老年萎缩性胃炎患者Hp感染状况调查及根治方法和药物敏感性分析

Analysis of Helicobacter pylori infection status,radical cure methods and drug sensitivity in elderly patients with atrophic gastritis

目的调查老年萎缩性胃炎患者幽门螺杆菌(Hp)感染状况,并对Hp感染的根治方法以及药物敏感性进行分析。方法选取2018年12月-2020年12月本院收治的148例老年萎缩性胃炎患者,采集胃黏膜标本进行Hp的分离培养及鉴定;Hp阳性者采用铋剂四联或无铋剂三联疗法治疗,然后采用^(13)C-UBT检测Hp根治情况;采用琼脂稀释法测定Hp药物敏感性;提取Hp基因组DNA,采用测序方法检测克拉霉素耐药菌株23SrRNA基因突变位点。结果148例老年萎缩性胃炎患者中检出Hp感染108例(72.93%)。经多因素Logistic回归分析显示,吸烟、暴饮暴食、进食辣食、有家族性胃肠道疾病史是老年萎缩性胃炎患者发生Hp感染的危险因素,进食酸奶是保护因素(P<0.05)。108例患者经治疗后88例(81.48%)得到根治,其中PPI+阿莫西林+克拉霉素、PPI+枸橼酸铋钾+替硝唑+克拉霉素治疗的根治率>80%。药敏检测显示,Hp对克拉霉素、阿莫西林、甲硝唑、左氧氟沙星、四环素的耐药率分别为35.19%、13.89%、41.67%、53.70%和18.52%。22株克拉霉素耐药菌株23SrRNA基因中共检出6个突变位点(A1821G、G1826A、T1830C、A2143G、T2182C、A2223G),其中A1821G、G1826A、T1830C存在于所有(耐药、敏感)菌株中。12株(54.55%)耐药菌株存在A2143G突变,20株(90.91%)耐药菌株存在T2182C突变,8株(36.36%)耐药菌株存在A2223G突变。结论老年萎缩性胃炎患者Hp感染率较高,常用抗生素的高耐药性是导致Hp根治率下降的重要原因,其中克拉霉素耐药机制多以Hp的23SrRNA基因位点突变为主。

Objective To analyze the Helicobacter pylori(Hp)infection status,radical cure methods and drug sensitivity in elderly patients with atrophic gastritis.Methods 148elderly patients with atrophic gastritis admitted our hospital from December 2018to December 2020were enrolled in this study.The patient's gastric mucosal specimens were collected for Hp separation,culture and identification.Bismuth quadruple or triple bismuth-free drugs were used to treat Hppositive patients,and then the patient's Hp radical cure status was tested by ^(13)C-UBT.Drug sensitivity was tested by agar dilution method.The Hp genomic DNA was extracted,and the 23SrRNA gene mutation site of clarithromycin-resistant strains was detected by sequencing method.Results Among 148patients with senile atrophic gastritis,108cases(72.93%)of Hp infection were detected.Multivariate logistic regression analysis showed that smoking,overeating,eating spicy food,and having a family history of gastrointestinal diseases were risk factors for Hp infection in elderly patients with atrophic gastritis,and eating yogurt was a protective factor(P<0.05).After treatment,88patients(81.48%)were cured.Among them,the cure rates of PPI+amoxicillin+clarithromycin and PPI+bismuth potassium citrate+tinidazole+clarithromycin were more than 80%.The drug sensitivity test showed that the resistance rates of Hp to clarithromycin,amoxicillin,metronidazole,levofloxacin,and tetracycline were 35.19%,13.89%,41.67%,53.70%,and 18.52%,respectively.A total of 6mutation sites(A1821G,G1826A,T1830C,A2143G,T2182C,A2223G)were found in the 23SrRNA gene of 22clarithromycin-resistant strains,of which A1821G,G1826A,and T1830Cexist in all drug-resistant and sensitive strains.12(54.55%)resistant strains had A2143Gmutation,20(90.91%)resistant strains had T2182Cmutation,and 8(36.36%)resistant strains had A2223G mutation.Conclusion The Hp infection rate is relatively high in elderly patients with atrophic gastritis.The high resistance of commonly used antibiotics is an important reason for the decline in e-radication rate.Among them,the mechanism of clarithromycin resistance is mostly based on the mutation of Hp 23SrRNA gene.