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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳燕惠 | zh_TW |
dc.contributor.advisor | Yen-Hui Chen | en |
dc.contributor.author | 賴子齊 | zh_TW |
dc.contributor.author | Tzu-Chi Lai | en |
dc.date.accessioned | 2021-07-11T15:47:03Z | - |
dc.date.available | 2024-02-28 | - |
dc.date.copyright | 2018-10-11 | - |
dc.date.issued | 2018 | - |
dc.date.submitted | 2002-01-01 | - |
dc.identifier.citation | 1. Hildreth CJ, Lynm C, Glass RM. Helicobacter pylori. JAMA 2008;300:1374-.
2. Raymond J, Lamarque D, Kalach N, et al.. High level of antimicrobial resistance in French Helicobacter pylori isolates. Helicobacter 2010;15:21-7. 3. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut 2017;66:6-30. 4. Shiota S, Reddy R, Alsarraj A, et al. Antibiotic Resistance of Helicobacter pylori Among Male United States Veterans. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2015;13:1616-24. 5. Megraud F, Coenen S, Versporten A, et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut 2013;62:34-42. 6. Liou JM, Chang CY, Chen MJ, et al. The Primary Resistance of Helicobacter pylori in Taiwan after the National Policy to Restrict Antibiotic Consumption and Its Relation to Virulence Factors-A Nationwide Study. PloS one 2015;10:e0124199. 7. Poon SK, Chang CS, Su J, et al. Primary resistance to antibiotics and its clinical impact on the efficacy of Helicobacter pylori lansoprazole-based triple therapies. Aliment Pharmacol Ther 2002;16:291-6. 8. Chi‐Tan H, Chao‐Chuan W, Chih‐Yung L, et al. Resistance rate to antibiotics of Helicobacter pylori isolates in eastern Taiwan. Journal of gastroenterology and hepatology 2007;22:720-3. 9. Hung KH, Sheu BS, Chang WL, et al. Prevalence of primary fluoroquinolone resistance among clinical isolates of Helicobacter pylori at a University Hospital in Southern Taiwan. Helicobacter 2009;14:61-5. 10. Camargo MC, Garcia A, Riquelme A, et al. The problem of Helicobacter pylori resistance to antibiotics: a systematic review in Latin America. The American journal of gastroenterology 2014;109:485-95. 11. Chey WD, Leontiadis GI, Howden CW, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. The American journal of gastroenterology 2017;112:212-39. 12. Puig I, Baylina M, Sánchez-Delgado J, et al. Systematic review and meta-analysis: triple therapy combining a proton-pump inhibitor, amoxicillin and metronidazole for Helicobacter pylori first-line treatment. Journal of Antimicrobial Chemotherapy 2016;71:2740-53. 13. Filipec Kanizaj T, Katicic M, Skurla B, et al. Helicobacter pylori Eradication Therapy Success Regarding Different Treatment Period Based on Clarithromycin or Metronidazole Triple-Therapy Regimens. Helicobacter 2009;14:29-35. 14. T. KT, I. RH, E. VM, et al. First‐line eradication therapy for Helicobacter pylori in primary health care based on antibiotic resistance: results of three eradication regimens. Alimentary Pharmacology & Therapeutics 2005;21:773-82. 15. Liou JM, Lin JT, Chang CY, et al. Levofloxacin-based and clarithromycin-based triple therapies as first-line and second-line treatments for Helicobacter pylori infection: a randomised comparative trial with crossover design. Gut 2010;59:572-8. 