幽门螺杆菌培养及药敏试验的临床应用

Clinical application of Hp culture and susceptibility test

[目的]分析山西省吕梁地区幽门螺杆菌(Hp)对该地区5种常用抗生素的耐药率,探讨不同治疗方案对Hp相关性消化性溃疡(PU)治疗的经济效果。[方法]将284例胃黏膜标本进行Hp临床菌株分离培养成功104例,对该地区常用的5种抗生素进行纸片法药敏实验。根据药敏试验结果选取135例Hp阳性的PU患者,随机分成3组。A组45例(奥美拉唑胶囊加阿莫西林胶囊加呋喃唑酮片);B组45例(埃索美拉唑片加阿莫西林胶囊加克拉霉素片);C组45例(枸椽酸铋钾胶囊加阿莫西林胶囊加甲硝唑片)。3组疗程均为4周。观察Hp根除率及溃疡愈合率,运用药物经济学的成本-效果分析(C/E)法对Hp相关性PU的3种治疗方案进行分析评价,比较3种治疗方案对Hp相关性PU治疗的经济效果。[结果]Hp培养阳性率为36.6%,耐药率分别为:甲硝唑片75.3%、克拉霉素片7.4%、阿莫西林胶囊7.4%、左氧氟沙星胶囊12.4%、呋喃唑酮片8.6%。Hp根除率:A、B、C组分别为91.12%、93.33%、51.12%;溃疡愈合率:A、B、C组分别为93.34%、95.56%、42.23%。C/E、增长的成本-效果比分析(△C/△E)及1年内溃疡的复发率调查表明,治疗Hp相关性PU,B组方案最佳。[结论]细菌培养、药敏试验、药物经济学在优化治疗方案、指导合理用药、提高经济效益方面具有重要作用。

[Objective]To analyze the HP＇s drug resistance rate of 5 major antibiotics and in- quire into the economic effect of the different treatment plans for peptic ulcer relevant to Hp in Lvliang, Shanxi province. [Methods]Samples of gastric mucosa were segregated and cultured in diagnosis of Hp clinical strain. The 104 successful samples were given the susceptibility test by paper disk method to 5 major antibiotics. According to the result of susceptibility test, 135 positive samples of Hp culture were selected and devided into three groups at random： 45samples of A group （Omeprazole ＋ Amoxil＋ Furaltadone）;45 samples of B group（Astravenbca ＋Amoxil＋ Clarithromycin） ;45 samples of C group（Colloidal bismuth subcitrate ＋ Amoxil ＋ Arilin）. The course of treatment on 3 groups were all 4 weeks. The eradicating rate of Hp and coalescence rate of peptic ulcer were observed. Pharmacoeconomics＇ cost-effect analysis was used to evaluate the three kinds of treatments. [Results]The positive rate of Hp culture was 36.6%. The drug resisitance rate of Arilin was 75. 3%; Clarithromycin 7. 4%; Amoxil 7. 4%; Levofloxacin 12. 4%; Furaltadone 8. 6 %. The eradicating rate of Hp：A group was 91. 12%, B group 93. 33%, C group 51.12%. The coalescence rate of ulcer： A group was 93. 34%, B group 95. 56%, C group 42.23%. The cost effect analysis,the increasing cost-effect analysis （△C/△E）and rearising rate of ulcer in 1 year indicate B group was the best scheme for peptic ulcer relevant to Hp. [Conclusion]Bacterial culture,susceptibility tests, and pharmacoeconomics are very important in optimizing treatment plans, guiding rational drug usage and increasing economic efficiency.