湖州地区消化系统疾病幽门螺杆菌耐药情况及根除疗效分析

Analysis af antibiatic resistance and eradicatation effects af Helicobacter pylori in digestive diseases in Huzhau district

目的了解浙江省湖州地区H. pylori常用抗菌药物的耐药变迁，总结相关消化系统疾病的根除疗效。方法收集2009、2013、2014、2015年8 139例胃镜检查患者的胃黏膜标本，进行H. pylori分离培养，分析左氧氟沙星、克拉霉素、甲硝唑、阿莫西林、四环素和呋喃唑酮的耐药现状，分析功能性消化不良、慢性胃炎、急性胃炎、十二指肠炎、胃溃疡、十二指肠溃疡、胃肠功能紊乱、胃癌、残胃炎、反流性食管炎、胃淋巴瘤11种疾病的H. pylori感染情况和H. pylori的耐药情况，以及功能性消化不良、慢性胃炎、十二指肠炎、胃溃疡、十二指肠溃疡、反流性食管炎6种消化系统疾病的H. pylori根除方案和根除率。以Fisher确切概率法比较各组率的差异。 结果共3 263例获得H. pylori临床分离株，H. pylori感染率为40.09%（3 263/8 139）。11种消化系统疾病的H. pylori感染率为0～57.89%，其中十二指肠溃疡、胃溃疡、十二指肠炎、慢性胃炎、功能性消化不良感染率较高，分别为57.89%（726/1 254）、49.83%（301/604）、42.91%（118/275）、37.45%（1 518/4 053）、36.78%（146/397）。需要根除或计划根除H. pylori的6个病种的单一抗菌药物耐药分析显示，H. pylori对左氧氟沙星和克拉霉素的耐药率分别达到23.09%（663/2 871）和17.87%（513/2 871），左氧氟沙星的耐药率由2009年的5.03%（8/159）急剧升高至2015年的28.24%（586/2 075），克拉霉素的耐药率由2009年的12.58%（20/159）较快升高至2015年的21.78%（452/2 075）；H. pylori对甲硝唑的耐药率一直接近100.00%；对阿莫西林、四环素和呋喃唑酮的耐药率均为0。需要根除或计划根除H. pylori的6个病种的总体双重耐药率分析发现，左氧氟沙星和克拉霉素同时耐药率为7.73%（222/2 871）。不同病种的H. pylori对左氧氟沙星和克拉霉素双重耐药率波动在4.82%～10.96%。6种消化系统疾病中的1 479例给予四联方案根治治疗，根治治疗后随访1 363例患者，根除率为85.99%（1 172/1 363）。结论对湖州地区常见的需要根除或计划根除H. pylori的6种消化系统疾病而言，应该首选阿莫西林、四环素、呋喃唑酮的两两组合进行治疗。如果对青霉素过敏或呋喃唑酮、四环素无法获得的情况下，再考虑选用左氧氟沙星和克拉霉素。监测并根据本地区的H. pylori药物敏感试验结果选择根除治疗方案能够取得较好的根除率。

ObjectiveTo investigate the antibiotic resistance trend of commonly used antibiotics of Helicobacter pylori （H. pylori） in Huzhou district, and to summarize the efficacy of eradication in related digestive diseases.MethodsIn year 2009, 2013, 2014 and 2015, 8 139 gastric mucosa samples of patients undergoing gastroendoscopy examination were collected and H. pylori strains were isolated and cultured. The situation of resistance to levofloxacin, clarithromycin, metronidazole, amoxicillin, tetracycline and furazolidone was analyzed. The infection and antibiotics resistance of H. pylori were analyzed in 11 digestive diseases including functional dyspepsia, chronic gastritis, acute gastritis, duodenitis, gastric ulcer, duodenal ulcer, gastrointestinal dysfunction, gastric cancer, residual gastritis, reflux esophagitis and gastric lymphoma. The eradication schemes and eradication rate of H. pylori was reviewed in six digestive diseases including functional dyspepsia, chronic gastritis, duodenitis, gastric ulcer, duodenal ulcer and reflux esophagitis. Fisher′s exact test was performed to compare the differences among the groups.ResultsA total of 3 263 H. pylori strains were obtained and the infection rate of H. pylori was 40.09% （3 263/8 139）. The H. pylori infection rates of 11 digestive diseases were from 0 to 57.89%, and which was high in duodenal ulcer, gastric ulcer, duodenitis, chronic gastritis and functional dyspepsia （57.89%, 726/1 254; 49.83%, 301/604; 42.91%, 118/275; 37.45%, 1 518/4 053 and 36.78%, 146/397; respectively）. The results of single antibiotic resistance analysis in six digestive diseases needed or planed for H. pylori eradication indicated that resistance rate of H. pylori to levofloxacin and clarithromycin reached 23.09% （663/2 871） and 17.87% （513/2 871）, respectively. The resistance rate to levofloxacin dramatically increased from 5.03% （8/159） in 2009 to 28.24% （586/2 075） in 2015; the resistance rate to clarithromycin increased from 12.58% （20/159） in 2009 to 21.78% （452/2 075） in 2015; meanwhile, the resistance rate of H. pylori to metronidazole was nearly 100.00%. However, the resistance rates to amoxicillin, tetracycline and tetracycline were all zero. The results of double antibiotic resistance analysis in six digestive diseases needed or planed for H. pylori eradication indicated that the rate of both levofloxacin and clarithromycin resistance was 7.73%（222/2 871）. The double antibiotic resistance rate of levofloxacin and clarithromycin in different diseases fluctuated between 4.82% and 10.96%. Totally 1 479 patients of six digestive diseases were treated with quadruple therapy, and 1 363 patients were followed up after eradication therapy, with the eradication rate of 85.99% （1 172/1 363）.ConclusionsIn Huzhou district, for six common digestive diseases needed or planed for H. pylori eradication, any combination of two drugs in all three drugs including amoxicillin, tetracycline and furazolidone is the first choice for treatment. Only when patients are allergic to penicillin or furazolidone and tetracycline can not be obtained, will levofloxacin and clarithromycin be chosen. A high eradication rate can be achieved by choosing eradication schemes according to the results of H. pylori drug sensitivity test in local region.