幽门螺杆菌耐药性对其根除治疗影响的研究

Influence of resistance of Helicobacter pylori to antibiotics on the Helicobacter pylori eradication regimens

目的了解幽门螺杆菌(Hp)耐药菌株以及患者性别、年龄和不同临床疾病对 Hp 根除治疗的影响,阐明 Hp 根除治疗失败的主要原因。方法对因上胃肠道症状而来北京大学第一医院胃镜室接受胃镜检查的 Hp 培养阳性患者,采用 E-试验法测定 Hp 菌株对甲硝唑及克拉霉素的最低抑菌浓度(MIC)。对所有入选患者采用兰索拉唑、甲硝唑和克拉霉素的三联7d 疗法进行 Hp 根除治疗。结果共有157例患者进入本研究,并完成了治疗。Hp 对甲硝唑和克拉霉素的耐药率分别为:45.9％(72/157)和18.5％(29/157)。157例接受治疗患者的 Hp 根除率为61.8％(97/157),Hp 根除率在不同性别、年龄及不同临床疾病患者之间差异均无统计学意义(均 P>0.05);甲硝唑敏感菌株和耐药菌株的根除率分别为89.4％(76/85)和29.2％(21/72)(P<0.01)。克拉霉素敏感菌株和耐药菌株的根除率分别为72.7％(93/128)和16.0％(4/29)(P<0.01)。结论 Hp 对抗生素耐药是导致Hp 根除治疗失败的主要原因。

Objective To investigate the influence of resistance of Helicobacter pylori （ H. pylori） to antibiotics on the efficacy of lasoprazole triple therapy for H. pylori eradication. Methods 157 patients, 102 males and 55 females, aged 42. 7 （ 18-70）, with upper abdominal symptoms, 59 with chronic gastritis and 98 with peptic ulcer, underwent gastroendoscopy 157 H. pylori strains were isolated from the gastric biopsy specimens of these patients and cultured. Minimal inhibitory concentrations of 3 antibiotics （metronidazole and clarithromycin） were determined by E-test. The 157 patients were treated by triple therapies, including lansoprazole, metronidazole, and clarithromycin for 7 days. Reexamination was done at least 4 weeks after the therapy. Results The resistance rates of H. pylori to metronidazole and clarithromycin were 45.9% （ 72/157 ） and 18. 5% （ 29/157 ） respectively. The reexamination showed an eradication rate of H. pylori of 61.8% （97/157）. The eradication rates of the metronidazole-sensitive and resistant strains were 89.4% （ 76/85 ） and 29.2% （ 21/72 ） respectively （ P 〈 0. 01 ） , and the eradication rates of the clarithromycin-sensitive and resistant strains were 72. 7% （ 93/128 ） and 16. 0% （ 4/29 ） respectively（ P 〈 0. 01 ）. Presence of a gastroduodenal ulcer, age and gender did not differ significantly between the eradicated and non-eradicated groups （ all P 〉0. 05 ）. Conclusion Resistance of H. pylori to antibiotics is the most important cause of the failure of H. pylori eradication.