温岭地区2014—2018年幽门螺杆菌对克拉霉素和左氧氟沙星耐药趋势分析

Trend analysis of Helicobacter pylori resistance to clarithromycin and levofloxacin in Wenling area from 2014 to 2018

【目的】了解温岭地区幽门螺杆菌(Helicobacter pylori,Hp)对克拉霉素和左氧氟沙星的耐药情况与变化趋势,指导该地区根除Hp临床用药。【方法】选择2014年1月至2018年12月因消化道症状在温岭市第一人民医院就诊患者为研究对象,共计66515例。根据患者年龄段分为童年期(0~6岁);少年期(7~17岁);青年期(18~40岁);中年期(41~65岁);老年期(≥66岁)。所有患者均进行胃镜检查、胃黏膜活体组织检查及Hp分离培养,并对其进行克拉霉素和左氧氟沙星耐药性检测分析。【结果】2016、2017、2018年Hp阳性率呈明显下降趋势(χ2=14.317、47.079、88.054,均P<0.05)。2014—2018年Hp对克拉霉素平均耐药率为22.72%(4732/20831),呈逐年上升趋势,但2017年后上升幅度较缓;Hp对左氧氟沙星平均耐药率为30.55%(6364/20831),总体趋势呈现为2015—2017年急剧上升(χ^(2)=38.383、49.569,均P<0.05),2017年后明显下滑(χ^(2)=18.841,P<0.05)。克拉霉素耐药率随年龄增长呈现先下降后上升趋势,老年期克拉霉素耐药率为32.52%(763/2346),高于青年期的22.09%(1086/4916)和中年期的21.21%(2854/13458),差异均有统计学意义(χ^(2)=991.071、144.968,均P<0.05)。各年龄段患者Hp对左氧氟沙星耐药率随年龄增长急剧上升,从少年期的12.73%(14/110)上升至老年期的43.31%(1016/2346),差异有统计学意义(χ^(2)=228.867,P<0.05)。【结论】近年来,温岭地区Hp阳性率有下降趋势。Hp对克拉霉素和左氧氟沙星的耐药率虽然近期有上升缓慢或下降趋势,但仍处于较高水平。在Hp根除方案的选择上,应考虑到不同年龄段患者之间的差异,尤其是少年期患者的用药选择。

[Objective]To understand the trend of Helicobacter pylori(Hp)resistance to clarithromycin and levofloxacin and to provide guidance for Hp eradication therapy.[Methods]From January 2014 to December 2018,a total of 66515 patients with gastrointestinal symptoms were enrolled in the First People's Hospital of Wenling.The patients were divided into the following groups:childhood(0 to 6 years old);juvenile(7 to 17 years old);youth(18 to 40 years old),middle age(41 to 65 years old),and old age(≥66 years old).All patients received gastroscopy,gastric mucosal biopsy,Hp culture and drug sensitivity test of clarithromycin and levofloxacin.[Results]The Hp positive rate showed a significant downward trend in 2016,2017 and 2018(χ^(2)=14.317,47.079,88.054,all P<0.05).The average resistance rate of Hp to clarithromycin from 2014 to 2018 was 22.72%(4732/20831)showing an increasing trend,but the increase was slower after 2017.The average resistance rate to levofloxacin was 30.55%(6364/20831),and the overall trend showed a sharp rise from 2015 to 2017(χ^(2)=38.383,49.569,both P<0.05),and a significant decline was detected after 2017(χ^(2)=18.841,P<0.05).The resistance rate of Hp to levofloxacin in patients increased with age.The clarithromycin resistance rate first decreased and then increased with age,and the resistance rate in old age(32.52%,763/2346)was higher than that in youth(22.09%,1086/4916)and middle age patients(21.21%,2854/13458),and the differences were significant(χ^(2)=991.071,144.968,both P<0.05).The resistance rate of Hp rose from 12.73%(14/110)in juvenile to 43.31%(1016/2346)in old age(χ^(2)=228.867,P<0.05).[Conclusion]In recent years,the positive rate of Hp infection in Wenling area has a decreasing trend.Although the resistance rate of Hp to clarithromycin and levofloxacin has been rising slowly or decreasing,it is still at a high level.In the selection of Hp eradication program,the differences between patients in different age groups should be considered with particular attention on the minors.