16. Hsu P-I, Wu D-C, Chen W-C, et al. Randomized Controlled Trial Comparing 7-Day Triple, 10-Day Sequential, and 7-Day Concomitant Therapies for Helicobacter pylori Infection. Antimicrobial agents and chemotherapy 2014;58:5936-42. 17. Kim BG, Lee DH, Ye BD, et al. Comparison of 7-day and 14-day Proton Pump Inhibitor-Containing Triple Therapy for Helicobacter pylori Eradication: Neither Treatment Duration Provides Acceptable Eradication Rate in Korea. Helicobacter 2007;12:31-5. 18. Fuccio L, Minardi ME, Zagari RM, et al. Meta-analysis: duration of first-line proton-pump inhibitor based triple therapy for Helicobacter pylori eradication. Annals of internal medicine 2007;147:553-62. 19. Calvet, García, López, et al. A meta-analysis of short versus long therapy with a proton pump inhibitor, clarithromycin and either metronidazole or amoxycillin for treating Helicobacter pylori infection. Alimentary Pharmacology & Therapeutics 2000;14:603-9. 20. Zagari RM, Bianchi-Porro G, Fiocca R, et al. Comparison of 1 and 2 weeks of omeprazole, amoxicillin and clarithromycin treatment for Helicobacter pylori eradication: the HYPER Study. Gut 2007;56:475-9. 21. Essa AS, Kramer JR, Graham DY, et al. Meta-analysis: Four-Drug, Three-Antibiotic, Non-bismuth-Containing “Concomitant Therapy” Versus Triple Therapy for Helicobacter pylori Eradication. Helicobacter 2009;14:109-18. 22. Georgopoulos SD, Xirouchakis E, Martinez-Gonzalez B, et al. Clinical Evaluation of a Ten-Day Regimen with Esomeprazole, Metronidazole, Amoxicillin, and Clarithromycin for the Eradication of Helicobacter pylori in a High Clarithromycin Resistance Area. Helicobacter 2013;18:459-67. 23. Chung JW, Han JP, Kim KO, et al. Ten-day empirical sequential or concomitant therapy is more effective than triple therapy for Helicobacter pylori eradication: A multicenter, prospective study. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2016;48:888-92. 24. Seddik H, Ahid S, El Adioui T, et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a prospective randomized study. European journal of clinical pharmacology 2013;69:1709-15. 25. Park HG, Jung MK, Jung JT, et al. Randomised clinical trial: a comparative study of 10-day sequential therapy with 7-day standard triple therapy for Helicobacter pylori infection in naive patients. Aliment Pharmacol Ther 2012;35:56-65. 26. Jafri NS, Hornung CA, Howden CW. Meta-analysis: sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. Annals of internal medicine 2008;148:923-31. 27. Liou JM, Chen CC, Chang CY, et al. Sequential therapy for 10 days versus triple therapy for 14 days in the eradication of Helicobacter pylori in the community and hospital populations: a randomised trial. Gut 2016;65:1784-92. 28. Hong J, Shu X, Liu D, et al. Antibiotic resistance and CYP2C19 polymorphisms affect the efficacy of concomitant therapies for Helicobacter pylori infection: an open-label, randomized, single-centre clinical trial. Journal of Antimicrobial Chemotherapy 2016;71:2280-5. 29. Yang JC, Lin CJ, Wang HL, et al. High-dose dual therapy is superior to standard first-line or rescue therapy for Helicobacter pylori infection. