良性胃病患者5441例内镜下疾病分型与幽门螺杆菌抗生素耐药关联研究

Correlation between endoscopic classification and antibiotic resistance of Helicobacter pylori in 5441 patients with benign gastric diseases

目的以临床内镜下胃部疾病分型数据,以及H.pylori分离培养和抗生素耐药数据为基础,分析内镜下胃部疾病类型与H.pylori感染和抗生素耐药的关系。方法回顾性选择2015年1月1日至2019年12月31日于舟山市普陀区人民医院就诊的5441例有消化道症状良性胃病患者的内镜诊断与H.pylori药敏试验数据,分别统计分析不同性别、不同类型胃部疾病患者的H.pylori感染情况和对不同抗生素的耐药率。统计学方法采用卡方检验。结果5441例良性胃病患者H.pylori阳性率为51.37%(2795/5441),其中克拉霉素、左氧氟沙星、甲硝唑、阿莫西林、四环素和呋喃唑酮耐药率分别为26.73%(747/2795)、43.22%(1208/2795)、98.68%(2758/2795)、0.32%(9/2795)、0和0。2795例H.pylori阳性患者中仅23例(0.82%)对6种抗生素均敏感;1263例(45.19%)仅对单种抗生素耐药;1072例(38.35%)对2种抗生素组合耐药;433例(15.49%)对3种抗生素组合耐药,其中对克拉霉素、左氧氟沙星、甲硝唑3种抗生素同时耐药率最高[15.31%(428/2795)];4例(0.14%)患者对克拉霉素、左氧氟沙星、甲硝唑、阿莫西林4种抗生素同时耐药。男性患者H.pylori阳性率高于女性[55.23%(1615/2924)比46.88%(1180/2517)],差异有统计学意义(χ^(2)=37.76,P<0.01),但不同性别H.pylori阳性患者6种抗生素耐药率比较差异均无统计学意义(P均>0.05)。不同类型的胃部疾病患者间H.pylori阳性率比较差异有统计学意义(χ^(2)=909.07,P<0.01),其中十二指肠溃疡患者的H.pylori阳性率最高[97.53%(79/81)],胆汁反流性胃炎最低[19.79%(37/187)]。9种类型的胃部疾病患者间甲硝唑、克拉霉素、左氧氟沙星、阿莫西林耐药率比较差异均有统计学意义(χ^(2)=24.75、38.62、80.54、7.01,P均<0.01)。结论不同类型的胃部疾病患者的H.pylori阳性率和抗生素耐药率均有所不同,临床治疗过程中须注意溃疡性疾病的用药选择,推荐根据抗生素药物敏感试验结果采取个体化治疗。

Objective To analyze the relationship between the gastric diseases classification under endoscopy and infection and antibiotic resistance of Helicobacter pylori(H.pylori)based on the data of gastric diseases classification under endoscopy,H.pylori isolation and antibiotic resistance.Methods From January 1,2015 to December 31,2019,endoscopic diagnosis and the data of drug susceptibility of H.pylori of 5441 patients with benign gastric diseases along with gastrointestinal symptoms who visited The First People′s Hospital of Putuo District of Zhoushan were retrospectively collected.The H.pylori infection in patients with different genders and different types of gastric diseases and the drug resistance rates of H.pylori among different antibiotic types were analyzed.Chi-square test was used for statistical analysis.Results The positive rate of H.pylori in 5441 patients with benign gastric diseases was 51.37%(2795/5441).The drug resistance rates of clarithromycin,levofloxacin,metronidazole,amoxicillin,tetracycline and furazolidone were 26.73%(747/2795),43.22%(1208/2795),98.68%(2758/2795),0.32%(9/2795),0 and 0,respectively.Among the 2795 cases of H.pylori-positive patients,only 23 cases(0.82%)were sensitive to all six antibiotics;1263 cases(45.19%)were resistant to single antibiotic;1072 cases(38.35%)were resistant to combination of two antibiotics,and 433 cases(15.49%)were resistant to combination of three antibiotics.The drug resistance rate to three antibiotics,clarithromycin,levofloxacin and metronidazole simultaneously was the highest(15.31%,428/2795).And only four patients(0.14%)were simultaneously resistant to four antibiotics clarithromycin,levofloxacin,metronidazole and amoxicillin.H.pylori infection rate in men was higher than that in women(55.23%,1615/2924 vs.46.88%,1180/2517),and the difference was statistically significant(χ^(2)=37.76,P<0.01).However there were no statistically significant differences in the drug resistance rates of six antibiotics between different gender among H.pylori-positive patients(all P>0.05).There was statistically significant difference in the positive rate of H.pylori among patients with different types of gastric diseases(χ^(2)=909.07,P<0.01).The positive rate of H.pylori was the highest in patients with duodenal ulcer(97.53%,79/81),and the lowest in patients with bile reflux gastritis(19.79%,37/187).There were statistically significant differences in the drug resistance rates of metronidazole,clarithromycin,levofloxacin and amoxicillin among 9 types of gastric diseases(χ^(2)=24.75,38.62,80.54 and 7.01,all P<0.01).Conclusions The positive rate of H.pylori and antibiotic resistance rate are different in patients with different types of gastric diseases.It is necessary to pay attention to the selection of drugs for ulcerative diseases in the process of clinical treatment.Individualized treatment is recommended according to the results of antibiotic susceptibility test.