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2015³â 8¿ù 22ÀÏ Åä¿äÀÏ ¿ÀÈÄ 2½Ã, ¹é¹ü ±è±¸ ±â³ä°ü ÁöÇÏ 1Ãþ ±³À°Àå 1¿¡¼­ ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸ ¿öÅ©¼¥ÀÌ ÀÖ¾ú½À´Ï´Ù. ¹é¹ü ±â³ä°üÀº ȿâ°ø¿ø ³»¿¡ ÀÖ½À´Ï´Ù. ¸çÄ¥ ÀüºÎÅÍ °¡½¿ÀÌ ¶Ù¾ú½À´Ï´Ù. ȿâ°ø¿øÀº ¿©¸§ÀÇ ²É ¹éÀÏÈ«À¸·Î À¯¸íÇÑ °÷À̴ϱî¿ä. ±×·±µ¥... ¾Æ½±°Ôµµ ¹éÀÏÈ«ÀÌ ¹ú½á Àú¹°¾î°¡°í ÀÖ¾ú½À´Ï´Ù. ¿ÃÇØ´Â Á¶±Ý ºü¸¥ µí ÇÕ´Ï´Ù. ³Ê¹« ¹«´õ¿ü´ø Å¿Àϱî¿ä.


1. ¼Òº¯Ç×ü°Ë»ç¹ý (°í·Á´ëÇб³ Á¤¼º¿ì)

Ç×ü ÃøÁ¤Àº ÁÖ·Î Ç÷û°ú ¼Òº¯À» ÀÌ¿ëÇÏÁö¸¸ ÀüÇ÷ ¶Ç´Â ħÀ» »ç¿ëÇصµ ÃøÁ¤ °¡´ÉÇÏ´Ù.

Á¦±Õ 6°³¿ù ÈÄ Ç×ü°ªÀÌ Àý¹Ý ÀÌÇÏ·Î ¶³¾îÁö¸é Á¦±Õ ¼º°øÀ¸·Î ÆÇ´ÜÇÒ ¼ö ÀÖ´Ù.

Antibody tests developed using antigens from one region of the world may not perform well when applied to patients in another part of the world.

À¯·´°¡À̵å¶óÀο¡ ÀÇÇÏ¸é ¹è¾ç°Ë»ç´Â (1) clarithromycin ³»¼º 20% ÀÌ»óÀÎ Áö¿ª¿¡¼­´Â ÀÏÂ÷ °Ë»ç¿¡¼­ ±Ç°í, (2) 2Â÷ Ä¡·á ½ÇÆÐ ÈÄ ½ÃÇàÀÌ ±Ç°íµÇ°í ÀÖ½À´Ï´Ù.

¼¼°¡Áö ¹æ¹ýÀÌ ¼Ò°³µÇ¾ú½À´Ï´Ù. ¸ðµÎ ÀϺ» ¿ÀÃ÷Ä«¶ó¼­ Àú´Â ¸¶À½ÀÌ Á¶±Ý ºÒÆíÇß½À´Ï´Ù.
(1) Urinelisa (Otsuka): ELISA ¹ý. Miwa. Am J Gastroenterol 1999
(2) Rapirun kit (Otsuka): immunochromatography ¹ý. Yamamoto. Expert Rev Mol Diagn 2008
(3) Rapirun kit & stick (Otsuka): immunochromatography ¹ý. Quach. World J Gastroenterol 2014


2. ´ëº¯Ç׿ø°Ë»ç¹ý (ÀÎÁ¦ÀÇ´ë ÃÖÁ¤¹Î)

Stool antigen test
- sensitivity 0.94
- specificity 0.97
- positive likelihood ratio 24
- negative likelihood ratio 0.07

µÎ °¡Áö ¹æ¹ýÀÌ ¼Ò°³µÇ¾ú½À´Ï´Ù.
(1) Enzyme immunoassay (Premier Platinum)
(2) Immunochromatography (Immunocard HpSA)


3. Ä¡·á °¡À̵å¶óÀÎ (°¡Å縯º´¿ø ¹ÚÀç¸í)

Á¦±Õ ½ÇÆнà »ç¿ëÇÒ ¼ö ÀÖ´Â Ç×»ýÁ¦
(1) levofloxacin
(2) rifabutin - °áÇÙ À¯º´·ü¶§¹®¿¡ Á¶½ÉÇØ¾ß ÇÑ´Ù´Â ÀÇ°ßÀÌ ÀÖÀ½.
(3) furazolidone - ¿ì¸®³ª¶ó¿¡¼­´Â ÀǾàÇ°À¸·Î Çã¿ëµÇÁö ¾ÊÀ½. Áß±¹¿¡¼­´Â ´ß¿¡¼­ »ç¿ëµÈ´Ù.


