上海市青浦区幽门螺杆菌抗生素耐药情况的研究

Study on Antibiotic Resistance of Helicobacter pylori Isolated in Qingpu District,Shanghai

背景:幽门螺杆菌(H.pylori)对抗生素的耐药率在世界范围内呈上升趋势,但存在地域差异。目的:调查上海市青浦区H.pylori对5种根除治疗方案中常用抗生素的耐药情况。方法:选取青浦区两所医院因上消化道症状行胃镜检查、快速尿素酶试验阳性并符合纳入和排除标准的患者,取胃窦黏膜分离培养H.pylori,采用Kirby-Bauer纸片扩散法行药敏试验。结果:成功分离培养出120株H.pylori临床菌株,对甲硝唑、阿莫西林、克拉霉素、左氧氟沙星和呋喃唑酮的耐药率分别为82.5%、22.5%、36.7%、41.7%和0.8%。耐药率与患者性别无关;慢性胃炎菌株对左氧氟沙星的耐药率显著高于十二指肠溃疡菌株(P<0.05)。60.8%的菌株对两种以及两种以上抗生素联合耐药。结论:青浦区H.pylori对甲硝唑、阿莫西林、克拉霉素、左氧氟沙星的耐药情况相当严重且多重耐药率高。初次根除治疗失败后,再次治疗时可在药敏试验指导下选择有效抗生素。呋喃唑酮可作为当地根除治疗方案的一线用药。

Background： Antibiotic resistance of Helicobacter pylori （H. pylori） is increasing worldwide in recent years, however, the status is different in various regions. Aims：To investigate the resistance rates of H. pylori to five antibiotics, which are commonly used in the eradication therapy, in Qingpu District, Shanghai. Methods： Gastric mucosa biopsy specimens were taken from patients who had upper gastrointestinal symptoms, met the inclusion and exclusion criteria and were diagnosed as having H. pylori infection by rapid urease test in two hospitals of Qingpu District. H. pylori strains isolated were tested for drug resistance by Kirby-Bauer method. Results： One hundred and twenty strains of H. pylori were isolated. The resistance rates to metronidazole, amoxicillin, clarithromycin, levofloxacin and furazolidnne were 82.5%, 22.5%, 36.7%, 41.7% and 0.8%, respectively. No relationship was found between drug resistance and gender. Strains isolated from patients with chronic gastritis were more resistant to levofloxacin than those isolated from duodenal ulcer （P〈 0.05）. 60.8% of the strains exhibited double, triple or quadruple resistance. Conclusions： Resistances of H. pylori isolated in Qingpu District to metronidazole, amoxicillin, clarithromycin and levofloxacin are considerably high, and many were of muhidrug resistance. Therefore, after failure of first therapy, drug resistance of H. pylori should be tested before the initiation of second therapy. Furazolidone can be used as the first-line agent in this area.