儿童幽门螺杆菌感染根除失败及再发的临床分析

Clinical analysis of eradication therapy failure and recurrence for Helicobacter pyloric infection in children

目的分析儿童幽门螺杆菌(Hp)感染根除失败及再发的主要原因。方法对819例确诊Hp感染的病例,分别选用奥美拉唑、阿莫西林、甲硝唑、克拉霉素进行根除治疗。治疗结束停药4周以上,复查快速尿素酶试验(RUT)1、3C或14C尿素呼气试验(UBT),判断疗效。调查失败病例治疗的顺应性及家庭成员上消化道疾病状况,对根除失败者中的30例行阿莫西林、甲硝唑(MTZ)药物敏感试验;对再发的103例家庭成员168例行血清Hp-IgG及UBT测定。结果 MTZ耐药率为43.33%(13/30),阿莫西林耐药率为6.67%(2/30);未按要求完成治疗者9.61%(5/52),家庭成员中患有上消化道疾病84.62%(44/52)。Hp再发与家庭成员Hp聚集现象有关,家庭成员中Hp阳性检出率为86.31%(145/168)。结论 MTZ的耐药性提高了含MTZ根除方案的失败率;未按要求完成治疗及家庭成员中上消化道疾病感染状况均是导致失败的原因。再发病例与家庭成员Hp检测阳性相关,存在明显的家庭聚集现象。

Objective To analyze the main causes of eradication therapy failure and recurrence for Helicobacter pyloric（Hp） infection in children.Methods Eight hundred and nineteen children with Hp infection were given eradication therapy consisted of omeperazole,amoxycillin（AMO）,metronidazole（MET） and clarithromycin.The children were undertaken,RUT,BUT or Hp measurement in stool for checking curative effect after 4 weeks eradication therapies ended.Children in whom Hp was eradicated therapy failure were investigated for compliance and upper digective tract diseases of family numbers.Thirty children in whom Hp was eradicated therapy failure undertake medicine sensitive test of AMO and MTZ.Hp-IgG of serum and UBT were done on 168 family numbers of 103 recurrence children.Results It was found that MTZ resistant rate was 43.33%（13/30）,AMO resistant rate was 6.67%（2/30）.The children who have not finished therapy as doctor＇s order was 9.61%（5/52）,family numbers who had upper digestive tract diseases was 84.62%（44/52）.Hp recurrence was related to phenomenon of family aggregation of HP infection.The positive rate of Hp infection in family numbers was 86.31%（145/168）.Conclusion Resistance of MTZ increase the failure rate in children who had MTZ triple therapy.It is the main cause of eradication failure for Hp infection that the children have not finished triple therapy as doctor＇s orderes and family numbers had upper digestive tract diseases.Recurence of Hp infection is associated with positive of Hp infection family numbers.There is a remarkable phenomenon of family aggregation in HP infection.