4. Ä¡·á - ÃÖ±Ù ¹®Çå ¸®ºä (±¹¸³¾Ï¼¾ÅÍ ÀÌÁ¾¿­)

°­ÀÇ Áß GrahamÀ̶ó´Â »ç¶÷ÀÇ ÃÖ±Ù ÁÖÀåÀÌ ¼Ò°³µÇ¾ú½À´Ï´Ù (Graham. Helicobacter 2015, Graham. Korean J Intern Med 2015). "As a general rule, any clinical study where the result is already known or when the investigator(s) compares an assigned treatment against another assigned treatment known to be ineffective in the study population (e.g., in a population with known clarithromycin resistance) is unethical."À̶ó°í ½ÃÀÛÇÏ´Â editorialÀÔ´Ï´Ù.

¿¬±¸ÀÇ À±¸®¼ºÀº ½±°Ô ´ÜÁ¤ÁöÀ» ¼ö ¾ø´Â ¹®Á¦ÀÔ´Ï´Ù. ¾î´À Á¤µµ ¾Ë·ÁÁø ³»¿ëÀÌ´õ¶óµµ »õ·Î¿î ȯ°æ°ú ³¸¼± Á¶°Ç¿¡¼­´Â ÀüÇô ´Ù¸¥ °á°ú°¡ ³ª¿Ã ¼ö ÀÖ½À´Ï´Ù. ÇÑ ±¹°¡¿¡¼­ÀÇ ¿¬±¸ °á°ú¸¦ ±×´ë·Î extrapolationÇϱ⺸´Ù´Â ¿ì¸® ³ª¶ó¿¡¼­ ¿ì¸® Çö½Ç¿¡ ¸Â°Ô ´Ù½Ã ¿¬±¸ÇÏ°í È®ÀÎÇÏ°í ¹ßÀü½ÃÅ°´Â °ÍÀº ÀǹÌÀÖ´Â ÀÏÀÔ´Ï´Ù (Park. Am J Gastroenterol 2015). ±×·±µ¥ À̸¦ unethicalÀ̶ó°í ´Ü¾ðÇÏ´Ù´Ï...... ³²ÀÇ ¿¬±¸¸¦ ³Ê¹« ½±°Ô "unethical"À̶ó°í ºñ³­ÇÏ´Â ÃßÅ¿¡¼­ ´ë°¡ÀÇ Àú¹°¾î°¡´Â ¸ð½ÀÀ» º¾´Ï´Ù. ÒÇé¯ÀÌ ¾Æ´Ò·±Áö...... ÆÇ´Ü·ÂÀ» ÀÒÀº ¸ð½ÀÀ» º¸´Ï ÀÌÁ¦´Â ¹°·¯³¯ ¶§°¡ µÈ °Í °°½À´Ï´Ù. ¾Æ´Ï ÇÑÂü Áö³µ½À´Ï´Ù. Á¦±¹ÁÖÀÇ ³¿»õµµ ´À²¸Á³½À´Ï´Ù. ´ÄÀº ¼­¾ç »ç¶÷ ÇÏ´Â ¸» ½Å°æ¾²Áö ¸»°í ¿ì¸®´Â ¿ì¸® ÇÒÀÏÀ» Àß ÇÏ¸é µÉ °Í °°½À´Ï´Ù.

Successful use of sequential therapy is restricted to regions where clarithromycin resistance is high and metronidazole resistance is low.

¿ì¸®³ª¶ó¿¡¼­´Â ¾ÆÁ÷ firstlineÀ¸·Î quadruple therapy¸¦ »ç¿ëÇÑ ¿¬±¸´Â ¾ø½À´Ï´Ù. Áö±ÝÀÌ¶óµµ ÀڷḦ ¸ðÀ» ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù.


¹Ì±¹¿¡¼­´Â °ú°Å¿Í Ä¡·á¹ýÀÌ ¸¹ÀÌ ¹Ù²î¾î°¡´Â ¸ð½À´Ï´Ù.


