVX-resistant H pylori and some related factors 4.2.5.3 History of treatment H pylori and LVX resistance We did not find relation between patients with history of treatment H pylori and the rate of LVX resistance H pylori (Table 3.9), which was similar to the results of Shiota’s study showing that historic factor of treating with H pylori is only significant in univariate analysis and is no longer significant in multivariate analysis This was similar with Boyanova’s remark when explaining the likely of infected with LVX resistance H pylori in patients after treatment failure with LVX-based triple therapy 4.3 ANALYSIS OF RESULTS OF H PYLORI ERADICATION BY EBMT REGIMEN IN PATIENTS WITH CHRONIC GASTRITIS, MEDICATION ADHERENCE, SIFE EFFECTS AND SOME RELATED FACTORS AFFECTING THE EFICACY OF ERADICATION THERAPY 4.3.1 Analysis of treatment results according to patient characteristics 4.3.1.1 Results of H pylori eradication by patient object - In our study, the overall H pylori eradication results of all patients treated by 10-day EBMT was 80.7% in ITT analysis (Table 3.14) and 89.3% in PP analysis (Table 3.15) Our results were lower than that of Dore (2002), the author achieved 95% of eradication rate (ITT) and 98% (PP) with PBMT regimen (total MTZ and bismuth doses were equal, total TET and omeprazole doses were lower than our; with twice daily, 14-day course), treatment for 76 naïve patients and 42 patients who had failed one or more eradication therapies This can be explained by the fact that Dore’s study had fewer daily doses than we did, that helped patients adhere better to treatment, resulting in higher eradication efficacy On the other hand, Dore’s treatment adherence threshold was ≥90%, higher than our (≥80%) and 14-day course of Dore was also longer than our 10-day course, which helps to increase the rate of H pylori eradication - The rate of H pylori eradication in first-line therapy patients were 79.5% by ITT (Table 3.14) and 90.7% by PP (Table 3.15), similar to Malfertheiner (2011) when using PBMT regimen including omeprazole and “3-in-1” pills (containing TET, MTZ and bismuth) for the treatment of 22 H pylori eradication, which resulted in 80% eradication by ITT and 93% by PP However, our results of H pylori eradication were higher than those of Uygun (2007), the author’s results were 70% for ITT and 82.3% for PP This is due to the fact that we were using esomeprazole more effectively than other PPIs (Wang X) and high-dose PPIs were more effective than the standard dose (Villoria A) Furthermore, the percentage of patients excluded from our PP analysis was 9.6% lower than Uygun’s 15% (18/120 patients) - In 24 patients of second-line therapy, the rate of H pylori eradication was 91.7% (Table 3.14, 3.15) in both ITT and PP analysis These results were lower than that of Tran Thien Trung with the eradication rate of 93.3% by ITT and 95.7% by PP, when the author used EBMT regimen for H pylori treatment in 26 patients with treatment failure Our results of H pylori eradication were lower than that of Tran Thien Trung because the author used both higher doses of MTZ (1500 mg/day versus our 1000 mg/day), and longer course duration (14 days versus our 10 days), which can help that regimen to overcome the impact of MTZ resistant strains 4.3.4 Analysis of treatment results according to adherence 4.3.4.2 The rate of H pylori eradication and level of adherence Our results showed that the eradication rate in patients with high levelgood medication adherence was 91.0%, higher than in those with low level-good medication adherence, which was only 50.0%, p = 0.017 (Table 3.28) Analysis from our results indicated that: among the good medication adherence patients who taking ≥80% of the prescribed medicine, those were adherent >90% of the prescribed medicine will have a higher eradication rate, which was statistically significant 4.3.5 Analysis of regimen’s side effects and treatment outcomes 4.3.5.1 Frequency of side effects The rate of patients met side effects in our study was 81.9% (Table 3.30) This rate was insignificantly higher than that of other studies, for example, Katelaris’s 78%, De Boer’s 75.5% and O'Morain’s 73.8% 4.3.6 Factors affecting H pylori eradication 4.3.6.6 Relation between adherence and eradication outcomes Our study showed that although having the same good adherence level, characteristic of high level-good medication adherence patients 23 was independent factor, positively correlated with the eradication result in multivariate analysis, with OR= 13.4 (95% CI 2.1-86.7), p = 0.006 (Table 3.34) So far, through medical literature, we found that our study is the first to address this issue: the possibility of H pylori eradication in high level-good medication adherence patients is 13.4 times higher than the possibility of H pylori eradication in low level-good medication adherence patients CONCLUSIONS Based on the study of 176 patients with Helicobacter pyloriassociated chronic gastritis to investigate the clarithromycin, levofloxacin resistance by Epsilometer, and evaluate the eradication efficacy of 10-day EBMT regimen at Thong Nhat-Dong Nai general hospital, we draw the following conclusions: The rate of resistance in H pylori to clarithromycin and levofloxacin investigated by Epsilometer in patients with chronic gastritis and some related factors associated with antibiotic resistance 1.1 The rate of resistance in H pylori to clarithromycin and levofloxacin - Overall rate of resistance in H pylori to clarithromycin is 72.5% The clarithromycin resistance rate in patients with history of eradication failure is 94.3%, higher than in naïve patients, which is 66.1%, p
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