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2015;13:895-905.e5. 30. I. HP, Deng‐Chyang W, Jeng‐Yih W, et al. Is There a Benefit to Extending the Duration of Helicobacter pylori Sequential Therapy to 14 Days? Helicobacter 2011;16:146-52. 31. Liou JM, Chen CC, Chen MJ, et al. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet (London, England) 2013;381:205-13. 32. Gisbert JP, Calvet X. Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori. Clinical and experimental gastroenterology 2012;5:23-34. 33. Salazar CO, Cardenas VM, Reddy RK, et al. Greater than 95% success with 14-day bismuth quadruple anti- Helicobacter pylori therapy: a pilot study in US Hispanics. Helicobacter 2012;17:382-90. 34. Malfertheiner P, Bazzoli F, Delchier JC, et al. Helicobacter pylori eradication with a capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline given with omeprazole versus clarithromycin-based triple therapy: a randomised, open-label, non-inferiority, phase 3 trial. Lancet (London, England) 2011;377:905-13. 35. Fischbach LA, van Zanten S, Dickason J. Meta-analysis: the efficacy, adverse events, and adherence related to first-line anti-Helicobacter pylori quadruple therapies. Aliment Pharmacol Ther 2004;20:1071-82. 36. Liu KS, Hung IF, Seto WK, et al. Ten day sequential versus 10 day modified bismuth quadruple therapy as empirical firstline and secondline treatment for Helicobacter pylori in Chinese patients: an open label, randomised, crossover trial. Gut 2014;63:1410-5. 37. Liou JM, Fang YJ, Chen CC, et al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet (London, England) 2016;388:2355-65. 38. Okamura T, Suga T, Nagaya T, et al. Antimicrobial resistance and characteristics of eradication therapy of Helicobacter pylori in Japan: a multi-generational comparison. Helicobacter 2014;19:214-20. 39. Seo SI, Kim SJ, Kim HS, et al. Is There Any Difference in the Eradication Rate of Helicobacter pylori Infection According to the Endoscopic Stage of Peptic Ulcer Disease? Helicobacter 2015;20:424-30. 40. Lee JY, Kim N, Kim MS, et al. Factors affecting first-line triple therapy of Helicobacter pylori including CYP2C19 genotype and antibiotic resistance. Digestive diseases and sciences 2014;59:1235-43. 41. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 8.0. http://www.eucast.org. ed2018. 42. Liou JM, Chang CY, Sheng WH, et al. Genotypic resistance in Helicobacter pylori strains correlates with susceptibility test and treatment outcomes after levofloxacin- and clarithromycin-based therapies. Antimicrobial agents and chemotherapy 2011;55:1123-9. 43. Wheeldon TU, Granström M, Hoang TTH, et al. The importance of the level of metronidazole resistance for the success of Helicobacter pylori eradication. Alimentary Pharmacology & Therapeutics 2004;19:1315-21. 44. Ueki N, Miyake K, Kusunoki M, et al. Impact of quadruple regimen of clarithromycin added to metronidazole-containing triple therapy against Helicobacter pylori infection following clarithromycin-containing triple-therapy failure. Helicobacter 2009;14:91-9. 45. Chen MJ, Wu MS, Chen CC, et al. Impact of amoxicillin resistance on the efficacy of amoxicillin-containing regimens for Helicobacter pylori eradication: analysis of five randomized trials. The Journal of antimicrobial chemotherapy 2017;72:3481-9. 