摘要
目的了解徐州及其周边地区幽门螺杆菌(Helicobacter pylori,H.pylori)感染菌株的耐药现况,并为制定较为精准的治疗方案提供科学依据。方法采用随机抽样法,抽取2019年3月1日至2021年5月14日在徐州医科大学附属徐州市立医院就诊的H.pylori阳性患者共450例,所有患者均取胃黏膜标本进行免疫组化检测、H.pylori分离培养及药敏试验,并对检测结果进行进一步统计分析。结果徐州及其周边地区感染H.pylori菌株对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林和呋喃唑酮的耐药率分别为90.10%、58.15%、49.84%、1.60%和0.64%,四环素暂未发现耐药。有16例(5.11%)药物均敏、88例(28.12%)单药耐药、89例(28.43%)双重耐药、119例(38.02%)三重耐药及1例(0.32%)四重耐药。H.pylori对克拉霉素、左氧氟沙星的耐药性与抗生素使用史有关,差异有统计学意义(P<0.05);既往有根除治疗史患者的H.pylori体外培养成功率低于初治患者,差异有统计学意义(P<0.05)。结论徐州及其周边地区感染的H.pylori菌株对甲硝唑、克拉霉素、左氧氟沙星的耐药率均较高,且多重耐药形势严峻。克拉霉素及左氧氟沙星使用后H.pylori耐药率显著提高,且抗生素多次使用降低H.pylori体外培养成功率,建议有条件者初次即根据患者药敏培养结果选择个体化治疗方案,无条件者可采用阿莫西林、呋喃唑酮、质子泵抑制剂联合铋剂的四联方案,提高H.pylori根除率。
Objective To analyze the drug resistance condition of H.pylori infection strains in Xuzhou and its surrounding areas,and provide scientific basis for the formulation of an accurate therapy scheme.Methods A random sampling method was adopted to extract 450 samples of H.pylori positive patients who conducted curing in the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University from Mar.1st 2019 to May 14th 2021,gastric mucosa samples were taken from all patients for immunohistochemical detection,isolation and culture of H.pylori and drug sensitivity test,and the detection results were further statistically analyzed.Results The drug resistance rates of H.pylori infection strains in Xuzhou and its surrounding areas to Metronidazole,Clarithromycin,Levofloxacin,Amoxicillin and Furazolidone were 90.10%,58.15%,49.84%,1.60%and 0.64%,respectively,and Tetracycline resistance was not found.There were 16 cases(5.11%)of drugs homosensitivity,88 cases(28.12%)of single drug resistance,89 cases(28.43%)of double drug resistance,119 cases(38.02%)of triple drug resistance and 1 case(0.32%)of quadruple drug resistance.The resistance of H.pylori to Clarithromycin and Levofloxacin was related to the history of using antibiotic,and the difference was statistically significant(P<0.05).The success rate of H.pylori in vitro culture of patients with previous history of eradication treatment was lower than that of patients with initial treatment,and the difference was statistically significant(P<0.05).Conclusion H.pylori infection strains in Xuzhou and its surrounding areas have high drug resistance rates to Metronidazole,Clarithromycin and levofloxacin,and the situation of multiple drug resistance is severe.The H.pylori resistant rate increased significantly after using Clarithromycin and Levofloxacin,and repeat use of antibiotics reduces the success rate of H.pylori in vitro culture,it is suggests that patients with conditions choose individualized treatment plan according to the results of drug sensitivity culture of the patient for the first time,patients without conditions may use Amoxicillin,Furazolidone,proton pump inhibitors joint bismuth agent,which form a quadruple solution to improve eradicate rate of H.pylori.
作者
周广青
张海涵
刘世育
吴传楠
李振涛
曹琳琳
陈光侠
ZHOU Guangqing;ZHANG Haihan;LIU Shiyu;WU Chuannan;LI Zhentao;CAO Linlin;CHEN Guangxia(Xuzhou Medical University,Xuzhou 221004;Department of Gastroenterology,the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第4期416-420,共5页
Chinese Journal of Gastroenterology and Hepatology
基金
徐州市科技计划项目(KC21169)
江苏大学临床医学科技发展基金项目(JYL2021180)。
关键词
幽门螺杆菌
抗生素耐药
药敏试验
徐州地区
Helicobacter pylori
Antibiotic resistance
Drug sensitive test
Xuzhou area
