上海地区幽门螺杆菌的检出率及耐药性分析

Prevalence and antibiotic resistance profile of Helicobacter pylori in Shanghai

目的了解幽门螺杆菌的阳性检出率及其影响因素,分析上海2所医院幽门螺杆菌临床分离菌株对一线治疗幽门螺杆菌抗菌药物的耐药性,为临床幽门螺杆菌根治提供用药依据。方法收集上海2所医院2013年9月—2015年1月临床胃组织活检样本,进行幽门螺杆菌分离培养和鉴定;采用E试验法对131株幽门螺杆菌临床菌株分别进行4种治疗幽门螺杆菌的一线抗菌药物克拉霉素、甲硝唑、阿莫西林和四环素的体外药敏试验。结果共收集955例胃组织活检样本,分离出幽门螺杆菌248株,检出率为26.0%。幽门螺杆菌对克拉霉素、甲硝唑、四环素和阿莫西林的耐药率分别为14.5%、64.1%、0和0.8%,对上述药物中的2种同时耐药占10.7%(14/131),其中92.8%(13/14)为克拉霉素和甲硝唑同时耐药。结论幽门螺杆菌阳性检出率较以前报道的阳性携带率低,且与性别、年龄与疾病类型等因素相关,而耐药率则与之无明显相关性。幽门螺杆菌的临床治疗应根据体外药敏结果进行个体化用药。

Objective To examine the prevalence of Helicobacter pylori in Shanghai and relevant risk factors, evaluate the resistance profile ofH. pylori isolates to antibiotics used in first-line therapy in two hospitals in Shanghai. Methods H. pylori were isolated from the biopsy samples of gastric mueosa collected from September 2013 to January 2015. Antimicrobial susceptibility test was performed by E-test method for 131 H. pylori strains to 4 antibiotics, elarithromycin, metronidazole, amoxicillin and tetracycline. Results A total of 955 patients receiving gastroscopy were enrolled. And 248 （26.0%） H. pylori strains were isolated from the biopsy samples of gastric mucosa. Overall, 14.5%, 64.1%, 0 and 0.8% of the strains were resistant to clarithromycin, metronidazole, amoxicillin and tetracycline, respectively. Resistance to two drugs was found in 10.7% （ 14/131 ） of the strains, and majority （92.8%, 13/14） of which were resistant to elarithromycin and metronidazole. Conclusions The prevalence of H. pylori in gastric mucosa is rather lower compared with the data reported previously. It is associated with the sex, age and clinical outcome of patients, however,antibiotic resistance profile is not related to these factors. H. pylori eradication therapy should be individualized according to the results of susceptibility test in Shanghai.