46. Georgopoulos SD, Ladas SD, Karatapanis S, et al. Factors that May Affect Treatment Outcome of Triple Helicobacter pylori Eradication Therapy with Omeprazole, Amoxicillin, and Clarithromycin. Digestive diseases and sciences 2000;45:63-7. 47. Fock, Chelvam, Lim, The South-East Asia Multicentre Study G. Triple therapy in the eradication of Helicobacter pylori in patients with duodenal ulcer disease: results of a multicentre study in South-East Asia. Alimentary Pharmacology & Therapeutics 2000;14:225-31. 48. Sugizaki K, Sakata Y, Arai T, et al. A multicenter prospective observational study of triple therapy with rabeprazole, amoxicillin and metronidazole for Helicobacter pylori in Japan. Internal medicine (Tokyo, Japan) 2012;51:3103-8. 49. Wenzhi C, Liping Z, Wei R, et al. Variables Influencing Outcome of Helicobacter pylori Eradication Therapy in South China. Helicobacter 2009;14:443-8. 50. Kim SY, Lee SW, Choe JW, et al. Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea. Helicobacter 2017;22:n/a-n/a. 51. Park HG, Jung MK, Jung JT, et al. Randomised clinical trial: comparative study of 10-day sequential therapy with 7-day standard triple therapy for Helicobacter pylori infection in naïve patients. Alimentary Pharmacology & Therapeutics 2012;35:56-65. 52. Chang JY, Shim KN, Tae CH, et al. Triple therapy versus sequential therapy for the first-line Helicobacter pylori eradication. BMC gastroenterology 2017;17:16. 53. Misiewicz JJ, Harris AW, Bardhan KD, et al. One week triple therapy for Helicobacter pylori: a multicentre comparative study. Lansoprazole Helicobacter Study Group. Gut 1997;41:735-9. 54. McNicholl AG, Linares PM, Nyssen OP, et al. Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection. Alimentary Pharmacology & Therapeutics 2012;36:414-25. 55. G. HN, J. TD, A. MR, et al. A comparison of the acid-inhibitory effects of esomeprazole and pantoprazole in relation to pharmacokinetics and CYP2C19 polymorphism. Alimentary Pharmacology & Therapeutics 2010;31:150-9. 56. S. S, M. S, T. U, et al. Twice-daily dosing of esomeprazole effectively inhibits acid secretion in CYP2C19 rapid metabolisers compared with twice-daily omeprazole, rabeprazole or lansoprazole. Alimentary Pharmacology & Therapeutics 2013;38:1129-37. 57. Zhou L, Zhang J, Song Z, et al. Tailored versus Triple plus Bismuth or Concomitant Therapy as Initial Helicobacter pylori Treatment: A Randomized Trial. Helicobacter 2016;21:91-9. 58. Cosme A, Lizasoan J, Montes M, et al. Antimicrobial Susceptibility-Guided Therapy Versus Empirical Concomitant Therapy for Eradication of Helicobacter pylori in a Region with High Rate of Clarithromycin Resistance. Helicobacter 2016;21:29-34. 59. Kwon YH, Kim N, Lee JY, et al. Comparison of the efficacy of culture-based tailored therapy for Helicobacter pylori eradication with that of the traditional second-line rescue therapy in Korean patients: a prospective single tertiary center study. Scandinavian journal of gastroenterology 2016;51:270-6. 60. Butenko T, Jeverica S, Orel R, et al. Antibacterial resistance and the success of tailored triple therapy in Helicobacter pylori strains isolated from Slovenian children. Helicobacter 2017;22. 61. Bhakta D, Graham DY, Chan J, et al. Lessons From Using Culture-Guided Treatment After Referral for Multiple Treatment Failures for Helicobacter pylori Infection. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2018. | - |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/79138 | - |
