广东云浮地区幽门螺旋杆菌临床分离菌株耐药状况分析及其应对策略

Analysis of Drug Resistance Status of Helicobacter Pylori Strain Clinically Isolated in Yunfu District of Guangdong Province and the Corresponding Strategies

目的:分析广东云浮地区幽门螺杆菌(Hp)临床分离菌株对常规治疗药物的耐药情况,观察补救疗法的疗效,为临床治疗幽门螺杆菌感染提供理论依据,探究根治幽门螺杆菌感染的应对策略。方法:选自2013年6月-2016年6月我院确诊为Hp感染的当地患者420例。本研究对420例Hp阳性患者进行Hp分离及阳性培养,共成功分离357组,在体外行药敏试验,探究幽门螺杆菌对甲硝唑、克拉霉素、阿莫西林、及左氧氟沙星等一种或多种常用抗生素的敏感性。将所有Hp阳性患者按不同治疗方案平均且随机分为3组,记为Ⅰ组、Ⅱ组、Ⅲ组,应用三联疗法规范治疗后,按照统计学方法计算Hp根除率,若Hp未根除,则给予四联疗法,记为Ⅳ组,经积极规范治疗后,计算Hp根除率。结果:初治3个组(Ⅰ、Ⅱ、Ⅲ组)Hp根除率中的Ⅰ组、Ⅱ组间根除率差异无统计学意义(P>0.05),Ⅰ组、Ⅲ组间差异较大(P<0.05);Ⅳ组Hp根除率明显高于初治3个组,第Ⅳ组与Ⅰ、Ⅱ、Ⅲ组根除率差异有统计学意义(P<0.05);对所有Hp阳性患者进行Hp分离及阳性培养,根据统计分析,Hp对甲硝唑耐药率明显高于对左氧氟沙星、阿莫西林和克拉霉素的耐药率,具有统计学意义(P<0.05);Hp对克拉霉素耐药率明显高于对左氧氟沙星和阿莫西林的耐药率,具有统计学意义(P<0.05)。结论:研究显示Hp对甲硝唑和克拉霉素的耐药性较高,为临床治疗幽门螺杆菌感染提供了一定的理论依据。

Objective： To analyze the drug resistance status of Helicobacter pylori （Hp） strain clinically isolated to conventional drugs in Yunfu District of Guangdong Provinc and observe efficacy of remedial therapy, so as to provide a theoretical basis for clinical treatment of Helicobacter pylori infection and explore the corresponding strategies to eradication of Hp infection. Methods： There were a total of 420 patients diagnosed with Hp infection in our hospital from June 2013 to June 2016. In this study, Hp isolation and positive culture were carried out in 420 Hp positive patients. 357 successfully isolated groups were conducted drug sensitivity test in vitro in order to explore the sensitivity of Hp to one or more commonly used antibiotics, such as metronidazole, clarithromycin, amoxicillin and levofloxacin. Hp positive patients were randomly and averagely divided into three groups, recorded as group I, group Ⅱ, and group Ⅲ. After standardized treatment of the patients with triple therapy, the eradication rate of Hp was calculated according to the statistical method. If Hp was not eradicated, the quadruple therapy was used and recorded as group IV and the eradication rate of Hp was calculated again after standardized treatment. Results： There was no significant difference in the eradication rate between groupⅠand groupⅡ （P〉0.05） in the first 3 groups （groupⅠ, groupⅡ, and groupⅢ） but there was significant difference in the eradication rate between groupⅠand group Ⅲ （P〈0.05）. The Hp eradication rate of Group IV was significantly higher than that of the first three groups. There was significant difference in the eradication rate between group IV and the first 3 groups （groupⅠ, groupⅡ, and groupⅢ） （P〈0.05）. According to the statistical analysis, the resistance rate of Hp to metronidazole was significantly higher than that of levofloxacin, amoxicillin and clarithromycin （P〈0.05）. The resistance rate of Hp to clarithromycin was significantly higher than that of levofloxacin and amoxicillin （P〈0.05）. Conclusion： The study found out that the Hp was highly resistant to clarithromycin and metronidazole, providing a theoretical basis for clinical treatment of Hp infection.