浙中地区幽门螺旋杆菌耐药性临床分析

Clinical analysis of antibiotic resistance to Helicobacter pylori in central Zhejiang of China

目的 分析浙中地区幽门螺杆菌临床分离菌株对常用抗生素的体外耐药情况及临床耐药特征。方法 选取2015年5月至2015年8月浙江省金华市中心医院胃镜标本中分离到的296株幽门螺杆菌菌株进行体外药敏试验,分析其对甲硝唑、左氧氟沙星、克拉霉素、呋喃唑酮、阿莫西林、庆大霉素和四环素等7种抗生素的幽门螺杆菌耐药情况。分别根据性别、年龄及疾病类型将所有病例分组。其中男性组139株,女性组157株;17~35岁组58株,36~55岁组157株,56~79岁组81株;上消化道炎症组212株,上消化道溃疡组84株。结果 在检测的296株幽门螺杆菌菌株中,甲硝唑耐药率最高（86.8%,257/296）,其次为左氧氟沙星（35.1%,104/296）和克拉霉素（22.3%,66/296）,阿莫西林、庆大霉素、呋喃唑酮和四环素未检测到耐药菌株,即耐药率均为0%。296株幽门螺杆菌菌株中,对7种抗生素全部敏感的菌株有37株,占为12.50%;单独耐药的菌株有132株,占44.60%（包括甲硝唑单独耐药130株、左氧氟沙星单独耐药1株、克拉霉素单独耐药菌株1株）;双重耐药菌株86株,占29.05%（包括左氧氟沙星＋甲硝唑双重耐药62株、克拉霉素＋甲硝唑双重耐药24株）;三重耐药的菌株41株,占13.85%（左氧氟沙星＋克拉霉素＋甲硝唑耐药）。同时,女性患者左氧氟沙星的耐药率高于男性患者（41.4%vs.28.1%,χ^2=5.760,P=0.016）;17~35岁、36~55岁及56~79岁年龄组左氧氟沙星的耐药率分别为19.0%、42.0%、33.3%,三组比较差异有统计学意义（χ^2=10.052,P=0.007）,且17~35岁年龄组左氧氟沙星的耐药率明显低于36~55岁年龄组患者（P=0.002）。在炎症和溃疡患者中,左氧氟沙星耐药率（37.3%vs.29.8%,χ^2=1.486,P=0.223）、甲硝唑耐药率（86.3%vs.88.1%,χ^2=0.166,P=0.684）及克拉霉素耐药率（25.0%vs.15.5%,χ^2=3.150,P=0.076）的比较,差异亦均没有统计学意义。结论浙中地区幽门螺杆菌菌株对甲硝唑、左氧氟沙星和克拉霉素耐药率高。且左氧氟沙星的耐药率明显与性别及年龄相关,应严格遵循抗生素治疗规范,并根据药敏结果进行个体化治疗,进而提高幽门螺杆菌的根除率。

Objective To analyze the antibiotic resistance and clinical characteristics of Helicobacter pylori （H. pylori） in central of Zhejiang province. Methods A total of 296 strains of H. pylori isolated from May 2015 to August 2015 in Jinhua Central Hospital The resistance and clinical characteristics of these strains to metronidazole, levofloxacin, clarithromycin, furazolidone, amoxicillin, gentamicin and tetracycline were analyzed in vitro. All the strains were divided into different groups according to gender [male group （139 strains） and female group （157 strains）], age [17 ~ 35 years group （58 strains）, 36 ~ 55 years group （157 strains）, 56~79 years group （81 strains）, and disease types [inflammation group （212 strains） and ulceration group （84 strains）], respectively. Results Of the 296 strains of H. pylori, the rate of resistance to metronidazole, levofloxacin, clarithromycin were 86.8% （257/296）, 35.1% （104/296） and 22.3% （66/296）, respectively. No strains were resistant to furazolidone, amoxicillin, gentamicin and tetracycline. 12.50% of H. pylori isolates were susceptible to all tested antibiotic （37/296）, with mono 44.60% （resistance to metronidazole 130 strains, to ]evofloxacin 1 strains, to clarithromycin 1 strains）, double 29.05% （resistance to levofloxacin and metronidazole 62 strains, and to levofloxacin and clarithromycin 24 strains）, and triple 13.85% （resistance to levofloxacin, metronidazole and clarithromycin 41 strains）. Meanwhile, the resistance rate of levofloxacin was higher in the female group than that in the male group （41.4% vs. 28.1%,x^2 = 5.760, P= 0.016）, and were 19.0%, 42.0%, 33.3%, respectively, in the 17-35 years group, 36-55 years group, and 56-79 years group with significant differences （x^2 = 10.052, P= 0.007）, and it was much lower in the 17-35 years group than that in the 36- 55 years group （P= 0.002）. However, the resistance rates of metronidazole （37.3% vs. 29.8%, x^2 = 1.486, P = 0.223）, levofloxacin （86.3% vs. 88.1%, X2 = 0.166, P = 0.684）, clarithromycin （25.0% vs. 15.5%, X2 = 3.150, P = 0.076） were not statistically different between the inflammation group and ulceration group. Conclusions H. pylori resistance to metronidazole, levofloxacin and elarithromycin were high in the central Zhejiang, and gender and age were related to levofloxacin resistance. It is necessary to strictly follow the guidelines of antibiotic treatment and make an individual treatment according to the resuhs of drug sensitive test, thereby increase the eradication rate of H. pylori.