舟山群岛地区幽门螺杆菌感染现状及耐药分析

Prevalence and drug resistance of Helicobacter pylori in Zhoushan archipelago

目的了解舟山群岛地区幽门螺杆菌（Hp）感染的现状及其对甲硝唑、克拉霉素、阿莫西林等耐药情况。方法对舟山市第三人民医院2006年5月至2007年5月因胃肠道症状于胃镜室检查的2 047例患者胃黏膜进行Warthin-Starry染色检测幽门螺杆菌感染情况,并且对临床分离的185株幽门螺杆菌进行药敏试验,通过Kirby-ba-ner药敏纸片法检测Hp对甲硝唑、克拉霉素、阿莫西林等药物的敏感性。通过χ2检验进行统计分析,P〈0.05为差异有统计学意义。结果Hp总感染率为31.90%,其中浅表性胃炎31.12%、萎缩性胃炎31.03%、消化性溃疡42.06%、胃癌54.54%。对就诊患者进行各年龄组比较显示61~70岁年龄组Hp感染率最高为64.10%,P〈0.01。男性和女性患者Hp感染率分别为32.96%、30.62%,差异无统计学意义。Hp耐药结果显示：对抗生素的单药耐药率分别为：克拉霉素为28.1%、阿莫西林为32.4%、甲硝唑为99.4%。Hp菌株对抗生素的多重耐药率为：阿莫西林＋甲硝唑的双重耐药率最高为33.0%,克拉霉素＋甲硝唑于其次为27.0%,克拉霉素＋阿莫西林最低为17.8%。克拉霉素＋阿莫西林＋甲硝唑三重耐药率为17.3%。各抗生素的单药耐药率与患者的性别比较差异无统计学意义,P〉0.05。结论舟山群岛地区Hp总感染率低于全国平均水平,但是,耐药情况明显高于全国平均水平,耐药菌株产生的问题必须引起足够的重视。

Objective To analyze the prevalence ofHelicobacterpylori （Hp） infection and the antibiotic resistance of HP clinical isolates in Zhoushan Archipelago area. Methods A total of 2 047 patients were enrolled in this study. Warthin- Starry staining was used to detect Hp. Drug sensitivity test was performed on 185 Hp clinical isolates cultured with antibiotics. The antibiotic resistances of Hp to metronidazole, clarithromycin and amoxicillin were checked by Kirby-bauer test. Chi-square test was adopted to analyze the relationship between the antibiotic resistance rate of each drug and genders, previous diseases and ages. Results First, the total infection rate of Hp was 31.90%. The infection rate of Hp in ~atients with superficial gastritis was 31.12%, atrophic gastritis 31.03%, peptic ulcer 42.06%, gastric cancer 54. 55%. Otherwise, the infection rate of Hp was highest in age group of 61-70 （ 64. 10% , P 〈 0. 01 ）. There was no statistically significant difference in Hp prevalence between genders. Second, the single drug resistance rates to metronidazole, clarithromycin and amoxicillin were 99.5%, 28. 1% and 32.4% , respectively. The maltidrug resistance rates of amoxicillin plus metronidazole, clarithromycin plus metronidazole, and clarithromycin plus metronidazole were 33.0% , 27.0% and 17.8% , respectively. The triple drug resistance of them was 17.3%. There was no statistically significant difference between single drug resistance rate and gender, previous disease and age. Conclusion The prevalence of Helicobacterpylori infection in Zhoushan Archipelago area is lower than that of the average of our country, but the antibiotic resistance of Hp is more severe.