dc.description.abstract | 研究背景
現今常用於治療胃幽門螺旋桿菌 (Hp)感染的抗生素包括:克拉黴素 (clarithromycin; CLA)、安摩西林 (amoxicillin; AMO)、甲硝唑 (metronidazole; MET)、左氧氟沙星 (levofloxacin; LEV)、四環黴素 (tetracycline; TET)等。已有文獻指出抗生素抗藥性的趨勢與治療成效有重要的相關性,而選擇有效的治療方式也可以減少病菌抗藥性的持續增加。除了服藥順從性以及抗生素抗藥性之外,其餘因子包括年齡、性別、潰瘍診斷、共病症等,皆有可能影響療效。另外,從部分研究結果也可以發現,即使所有Hp菌株觀察到的抗生素最小抑制濃度 (minimal inhibitory concentration; MIC) (單位: μg/mL)皆已超過目前常用的臨界值 (breakpoint),被認為對此抗生素具有抗藥性,仍能有效治癒,但治癒率隨著菌株MIC值的升高而下降。然而目前少有研究將MIC數值高低納入為變動選項,與治療效果做相關性分析。 研究目的 探討年齡、性別、潰瘍診斷、共病症等,特別加上MIC數值這項因子與不同的治療組合進行治療效果的相關性分析。 研究方法 本研究設計採回溯性世代研究 (retrospective cohort study),以臺大醫院電子、紙本病歷等相關資料,回溯收集自1994年1月至2018年3月符合所定納入以及排除條件篩選的受試者進行分析。受試者相關資料的收集,包括年齡、性別、診斷、抗生素抗藥性以及MIC數值等。除描述性統計,本研究也進行單因子相關性分析以及羅吉斯複迴歸分析 (multiple logistic regression analysis)來檢定各個變項,對於治療幽門螺旋桿菌療效的影響是否具顯著性,並以勝算比 (odds ratio)以及95%信賴區間 (95% confidence interval)來表示各項危險因子變項對Hp治癒率的影響情形,本研究將以雙邊對立假設p值 (two-sided p value)小於0.05表示具有統計學顯著性。 研究結果 含有clarithromycin之三合一療法中,共納入784位符合分析條件的受試者進行分析。單因子相關性分析以及羅吉斯複迴歸分析的結果顯示,對clarithromycin具有抗藥性或依照不同clarithromycin MIC值進行分組的這兩因子會顯著影響治療效果。而在clarithromycin MIC<1、1≤clarithromycin MIC<4以及4≤clarithromycin MIC各組別的治癒率分別為:91.3%、59.1%以及13.3%。相較於clarithromycin MIC<1這一組別,1≤clarithromycin MIC<4以及4≤clarithromycin MIC兩組治療失敗的風險隨著MIC值的升高而顯著增加,其勝算比 (95%信賴區間)分別為:7.263 (2.971-17.753)以及68.191 (22.964-202.494)。 含有metronidazole之三合一療法以及同時性療法 (同時使用amoxicillin、metronidazole以及clarithromycin三種抗生素)中,分別有170人以及100人進行分析。單因子相關性分析以及羅吉斯複迴歸分析結果皆指出,抗生素抗藥性為最顯著影響療效的因子。在含有metronidazole之三合一療法中,具有metronidazole抗藥性的族群,其治療失敗的風險相較於無抗藥性的族群高。而在同時性療法中,具有clarithromycin或metronidazole抗藥性的族群,其治療失敗的風險相較於無抗藥性的族群高。另外,性別與年齡也會顯著影響含有metronidazole之三合一療法的治療效果。 連續性療法 (治療前五天使用的抗生素為amoxicillin,而後五天所使用的抗生素為metronidazole以及clarithromycin)中,納入了199位符合條件的受試者進行分析。單因子相關性分析以及羅吉斯複迴歸分析結果皆指出,只有依照clarithromycin或metronidazole MIC值分組或抗生素抗藥性為最顯著影響療效的因子。若受試者對clarithromycin以及metronidazole皆具有抗藥性,則治癒率會顯著下降至31.4%。相較於clarithromycin MIC小於1這一組別,clarithromycin MIC大於等於4此組治療失敗的風險會顯著增加,其勝算比 (95%信賴區間)為:20.397 (7.445-55.883);而相較於metronidazole MIC小於8這一組別,metronidazole MIC大於等於32此組治療失敗的風險會顯著增加,其勝算比 (95%信賴區間)為: 5.605 (2.149-14.617)。若族群對clarithromycin MIC值小於4且metronidazole MIC值小於32,治癒率仍可維持在90%以上,即使MIC值皆已超過現今常用之臨界值,被視為對此兩抗生素具有抗藥性。 結論 含有clarithromycin三合一療法中,治癒率會隨著菌株對clarithromycin MIC值的不同而有所不同。而在連續性療法中,即使菌株的MIC值皆已超過臨床常用的臨界值,已被視為具有抗藥性,但若在clarithromycin MIC<4且metronidazole MIC<32的情況下,治癒率仍可維持在90%以上。由上述結果可得知,目前臨床上常用於判斷菌株是否對抗生素具有抗藥性的臨界值,並未達到最好的分界。換句話說,雖然病患所帶的菌株依照現今臨床上常用之臨界值會被視為對clarithromycin或metronidazole具有抗藥性,但若屬於低抗藥性範圍的族群,仍然可以得到不錯的治療效果。 中文關鍵詞:幽門螺旋桿菌、抗藥性、最小抑制濃度、治療效果 | zh_TW |
dc.description.abstract | Background
