厦门市学龄期儿童幽门螺杆菌感染耐药性及4种治疗方案疗效

Drug resistance of Helicobacter pylori infection in school-age children in Xiamen and effects of four treatment options

目的探讨厦门市学龄期儿童幽门螺杆菌(Helicobacter pylori,Hp)感染的耐药特点及四种方案治疗效果分析。方法选择厦门市儿童医院消化科2017年4月-2019年3月收治Hp确诊阳性患儿198例为研究对象,随机将其分为A组50例、B组51例、C组45例、D组52例,A组治疗方案:奥美拉唑+阿莫西林+克拉霉素,B组治疗方案:奥美拉唑+阿莫西林+甲硝唑,C组治疗方案:奥美拉唑+甲硝唑+克拉霉素,D组治疗方案:奥美拉唑+阿莫西林+克拉霉素+枸橼酸铋剂。对Hp培养阳性耐药性分布进行统计;比较四组患儿Hp根除率、统计不良反应并计算成本-效益比。结果 198例患儿共检出Hp 82株,检出率41.41%,检出的Hp菌株对甲硝唑、克拉霉素耐药率(74.39%、45.12%)较高,对阿莫西林、呋喃唑酮耐药率(8.54%、12.20%)较低。四种方案对Hp根除率分别为:94.00%、80.39%、80.00%、94.23%,均>80%,总体差异有统计学意义(P=0.035)。四组患儿在治疗及停药期间均无严重的不良反应出现,且轻度不良反应均在停药结束后逐渐消失,各组间不良反应发生率差异无统计学意义。四组成本-效益比分别为:A组:494.34、B组530.15、C组:512.52、D组:508.79,A组最低,B组最高。结论厦门地区学龄期儿童Hp总体耐药率偏低,三联或四联主流治疗方案均对Hp具有较高的根除率,可根据患者意愿及病情实际情况选择治疗方案。

OBJECTIVE To investigate the drug-resistant characteristics of Helicobacter pylori infection in school-age children in Xiamen and the analysis of the effects of four treatment options. METHODS A total of 198 children diagnosed with positive Hp in the Department of Gastroenterology of Xiamen Children′s Hospital from Apr. 2017 to Mar. 2019 were selected as the research subjects, and were randomly divided into 50 cases in group A, 51 cases in group B, 45 cases in group C, and 52 cases in group D. Treatment plan of group A: omeprazole+amoxicillin+clarithromycin;treatment plan of group B: omeprazole+amoxicillin+Metronidazole;treatment plan of group C: omeprazole+metronidazole+clarithromycin;treatment plan of group D: omeprazole+amoxicillin+clarithromycin+bismuth citrate. The distribution of Hp culture-positive drug resistance was counted;the Hp eradication rate, statistical adverse reactions and the cost-benefit ratio of the four groups were compared. RESULTS A total of 82 Hp strains were detected in 198 children, with a detection rate of 41.41%. The detected Hp strains had higher resistance to metronidazole and clarithromycin(74.39% and 45.12%, respectively), and lower resistance to amoxicillin and furazolidone(8.54% and 12.20%, respectively). The H. pylori eradication rates of the four schemes were: 94.00%, 80.39%, 80.00%, 94.23%, respectively, all >80%, and the overall difference was significant(P=0.035). There were no serious adverse reactions in the four groups of patients during treatment and drug withdrawal, and the mild adverse reactions gradually disappeared after the drug withdrawal. The incidence of adverse reactions between the groups was not significant. The component cost-benefit ratios of four groups were 494.34 of Group A, 530.15 of Group B, 512.52 of Group C, and 508.79 of Group D, respectively among which Group A was the lowest, Group B was the highest. CONCLUSION The overall resistance rate of HP in school-age children in Xiamen area was relatively low. The triple or quadruple mainstream treatment regimens had a high eradication rate for HP. Treatment options can be selected according to the patient′s wishes and the actual conditions of the disease.