1134例幽门螺旋杆菌培养及药敏分析

Investigation on cultivation and drug sensitivity of H.pylori in 1 134 cases

目的了解嘉兴地区H.pylori感染、耐药情况及依据药敏试验行抗H.pylori治疗后,H.pylori根除的情况。方法选取1 134例上消化道疾病患者胃黏膜组织,于微需氧环境的分离培养基上培养。采用抗生素药敏试验纸片琼脂扩散法(简称K-B法),对分离到的H.pylori菌株进行药物敏感试验,抗生素选用甲硝唑、阿莫西林、克拉霉素、呋喃唑酮、庆大霉素及左氧氟沙星。所有H.pylori培养阳性患者,均依据药敏试验结果进行抗H.pylori治疗,4周后复查。结果1 134例患者中,H.pylori分离培养阳性者341例,阳性率30.07%。病理组织学检测阳性者477例,阳性率42.06%,明显高于分离培养阳性者(P<0.001)。对341例分离培养的H.pylori菌株进行药敏试验,甲硝唑耐药率最高,左氧氟沙星最低,依次为甲硝唑(99.12%)、阿莫西林(46.04%)、克拉霉素(34.02%)、呋喃唑酮(16.42%)、庆大霉素(6.45%)、左氧氟沙星(0.59%)。细菌对抗生素的敏感度左氧氟沙星最高,甲硝唑最低,依次为左氧氟沙星(20.51%)、庆大霉素(18.43%)、阿莫西林(17.04%)、呋喃唑酮(16.92%)、克拉霉素(15.54%)、甲硝唑(10.33%)。结论依据药敏试验进行抗H.pylori治疗,是抗H.pylori治疗的最佳选择。

Objective To investigate the infection status drug resistance Of H. pylori and effect on eradication by drug sensitivity test in Jiaxing, Zhejiang province. Methods Gastric mucousa samples from 1 134 cases of upper gastrointestinal bleeding were cultivated in microaerobic condition. H. pylori strains were separated and drug sensitivity tests performed by means of K-B with Metronidazole, Amoxicillin, Clarithromycin, Furazolidone, Gentamicin and Levofloxacin. All H. pylori positive cases were treated according to drug sensitivity results and were followed up for four weeks. Results Of 1 134 cases, 341 cases were diagnosed as H. pylori positive by separated cultivation （30.07%）. Likewise, 477 cases were positive by pathologic test （42. 06% ） markedly more sensitive than the cultivation method （P 〈 0. 001 ）. The drug resistance rates from high to low were Metronidazole （99.12%） , Amoxieillin （46.04%） , Clarithromycin （34.02%）, Furazolidone （16.42%）, Gentamicin （6.45%）, Levofloxacin （0.59%） in turn. And the sensi- tivity of H. pylori to antibiotics from high to low were Levofloxacin （20.51%）, Gentamiein （18.43%）, Amoxicillin （17.04%） , Furazolidone （ 16.92% ） , Clarithromyein （ 15.54% ） , Metronidazole （ 10.33% ） in turn. Conclusion Eradication of H. pylori depending on drug sensitivity tests is the optimal treatment selection.