5. ±Õ ¹è¾ç ¹× Ç×»ýÁ¦ °¨¼ö¼º °Ë»ç (ÇѾç´ëÇб³ ±èÁ¤¸ñ)

Á¸°æÇÏ´Â ±èÁ¤¸ñ ±³¼ö´Ô²²¼­ ±×°£ÀÇ °æÇèÀ» ¹ÙÅÁÀ¸·Î Ç︮ÄÚ¹ÚÅÍ ¹è¾ç°ú Ç×»ýÁ¦ °¨¼ö¼º °Ë»çÀÇ ¼ÒÁßÇÑ tipÀ» Àü°Ý °ø°³Çϼ̽À´Ï´Ù.


±èÁ¤¸ñ. ´ëÇѼÒÈ­±âÇÐȸÁö 2003

Most studies have used E test, disc diffusion, or microdilution that are not authorized by NCCLS. E test´Â ÀÓ»ó¿¡¼­ ÆíÈ÷ »ç¿ëÇÒ ¼ö ÀÖÀ¸³ª ¸î °¡Áö Á¦ÇÑÁ¡ÀÌ ÀÖ½À´Ï´Ù.


±èÁ¤¸ñ. ´ëÇѼÒÈ­±âÇÐȸÁö 2006

Ç×»ýÁ¦ ³»¼º ±âÁØÀº ÀÎü ³»¿¡¼­ ±× Ç×»ýÁ¦¿¡ Á¢ÃËÇßÀ½¿¡µµ ºÒ±¸ÇÏ°í »ì¾Æ³²Àº ±ÕÀ» ´ë»óÀ¸·Î Á¤ÇÏ´Â °ÍÀÌ ¿øÄ¢ÀÌ´Ù. ³»¼º·ü ºñ±³´Â °Ë»ç¹æ¹ý°ú ³»¼º±âÁØÀÌ µ¿ÀÏÇؾ߸¸ ÇÑ´Ù.


±èÁ¤¸ñ. ´ëÇѼÒÈ­±âÇÐȸÁö 2006

±Õ ¼ö ÃøÁ¤: Hemocytometerº¸´Ù´Â Petroff-Hausser Counter°¡ Á¤È®ÇÏ´Ù. µÎ²²°¡ 0.02mm·Î ¾ã±â ¶§¹®ÀÔ´Ï´Ù.

¿¬±¸ ¹æ¹ý: ¼ÒÈ­¼º±Ë¾çÀ» Æ÷ÇÔÇÑ ¸¸¼ºÀ§¿° ȯÀÚ¿¡¼­ µ¿ÀÏ ºÎÀ§¿¡¼­ 2°³ äÃëÇÏ¿© Çϳª´Â CLOtest, ´Ù¸¥ Çϳª´Â Áï½Ã ¿¡ÆæµµÇÁ Æ©ºê¿¡¼­ ¾ó¸°´Ù. 30ºÐ ÈÄ CLOtest¿¡¼­ ¾ç¼ºÀ» º¸ÀÎ °æ¿ìÀÇ »ùÇÃÀ» ¿µÇÏ 80µµ deep freezer¿¡ º¸°üÇÑ´Ù. Frozen tissue¿¡¼­ H. pyloriÀÇ primary isolationÀº 50% Á¤µµ´Â °¡´ÉÇÒ °ÍÀÌ´Ù. Ç×»ýÁ¦°¨¼ö¼º °Ë»ç´Â agar dilution method¸¦ ÀÌ¿ëÇÑ´Ù. ¸ñÇ¥´Â 1,000 - 2,000 ±ÕÁÖ.


6. ±¹³» ³»¼º ÇöȲ (¼­¿ï¾Æ»êº´¿ø ¾ÈÁö¿ë)

´Ù¸¥ Ç×»ýÁ¦¿¡ ´ëÇÑ ³»¼º·üÀº Áõ°¡ Ãß¼¼ÀÎ ¹Ý¸é, metronidazole ³»¼º·üÀº ¾à°£ °¨¼ÒÃß¼¼¿´½À´Ï´Ù.

Amoxicillin°ú clarithromycinÀº agar dilutionÀÌ ´Ù¸¥ °Ë»ç¹ýº¸´Ù ³ôÀº ³»¼º·üÀ» º¸ÀÌ´Â °æÇâÀÌ ÀÖ½À´Ï´Ù. ¹Ý¸é metronidazoleÀº °Ë»ç¹ý¸¶´Ù ºñ½ÁÇÑ ³»¼º·üÀ» º¸ÀÌ°í ÀÖ½À´Ï´Ù.


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