Clarithromycin (CLA)、amoxicillin (AMO)、metronidazole (MET)、levofloxacin (LEV) and tetracycline (TET) are commonly used antibiotics for Helicobacter pylori (Hp) therapy. However, the efficacy of treatment for Hp infection has decreased due to increasing resistance to CLA, MET and LEV. Studies have reported that beside antibiotics resistance, other factors such as age, sex, underlying disease, etc. may also affect the treatment efficacy. In some cases, even the MICs (minimal inhibitory concentration, μg/mL) for Hp strains were greater than the breakpoint, Hp strains with lower MICs had better eradication than the ones with higher MIC values. However, few study investigated the relationship between MIC values and treatment outcome. Study objective We aimed to analyze the impact of influencing factors, especially minimal inhibitory concentration (MIC) value, on the efficacy of different treatment regimens. Methods We performed a retrospective study by using electric medical record at National Taiwan University Hospital (NTUH) in Taiwan. Patients who had been diagnosed with H. pylori infection and received H. pylori therapy between 1994 and 2018 were recruited. The demographic and clinical data (age, sex, gastrointestinal diagnosis, antibiotic resistance, MIC value, etc.) from each subject were collected. Univariate and multiple logistic regression analysis was performed to find out factors which significantly affected the treatment efficacy. The impacts of factors on the treatment efficacy were described by odds ratios and 95% CIs. Two-sided P values less than 0.05 were considered statistically significant. Results In clarithromycin-containing triple therapy group, 784 patients were recruited for analysis. In univariate analysis, sex, age and diagnosis did not significantly affect the treatment efficacy. However, resistant to clarithromycin significantly reduced the treatment efficacy (p value<0.001). Eradication rates at different clarithromycin MIC values (MIC<1; 1≤MIC<4; 4≤MIC) were 91.3%, 59.1% and 13.3%, respectively. The multiple logistic regression analysis revealed that group with 1≤CLA MIC<4 and 4≤CLA MIC were independent factors predictive of treatment failure, with odds ratio of 7.263 (95% CI: 2.971-17.753) and 68.191 (95% CI: 22.964-202.494), respectively. In metronidazole-containing triple therapy and concomitant therapy, 170 and 100 patients were recruited for analysis, respectively. In univariate analysis, resistant to clarithromycin or metronidazole significantly reduced the treatment efficacy (p value<0.001). Sex and age also affected the treatment efficacy of metronidazole-containing triple therapy significantly. In sequential therapy, 199 patients were recruited for analysis. In univariate analysis, sex, age and diagnosis did not significantly affect the treatment efficacy. However, resistant to clarithromycin or metronidazole significantly reduced the treatment efficacy (p value<0.001). Eradication rate was only 31.4% in patients with clarithromycin/metronidazole dual resistance. The multiple logistic regression analysis revealed that group with 4≤CLA MIC and 32≤MET MIC were independent factors predictive of treatment failure, with odds ratio of 20.397 (95% CI: 7.445-55.883) and 5.605 (95% CI: 2.149-14.617), respectively. However, eradication rate remained greater than 90% in patients with clarithromycin MIC <4 and metronidazole MIC <32. In multiple logistic regression