儿童感染幽门螺杆菌的耐药性及治疗分析

Drug- resistance and Treatment of Helicobacter Pylori Infection in Children

目的探讨儿童感染幽门螺杆菌(Hp)的耐药性及治疗情况,为儿童抗Hp治疗的药物选择提供参考。方法选取2013年6月—2014年5月在温州医科大学附属育英儿童医院确诊的Hp感染患儿163例,对其胃黏膜活检标本行Hp分离培养,采用E-test法对分离出的Hp菌株进行药敏试验。采用抽签法将患儿随机分为对照组(n=83)和观察组(n=80),其中观察组采用奥美拉唑+阿莫西林+呋喃唑酮三联抗Hp治疗,对照组采用奥美拉唑+阿莫西林+克拉霉素三联抗Hp治疗,比较两种不同方案的根除率。结果共分离出Hp 67株,Hp对阿莫西林、克拉霉素、呋喃唑酮、替硝唑和庆大霉素的耐药率分别为13.4%(58/67)、44.8%(30/67)、17.9%(12/67)、92.5%(62/67)、25.4%(17/67)。观察组患儿Hp根除率高于对照组〔85.0%(68/80)比72.3%(83/83)〕,差异有统计学意义(χ2=3.92,P<0.05)。结论本地区儿童感染Hp对克拉霉素、替硝唑的耐药率较高,而对阿莫西林、呋喃唑酮、庆大霉素的耐药率相对较低。目前临床上采用奥美拉唑+阿莫西林+克拉霉素的标准三联抗Hp方案对大多数患儿仍然有效。对于标准方案根除失败或者对克拉霉素不能耐受的患儿,采用呋喃唑酮替代克拉霉素是一个有效的选择。

Objective To Investigate the antibiotic resistance and treatment of Helicobacter pylori （Hp） infection in children and provide references for drug choice in the treatment. Methods We enrolled 163 children who were definitely diagnosed with Hp infection in the Affiliated Yuying Children＇s Hospital of Wenzhou Medical University from June 2013 to May 2014. Hp strains were isolated from gastric mucosa biopsy specimens and cultured. E - test method was employed to conduct drug sensitive test on the Hp strains. Lot drawing method was employed to rhndomly divide the children into control group （ n = 83 ） and observation group （ n = 80） . The observation group was administrated with omeprazole ＋ amoxicillin ＋ furazolidone, and the control group was administrated with omeprazole ＋ amoxicillin ＋ clarithromycin. Comparison was made between the two therapies. Results A total of 67 strains of Hp were isolated successfully, and resistant rates to amoxicillin, clarithromycin, furazolidone, tinidazole and gentamicin were 13.4% （58/67）, 44. 8% （30/67）, 17.9% （12/67）, 92. 5% （62/67） and 25. 4% （17/67）, respectively. Observation group was higher than control group in the eradication rate of Hp [ 85.0% （68 /80） vs. 72, 3 % （60/83）] （ χ2 = 3.92, P 〈 0. 05） . Conclusion Hp infectin in children in Wenzhou has high drug resistance rate to clarithromycin and tinidazole, but has relatively low drug resistance rate to amoxicillin, furazolidone and gentamicin. Currently, the therapy of omeprazole ＋ amoxicillin ＋ clarithromycin is still effective in the treatement of Hp infection in children. For the children with Hp. infection who have failed in standard regimen or have no tolerance for clarithromycin, furazolidone is a better choice than clarithromycin.