山西胃肠病患者幽门螺杆菌感染情况及耐药性分析

Analysis of Helicobacter pylori infection and drug resistance in patients with gastrointestinal diseases in Shanxi province

目的了解934例山西胃肠病患者幽门螺杆菌感染率及其抗生素耐药基因突变现状,为临床根治幽门螺杆菌提供用药依据。方法选取就诊于山西省人民医院消化科进行^(13)C-尿素呼气试验及胃镜检查的934例胃肠病患者,分析山西省胃肠病患者的幽门螺杆菌感染率。采集31例胃肠病患者的胃黏膜组织样本,利用荧光定量聚合酶链反应(PCR)方法检测幽门螺杆菌感染及抗生素耐药基因。结果山西胃肠病患者的幽门螺杆菌感染率为87.2%(814/934)。在20例H.pylori阳性标本中,65%(13/20)存在耐药突变,其中50%(10/20)有克拉霉素耐药突变,45%(9/20)有喹诺酮类耐药突变,10%(2/20)有阿莫西林耐药突变,5%(1/20)有四环素耐药突变,5%(1/20)有呋喃唑酮耐药突变,而双重耐药突变占45%(9/20),主要为克拉霉素及喹诺酮类耐药突变。结论山西为幽门螺杆菌感染的高发地区,且对克拉霉素和喹诺酮类抗生素耐药率极高,在经验性治疗方案的选择中应尽量避免选用克拉霉素和喹诺酮类抗生素。同时建议在临床工作中实施推广荧光定量PCR法检测抗生素耐药基因突变,帮助患者制定个体化治疗方案,进一步提升幽门螺杆菌根除率,避免耐药率的逐步上升。

Objective To investigate the infection rate and antibiotic resistance gene mutation of Helicobacter pylori(H.pylori)in 934 patients with gastrointestinal diseases in Shanxi province in order to provide medication basis for clinical eradication of HP.Methods A total of 934 patients of gastrointestinal diseases with ^(13)C urea breath test and gastroscopy in the Department of Gastroenterology of Shanxi Provincial People's Hospital were collected to analyze the infection rate of H.pylori in patients with gastrointestinal diseases in Shanxi Province.Fluorescence quantitative PCR method was used to detect the Helicobacter pylori infection and antibiotic resistance genes in gastric mucosa samples from 31 patients with gastrointestinal diseases.Results The rate of H.pylori infection in patients with gastrointestinal diseases in Shanxi Province was 87.2%.The drug resistance of the 20 specimens positive for H.pylori was 65% and the resistance rates to clarithromycin,quinolone,amoxicillin,tetracycline and furazolidone were 50%(10/20),45%(9/20),10%(2/20),5%(1/20)and 5%(1/20).Double antibacterial resistance mutations accounted for 45%,which mainly were clarithromycin and quinolone resistance mutations.Conclusion Clarithromycin and quinolones should be avoided as far as possible in the choice of empirical treatment for H.pylori in Shanxi province which is a high incidence area of H.pylori infection with a high resistance rate to clarithromycin and quinolones.It's also advisable to promote the application fluorescence quantitative PCR to detect antibiotic resistance gene mutation in clinical work,which can help develop individualized treatment plans for patients,further improve the eradication rate of H.pylori and avoid the gradual rise of drug resistance rates.