BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly dec...BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly declined,leaving a large number of patients with previous treatment histories.AIM To investigate secondary resistance rates,explore risk factors for antibiotic resistance,and assess the efficacy of susceptibility-guided therapy.METHODS We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023.Participants underwent a string test after an overnight fast.The gastric juice was obtained and transferred to vials containing storage solution.Subsequently,DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction(qPCR).Demographic information was also analyzed as part of the study.Based on these results,the participants were administered susceptibility-guided treatment.Efficacy was compared with that of the empiric treatment group.RESULTS A total of 132 individuals tested positive for the H.pylori ureA gene by qPCR technique.CLA resistance rate reached a high level of 82.6%(n=109),LFX resistance rate was 69.7%(n=92)and dual resistance was 62.1%(n=82).Gastric symptoms[odds ratio(OR)=2.782;95%confidence interval(95%CI):1.076-7.194;P=0.035]and rural residence(OR=5.152;95%CI:1.407-18.861;P=0.013)were independent risk factors for secondary resistance to CLA and LFX,respectively.A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment,respectively.The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5%(77/102)and 59.0%(59/411)by the intention-to-treat(ITT)analysis and 90.6%(77/85)and 70.2%(59/84)by the per-protocol(PP)analysis,respectively.The eradication rates of these two treatment strategies were significantly different in both ITT(P=0.001)and PP(P=0.012)analyses.CONCLUSION H.pylori presented high secondary resistance rates to CLA and LFX.For patients with previous treatment failures,treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.展开更多
目的研究老年高血压患者血清瘦素异常表达及动态血压参数对脑梗死复发和预后不良的预测。方法选取2019年6月至2022年1月涿州市医院神经内一科和保定市第二中心医院急诊科治疗的高血压合并脑梗死患者230例为脑梗死组,同期在涿州市医院神...目的研究老年高血压患者血清瘦素异常表达及动态血压参数对脑梗死复发和预后不良的预测。方法选取2019年6月至2022年1月涿州市医院神经内一科和保定市第二中心医院急诊科治疗的高血压合并脑梗死患者230例为脑梗死组,同期在涿州市医院神经内一科和保定市第二中心医院急诊科行身体检查的60例健康志愿者为对照组,采集平均血压和血压变异性等参数,血压变异性参数包括24 h收缩压变异性(24 h SBPV)和24 h舒张压变异性(24 h DBPV),采用酶联免疫吸附法测定血清瘦素水平,随访3个月,失访4例,脑梗死组复发49例,预后不良患者90例,采用多因素logistic回归分析脑梗死复发和预后不良的影响因素。结果脑梗死组血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于对照组(P<0.01)。脑梗死组复发患者血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于非复发患者(P<0.05,P<0.01)。脑梗死组预后不良患者血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于预后良好患者(P<0.01)。多因素logistic回归分析显示,血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV是脑梗死复发的影响因素(P<0.05,P<0.01)。5项指标联合诊断脑梗死复发和预后不良的ROC曲线下面积分别为0.893(95%CI:0.816~0.970),0.951(95%CI:0.918~0.985)。结论老年高血压患者血清瘦素和动态血压参数在脑梗死复发和预后不良中异常高表达,且其单独和联合回归检测可有效预测和诊断脑梗死复发或预后不良。展开更多
基金The study was reviewed and approved by the the Human Ethics Review Committee of the First Affiliated Hospital of China Medical University(Approval No.2021325).
文摘BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly declined,leaving a large number of patients with previous treatment histories.AIM To investigate secondary resistance rates,explore risk factors for antibiotic resistance,and assess the efficacy of susceptibility-guided therapy.METHODS We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023.Participants underwent a string test after an overnight fast.The gastric juice was obtained and transferred to vials containing storage solution.Subsequently,DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction(qPCR).Demographic information was also analyzed as part of the study.Based on these results,the participants were administered susceptibility-guided treatment.Efficacy was compared with that of the empiric treatment group.RESULTS A total of 132 individuals tested positive for the H.pylori ureA gene by qPCR technique.CLA resistance rate reached a high level of 82.6%(n=109),LFX resistance rate was 69.7%(n=92)and dual resistance was 62.1%(n=82).Gastric symptoms[odds ratio(OR)=2.782;95%confidence interval(95%CI):1.076-7.194;P=0.035]and rural residence(OR=5.152;95%CI:1.407-18.861;P=0.013)were independent risk factors for secondary resistance to CLA and LFX,respectively.A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment,respectively.The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5%(77/102)and 59.0%(59/411)by the intention-to-treat(ITT)analysis and 90.6%(77/85)and 70.2%(59/84)by the per-protocol(PP)analysis,respectively.The eradication rates of these two treatment strategies were significantly different in both ITT(P=0.001)and PP(P=0.012)analyses.CONCLUSION H.pylori presented high secondary resistance rates to CLA and LFX.For patients with previous treatment failures,treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.
文摘目的研究老年高血压患者血清瘦素异常表达及动态血压参数对脑梗死复发和预后不良的预测。方法选取2019年6月至2022年1月涿州市医院神经内一科和保定市第二中心医院急诊科治疗的高血压合并脑梗死患者230例为脑梗死组,同期在涿州市医院神经内一科和保定市第二中心医院急诊科行身体检查的60例健康志愿者为对照组,采集平均血压和血压变异性等参数,血压变异性参数包括24 h收缩压变异性(24 h SBPV)和24 h舒张压变异性(24 h DBPV),采用酶联免疫吸附法测定血清瘦素水平,随访3个月,失访4例,脑梗死组复发49例,预后不良患者90例,采用多因素logistic回归分析脑梗死复发和预后不良的影响因素。结果脑梗死组血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于对照组(P<0.01)。脑梗死组复发患者血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于非复发患者(P<0.05,P<0.01)。脑梗死组预后不良患者血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于预后良好患者(P<0.01)。多因素logistic回归分析显示,血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV是脑梗死复发的影响因素(P<0.05,P<0.01)。5项指标联合诊断脑梗死复发和预后不良的ROC曲线下面积分别为0.893(95%CI:0.816~0.970),0.951(95%CI:0.918~0.985)。结论老年高血压患者血清瘦素和动态血压参数在脑梗死复发和预后不良中异常高表达,且其单独和联合回归检测可有效预测和诊断脑梗死复发或预后不良。
