胃十二指肠疾病幽门螺杆菌感染及抗生素耐药状况分析

Analysis of Helicobacter pylori infection and antibiotic resistance in gastroduodenal diseases

目的观察西安地区胃十二指肠疾病患者幽门螺杆菌(H.pylori)感染及抗生素耐药情况,指导今后临床用药。方法对320例Hp阳性胃十二指肠疾病患者的胃黏膜样本进行H.pylori分离培养、鉴定,对所得H.pylori菌株进行甲硝唑、克拉霉素、左氧氟沙星、阿莫西林、呋喃唑酮、四环素的药敏检测。结果共获得有药敏结果H.pylori菌株121株。将患者分为慢性非萎缩性胃炎组、慢性萎缩性胃炎组、胃溃疡组、十二指肠溃疡组、复合性溃疡组及胃癌组,各组的H.pylori培养检出率之间有显著差异,胃、十二指肠溃疡组的H.pylori培养检出率及药敏培养检出率显著高于萎缩性胃炎及胃癌组(P<0.05)。H.pylori药敏结果显示甲硝唑的耐药率为80.17%,克拉霉素的耐药率为24.79%,左氧氟沙星的耐药率为30.58%,对阿莫西林、四环素与呋喃唑酮耐药率均为0.0%。对所有抗生素均敏感的H.pylori菌株占9.09%(11/121),单药耐药占56.20%(68/121),双重耐药占24.79%(30/121),三重耐药占9.92%(12/121)。各组H.pylori对不同抗生素的耐药情况无明显差异。结论不同类型疾病的H.pylori培养检出率之间有显著差异。西安地区H.pylori对克拉霉素、左氧氟沙星和甲硝唑耐药率高,对阿莫西林、四环素与呋喃唑酮耐药率低,推荐使用。

Objective To observe Helicobacter pylori(H.pylori)infection and antibiotic resistance in patients with gastroduodenal diseases in Xi′an,and to provide basis for guiding clinical medication in the future.Methods A total of 320 gastric mucosa samples that were taken from H.pylori positive patients were isolated,cultured and identified for H.pylori.The drug susceptibility of obtained H.pylori strains to metronidazole,clarithromycin,levofloxacin,amoxicillin,furazolidone and tetracycline was detected.Results There were 121 strains of H.pylori with drug sensitivity.The patients were divided into chronic non atrophic gastritis group,chronic atrophic gastritis group,gastric ulcer group,duodenal ulcer group,compound ulcer group and gastric cancer group.The detection rate of H.pylori culture in patients with gastric and duodenal ulcer was significantly higher than that in patients with atrophic gastritis and gastric cancer(P<0.05).The drug sensitivity of H.pylori strains showed that the resistance rate of metronidazole,clarithromycin and levofloxacin was respectively 80.17%,24.79%and 30.58%.The resistance rates to amoxicillin,tetracycline and furazolidone were all 0.0%.Sensitivity to all antibiotics accounted for 9.09%(11/121).Single drug resistance accounted for 56.20%(68/121),double drug resistance accounted for 24.79%(30/121),and triple drug resistance accounted for 9.92%(12/121).There was no significant difference in the resistance of H.pylori to different antibiotics in different disease.Conclusion There were significant differences in the detection rate of H.pylori culture among different types of diseases in each group.The drug resistance rate of H.pylori against clarithromycin,levofloxacin and metronidazole was high in Xi′an.The drug resistance rate to amoxicillin,tetracycline and furazolidone was low.These three drugs are recommended to use.