幽门螺杆菌感染者服药依从性及对病原菌耐药影响

Medication compliance of patients with Helicobacter pylori infection and its impact on pathogen resistance

目的 探讨幽门螺杆菌感染者服药依从性及对病原菌耐药影响。方法 以2020年7月至2022年12月在海口市中医医院做胃镜检查并确诊为Hp阳性的患者作为研究对象,采用自编问卷收集患者一般人口学资料,在完成抗幽门螺杆菌感染治疗疗程后应用Morisky用药依从性问卷进行调查,并采集患者治疗前的胃粘膜样本用于幽门螺杆菌耐药分析,采用描述性分析法分析幽门螺杆菌感染者服药依从性和幽门螺杆菌耐药情况,单、多因素分析幽门螺杆菌感染者服药依从性对病原菌耐药影响。结果 共纳入2 112例Hp患者,其中1 509例用药依从性良好,占71.44%。2 112例幽门螺杆菌感染者获得2 112株幽门螺杆菌,其中均敏感126株,占5.97%,单一耐药763株,占36.13%,双重耐药559株,占26.47%,多重耐药664株,占31.43%。Hp对甲硝唑和克拉霉素的耐药率最高,分别为51.18%、20.26%。多分类有序logistic回归分析结果显示使用抗生素种类≥4种(OR=1.881)、复治(OR=1.702)、服药依从性不足(OR=2.787)、既往3个月内使用左氧氟沙星(OR=1.179)、既往3个月内使用阿莫西林(OR=1.754)、既往3个月内使用头孢呋辛(OR=1.991)是Hp耐药的独立危险因素。结论 幽门螺杆菌感染者存在用药依从性差情况,且患者的耐药现状较严峻,需加强Hp感染患者服药依从性的管理和耐药性的监测,针对耐药性监测结果合理用药。

Objective To investigate the medication compliance of patients with Helicobacter pylori(Hp)infec-tion and its impact on pathogen resistance.Methods Patients who underwent gastroscopy at Haikou Hospital of Tradition-al Chinese Medicine from July 2020 to December 2022 and were confirmed to be Hp-positive were selected for the study.A self-designed questionnaire was used to collect general demographic data of the patients.After completing the anti-Hp treat-ment,Morisky medication compliance questionnaire was used for investigation.Pretreatment gastric mucosal samples were collected for Hp resistance analysis.The descriptive analysis was used to analyze the medication compliance and drug resis-tance of Hp infected individuals.Univariate and multivariate analysis methods were used to analyze the impact of medica-tion compliance on pathogen resistance in Hp infected individuals.ResultsAmong a total of 2112 patients with Hp infec-tion,1509 had good medication compliance,accounting for 71.44%.Among 2112 Hp infected patients,2112 Hp strains were obtained,of which 126 were sensitive(5.97%),763 were single drug resistant(36.13%),559 were double drug re-sistant(26.47%),and 664 were multiple drug resistant(31.43%).The highest resistance rates of Hp to metronidazole and clarithromycin were 51.18%and 20.26%,respectively.Multi classification ordered logistic regression analysis showed that the use of≥4 types of antibiotics(OR=1.881),retreatment(OR=1.702),insufficient medication compliance(OR=2.787),use of levofloxacin within the past 3 months(OR=1.179),use of amoxicillin within the past 3 months(OR=1.754),and use of cefuroxime within the past 3 months(OR=1.991)were independent risk factors for Hp resistance.Conclusions Patients with Hp infection have poor medication compliance,and their drug resistance status is relatively severe.It is necessary to strengthen the management of medication compliance and drug resistance monitoring for Hp infected patients,and use drugs reasonably based on the drug resistance monitoring results.