渝西地区幽门螺杆菌流行病学调查及耐药状况临床研究

Epidemiological Investigation and Drug Resistance of Helicobacter Pylori in Western Chongqing Region

目的调查渝西地区自然人群幽门螺杆菌(HP)感染率及其对克拉霉素、甲硝唑、阿莫西林、左氧氟沙星、呋喃唑酮等抗生素的耐药状况。方法根据2012年1月至2016年8月1 000例门诊患者的^(14)C-尿素呼气试验结果,调查渝西地区自然人群HP感染率,分析性别、年龄和疾病种类差异。取150例门诊胃镜检查活检标本,进行HP培养、鉴定,研究其对克拉霉素、甲硝唑、阿莫西林、左氧氟沙星、呋喃唑酮的耐药情况,并调查不同药物联合治疗HP的临床根除率。结果渝西地区自然人群HP总感染率为54.59%,男性占59.38%,女性占44.78%,性别差异显著(P<0.05);40~59岁感染率与其他年龄组比较差异显著(P<0.05);各组间HP感染率比较均有显著差异(P<0.05);甲硝唑耐药率最高(54.00%);雷贝拉唑+阿莫西林+克拉霉素与雷贝拉唑+克拉霉素+甲硝唑对HP首次治疗根除率分别为78.00%与52.00%,低于80.00%,而雷贝拉唑+阿莫西林+左氧氟沙星与雷贝拉唑+阿莫西林+呋喃唑酮对HP首次治疗根除率分别为92.00%与95.00%;对于克拉霉素与甲硝唑治疗失败者,使用上述2种方案治疗HP根除率分别为85.00%与90.00%。结论渝西地区为HP感染高发与高耐药地区,标准的三联疗法已不适合作为首次根除HP的治疗方案,阿莫西林、左氧氟沙星、呋喃唑酮可作为根除HP的优选用药。

Objective To investigate the prevalence of Helicobacter pylori（ HP） infection in a natural population of western Chongqing region and the HP resistance to antibiotics such as clarithromycin,metronidazole,amoxicillin,levofloxacin and furazolidone.Methods According to the results of the 14C-urea breath test（ 14C-UBT） of 1 000 outpatients from January 2012 to August 2016,the HP infection rate of natural population in western Chongqing region was investigated,and the differences of gender,age and disease types were analyzed.Totally 150 cases of biopsy specimens of gastroscopy in the outpatient were taken for HP culture and identification.The HP resistance to clarithromycin,metronidazole,amoxicillin,levofloxacin,and furazolidone was studied,and the clinical eradication rate of HP treated with different combination drugs was investigated.Results The total HP infection rate in the natural population of western Chongqing region was 54.59%,59.38% for males and 44.78% for females,and the difference in gender was significant（ P〈 0.05）.The infection rate of patients with 40-59 years old was significantly different from that of other ages（ P〈 0.05）,and the HP infection rates were significant differences in each group（ P 〈0.05）.The metronidazole resistance rate was the highest（ 54.00%）.The HP eradication rates of rabeprazole ＋ amoxicillin ＋ clarithromycin,rabeprazole ＋ clarithromycin ＋ metronidazole were 78.00% and 52.00%,respectively,which were lower than 80.00%,while the Hp eradication rates of rabeprazole ＋ amoxicillin ＋ levofloxacin,rabeprazole ＋ amoxicillin ＋ furazolidone were 92.00% and 95.00%,respectively.Even for patients with failure of clarithromycin or metronidazole,the HP eradication rates of last two regimens were still 85.00% and 90.00%,respectively.Conclusion Western Chongqing region is the area of high incidence of HP infection and high drug resistance.The traditional triple therapy is not suitable for eradicating Hp in the initial treatment.Amoxicillin,levofloxacin and furazolidone can be used as the preferred drug for the eradication of HP.