nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-178-6-64-70nogr-1353Research ArticleКЛИНИЧЕСКАЯ ГАСТРОЭНТЕРОЛОГИЯCLINICAL GASTROENTEROLOGYДифференцированный подход к эрадикационной терапии у больных хроническим панкреатитомDifferentiated approach to eradication therapy in patients with chronic pancreatitisСарсенбаеваА. С.SarsenbaevаA. S.

декан ИДПО, кафедра терапии ИДПО, профессор, д. м. н.,

454092, Челябинская область, г. Челябинск, улица Воровского, 64

Dean of the ICPE, Department of Therapy ICPE, Professor, Doctor of Medical Sciences,

64, Vorovskogo str., Chelyabinsk, 454092

ДомрачеваЕ. В.DomrachevaE. V.

аспирант кафедры терапии Института дополнительного профессионального образования,

454092, Челябинская область, г. Челябинск, улица Воровского, 64

graduate student,

64, Vorovskogo str., Chelyabinsk, 454092

agelstar.es@gmail.comЮжно-Уральский государственный медицинский университет Министерства здравоохранения Российской ФедерацииРоссияSouth-Ural State Medical UniversityRussian Federation202003082020066470Copyright © Сарсенбаева А.С., Домрачева Е.В., 20202020Сарсенбаева А.С., Домрачева Е.В.Sarsenbaevа A.S., Domracheva E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1353Цель исследования

Цель исследования. Сравнить эффективность различных схем эрадикационной терапии у больных хроническим панкреатитом с сопутствующим гастритом, ассоциированным с различными генетическими вариантами H. pylori.

Материалы и методы

Материалы и методы: обследовано 63 больных с хроническим панкреатитом и сопутствующим Helicobacter pylori-ассоциированным гастритом. Группу контроля составили 45 больных с хроническим гастритом. Диагностика хронического панкреатита базировалась на анамнестических, клинических данных, инструментальных исследованиях (МСКТ). Диагностика инфекции H. pylori проводилась морфологическим методом, уреазным дыхательным тестом 13С, методом иммуноблоттинга. Статистическая обработка проводилась с использованием пакетов прикладных программ SPSS Statistic 17.0.

Результаты

Результаты. У больных с хроническим панкреатитом CagA-позитивные штаммы H. pylori встречались на 19,3% реже по сравнению с группой контроля (р<0,05), VacA-позитивные—на 21,9% реже (p<0,05). В исследуемой группе достоверно чаще встречались гены H. pylori, кодирующие выработку уреазы А и гены, кодирующие синтез белков наружной мембраны H. pylori (р33, р30, р29, р26, р19, р17). В группе больных с хроническим панкреатитом стандартная тройная терапия 1 линии с включением висмута трикалия дицитрата оказалась эффективнее на 86,8% (p<0,01) по сравнению со стандартной тройной терапией 1 линии, причем максимальный прирост эффективности отмечен у обладателей штаммов H. pylori, экспрессирующих уреазу А и с представительством на наружной мембране белков р30, р33, р26, р19, р17 (р<0,01).

Заключение

Заключение. Эрадикационная терапия у пациентов с хроническим панкреатитом при наличии у H. pylori комплекса патогенности р30, р33, уреаза А, р26, р19, р17, по протоколу стандартной тройной терапии 1 линии с включением висмута трикалия дицитрата обладает преимуществами по сравнению с протоколом стандартной тройной терапии 1 линии (р<0,001). 

Purpose of the study

Purpose of the study. Compare the effectiveness of different eradication therapy regimens in patients with chronic pancreatitis with concomitant gastritis associated with various genetic variants of H. pylori.

Materials and methods

Materials and methods: 63 patients with chronic pancreatitis and concomitant Helicobacter pylori-associated gastritis were examined. The control group consisted of 45 patients with chronic gastritis. Diagnosis of chronic pancreatitis was based on anamnestic, clinical data, instrumental studies (MSCT). Diagnosis of H. pylori infection was carried out by the morphological method, 13C urease breath test, and immunoblotting. Statistical processing was carried out using application packages SPSS Statistic 17.0.

Results

Results. In patients with chronic pancreatitis, CagA-positive H. pylori strains were found 19.3% less often compared with the control group (p <0.05), VacA-positive—21.9% less often (p <0.05). In the study group, H. pylori genes encoding urease A production and genes encoding the synthesis of H. pylori outer membrane proteins (p33, p30, p29, p26, p19, p17) were significantly more frequently met. In the group of patients with chronic pancreatitis, the standard triple therapy of the 1st line with the inclusion of bismuth tripotassium dicitrate was 86.8% more effective (p <0.01) compared to the standard triple therapy of the 1st line, and the maximum increase in efficiency was observed among owners of H. pylori strains, expressing urease A and with the representation on the outer membrane of the proteins p30, p33, p26, p19, p17 (p <0.01).

Conclusion

Conclusion. Eradication therapy in patients with chronic pancreatitis in the presence of pathogenicity complex p30, p33, urease A, p26, p19, p17 in H. pylori according to the standard line triple therapy protocol with the inclusion of bismuth tripotassium dicitrate has advantages compared to the standard triple therapy protocol 1 line (p <0.001). 

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The authors declare that there are no conflicts of interest present.