2013—2020年浙江温州地区幽门螺杆菌耐药情况分析

The Helicobacter Pylori Antibiotic Resistance in Wenzhou,Zhejiang from 2013 to 2020

背景幽门螺杆菌(H.pylori)感染是胃癌发生的主要病因,但随着抗生素耐药情况的日趋严重,许多地区H.pylori根除率并没有实质性提高。目的了解温州地区2013—2020年H.pylori耐药情况,分析不同时期、不同年龄及不同性别人群的耐药情况差异。方法于2013-01-01至2020-12-31,选择在温州中心医院接受胃镜检查患者47658例,采集胃黏膜标本进行H.pylori分离培养,并对分离培养获得的H.pylori菌株进行左氧氟沙星、克拉霉素、阿莫西林、甲硝唑、四环素和呋喃唑酮6种抗生素的药物敏感性分析。采用χ~2检验比较不同年份、不同年龄段及不同性别人群的H.pylori耐药率。结果2013—2020年温州地区分离的16847株H.pylori菌株存在多重耐药情况。对6种常用抗生素耐药率的统计结果显示:该地区左氧氟沙星、克拉霉素、甲硝唑的人群耐药率较高,分别为32.81%(5536/16874)、26.02%(4390/16874)、95.67%(16144/16874);阿莫西林耐药率低[0.28%(47/16874)],2017年达1.36%(25/1844);未发现四环素和呋喃唑酮耐药菌株存在。2013—2020年,左氧氟沙星、克拉霉素、阿莫西林的人群耐药率比较,差异有统计学意义(P<0.01);甲硝唑的人群耐药率始终处于较高值(>88.00%),各年份比较,差异无统计学意义(P>0.05)。该地区不同性别人群的左氧氟沙星、克拉霉素、甲硝唑耐药率比较,差异有统计学意义(P<0.01);阿莫西林耐药率比较,差异无统计学意义(P>0.05)。该地区不同年龄段人群的左氧氟沙星、克拉霉素耐药率比较,差异有统计学意义(P<0.01);阿莫西林、甲硝唑耐药率比较,差异无统计学意义(P>0.05)。结论温州地区不同年度、不同年龄及不同性别H.pylori阳性患者间的人群耐药率存在差异,总体耐药率高,基于甲硝唑、克拉霉素、左氧氟沙星等药物的根除治疗方案难以获得理想效果,应鼓励开展药敏实验结果指导下的临床H.pylori精准根除治疗。

Background Helicobacter pylori(H. pylori)infection is the main cause of gastric cancer,but with the increase of H. pylori antibiotic resistance,the eradication rate has not substantially improved in many areas.Objective To understand the H. pylori antibiotic resistance situation in Wenzhou from 2013—2020,and analyse the difference of H. pylori antibiotic resistance with time period,age and gender. Methods From 2013-01-01 to 2020-12-31,a total of 47 658 patients undergoing gastroscopy in Wenzhou Central Hospital were selected. Gastric mucosa specimens were collected for H. pylori isolation and culture,and the isolated H. pylori strains obtained from the culture were analyzed for drug susceptibility to six antibiotics,including levofloxacin,clarithromycin,amoxicillin,metronidazole,tetracycline and furazolidone. A chi-square test was used to compare H. pylori antibiotic resistance rate between years,age groups and sexes. Results Multiple antibiotic resistance existed in 16 847 H. pylori strains isolated in Wenzhou from 2013—2020. Separate statistics on the resistance rates of H. pylori to the six commonly used antibiotics revealed that the resistance rates to levofloxacin,clarithromycin and metronidazole were high in the region,respectively 32.81%(5 536/16 874)、26.02%(4 390/16 874)、95.67%(16 144/16 874). The resistance rate to amoxicillin was low,only 0.28%(47/16 874),and 1.36%(25/1 844) in 2017. No strains were found with resistance to tetracycline hydrochloride and furazolidone. From 2013 to 2020,there were statistically significant differences in H. pylori resistance rates to levofloxacin,clarithromycin and amoxicillin(P<0.01). The metronidazole resistance rate in H. pylori was consistently high(>88.00%)with no statistical difference(P>0.05). There was statistically significant difference in the H. pylori resistance rate for evofloxacin,clarithromycin and metronidazole between female and male(P<0.01),with no statistical difference for amoxicillin(P>0.05). There was statistically significant difference in the H. pylori resistance rate for levofloxacin or clarithromycin among different age groups in the region(P<0.01),with no statistical difference for amoxicillin and metronidazole(P>0.05). Conclusion The H. pylori antibiotic resistance rate differed by year,and varied across different age and sex groups of H. pylori-positive cases in Wenzhou during the period. The overall H. pylori resistance rate was high. The eradication regimens based on metronidazole,clarithromycin or levofloxacin are difficult to achieve satisfactory results,so clinical H. pylori eradication treatment based on drug sensitivity test results should be encouraged.