analysis, the most important impact factor was clarithromycin and metronidazole MIC values. Conclusion In clarithromycin-containing triple therapy, treatment efficacy varied depending on the clarithromycin MIC values. In sequential therapy, eradication rate remained greater than 90% in patients with clarithromycin MIC <4 and metronidazole MIC <32, even the MIC values were higher than the common used breakpoint. Keywords:Helicobacter pylori, resistance, minimal inhibitory concentration, treatment efficacy | en |
dc.description.provenance | Made available in DSpace on 2021-07-11T15:47:03Z (GMT). No. of bitstreams: 1 ntu-107-R05451002-1.pdf: 2003157 bytes, checksum: d18a72ec55defb3d982c44c8a184162c (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 中文摘要 (I)
英文摘要 (IV) 目錄 (VII) 表目錄 (X) 圖目錄 (XII) 英文名詞與縮寫對照表 (XIII) 第1章 緒論 (1) 1.1 幽門螺旋桿菌抗藥性之盛行率 (1) 1.2 幽門螺旋桿菌之治療 (2) 1.3 幽門螺旋桿菌治療效果之相關影響因子分析 (3) 1.4 研究目的 (4) 第2章 研究方法與材料 (6) 2.1 研究材料 (6) 2.2 研究族群 (6) 2.2.1納入與排除條件 (6) 2.2.2 研究族群之分組 (6) 2.3 研究族群相關資料之收集 (8) 2.4 統計分析 (8) 2.4.1最小抑制濃度之分層 (8) 2.4.2 研究族群之描述性統計 (9) 2.4.3 單因子相關性分析 (9) 2.4.4 羅吉斯迴歸分析 (Logistic regression analysis)(9) 2.4.5 統計軟體 (9) 第3章 研究結果 (10) 3.1 研究族群之建立 (10) 3.2 研究族群之分組分析 (10) 3.2.1 含有clarithromycin之三合一療法 (Clarithromycin-containing triple therapy, CLA-TT) (10) 3.2.1.1 研究族群之背景資料敘述 (10) 3.2.1.2 單因子相關性分析 (11) 3.2.1.3 羅吉斯複迴歸分析 (11) 3.2.1.4 次族群分析 (11) 3.2.1.5 治癒率分析 (12) 3.2.2 含有metronidazole之三合一療法 (Metronidazole-containing triple therapy, MET-TT) (24) 3.2.2.1 研究族群之背景資料敘述 (24) 3.2.2.2 單因子相關性分析 (24) 3.2.2.3 羅吉斯複迴歸分析 (25) 3.2.2.4 性別與抗生素抗藥性以及抗生素一日總劑量之相關性 (25) 3.2.2.5 治癒率分析 (25) 3.2.3 同時性療法 (Concomitant therapy, CT) (34) 3.2.3.1 研究族群之背景資料敘述 (34) 3.2.3.2 單因子相關性分析 (35) 3.2.3.3 羅吉斯複迴歸分析 (35) 3.2.3.4 治癒率分析 (36) 3.2.4 連續性療法 (Sequential therapy, ST) (48) 3.2.4.1 研究族群之背景資料敘述 (48) 3.2.4.2 單因子相關性分析 (49) 3.2.4.3 羅吉斯複迴歸分析 (49) 3.2.4.4 治癒率分析 (50) 第4章 討論 (62) 4.1含有clarithromycin之三合一療法 (Clarithromycin-containing triple therapy, CLA-TT) (62) 4.2 含有metronidazole之三合一療法 (Metronidazole-containing triple therapy, MET-TT) (63) 4.3 同時性療法 (Concomitant therapy, CT) (65) 4.4 連續性療法 (Sequential therapy, ST) (66) 4.5 研究限制 (68) 4.6 研究優勢 (68) 第5章 結論與未來展望 (70) 參考文獻 (72) 附錄 (78) | - |
dc.language.iso | zh_TW | - |
dc.title | 抗生素的最小抑制濃度對胃幽門螺旋桿菌之治療組合療效的影響 | zh_TW |
dc.title | The impact of antibiotics MIC value on the efficacy of treatment regimens for Helicobacter pylori infection | en |
dc.type | Thesis | - |
dc.date.schoolyear | 106-2 | - |
dc.description.degree | 碩士 | - |
dc.contributor.coadvisor | 楊智欽 | zh_TW |
dc.contributor.coadvisor | Jyh-Chin Yang | en |
dc.contributor.oralexamcommittee | 吳登強;林淑文 | zh_TW |
dc.contributor.oralexamcommittee | Deng-Chyang Wu;Shu-Wen Lin | en |
dc.subject.keyword | 幽門螺旋桿菌,抗藥性,最小抑制濃度,治療效果, | zh_TW |
dc.subject.keyword | Helicobacter pylori,resistance,minimal inhibitory concentration,treatment efficacy, | en |
dc.relation.page | 79 | - |
dc.identifier.doi | 10.6342/NTU201802440 | - |
dc.rights.note | 未授權 | - |
dc.date.accepted | 2018-08-06 | - |
dc.contributor.author-college | 醫學院 | - |
dc.contributor.author-dept | 臨床藥學研究所 | - |
dc.date.embargo-lift | 2023-10-11 | - |
顯示於系所單位: | 臨床藥學研究所 |
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