儿童幽门螺杆菌三联疗法根除疗效及影响因素分析

Analysis of eradication effect and influencing factors of triple therapy of Helicobacter pylori in children

目的探索重庆地区儿童幽门螺杆菌(H.pylori)三联疗法根除疗效及影响因素。方法收集消化科门诊就诊的156例疑似H.pylori感染儿童的胃黏膜标本,进行H.pylori培养、药敏试验和基因检测。H.pylori感染诊断明确的患儿接受三联疗法根除治疗,计算三联疗法根除率并分析疗效的影响因素。结果156例疑似H.pylori感染儿童中符合H.pylori诊断标准的有138例,其中109例接受14天的标准三联方案(奥美拉唑+阿莫西林+克拉霉素)根除治疗,男53例、女56例,平均年龄(9.6±3.0)岁,最终64例(58.7%)根除成功。95例患儿H.pylori培养阳性,克拉霉素敏感株根除率81.6%(40/49)显著高于耐药株34.8%(16/46),差异有统计学意义(P<0.01)。95例患儿中87例行基因检测,根据基因检测结果克拉霉素敏感株根除率为76.2%(32/42),显著高于耐药株42.2%(19/45),差异有统计学意义(P<0.01)。患儿性别、年龄、内镜诊断、黏膜组织病理炎症程度、CYP 2 C 19基因多态性、毒力基因vacA与cagA与标准三联方案根除率无关(P>0.05)。结论标准三联疗法不适合重庆地区儿童H.pylori治疗,以药敏试验为基础的个体化治疗方案是更好的选择。

Objective To explore the eradication effect and influencing factors of triple therapy of Helicobacter pylori(H.pylori)in children from Chongqing.Methods Gastric mucosa samples were collected from 156 children with suspected H.pylori infection who visited the gastroenterology clinic.H.pylori culture,drug susceptibility test and gene detection were performed.Children diagnosed with H.pylori infection received triple therapy eradication.The eradication rate of triple therapy was calculated and the influencing factors of efficacy were analyzed.Results Among 156 children with suspected H.pylori infection,138 met the diagnostic criteria for H.pylori infection.Among them,109 children(53 boys and 56 girls)were treated with standard triple therapy(omeprazole+amoxicillin+clarithromycin)for 14 days,with an average age of(9.6±3.0)years,and 64(58.7%)were successfully eradicated from H.pylori infection.The eradication rate of clarithromycin sensitive strain was 81.6%(40/49),which was significantly higher than that of drug-resistant strain(34.8%,16/46),the difference was statistically significant(P<0.01).Of the 95 children,87 underwent genetic testing.The eradication rate of clarithromycin sensitive strains was 76.2%(32/42),which was significantly higher than that of drug-resistant strains(42.2%,19/45),and the difference was statistically significant(P<0.01).Gender,age,endoscopic diagnosis,histopathological appearance of mucosal tissue based on severity of inflammation,CYP 2 C 19 gene polymorphism,vacA and cagA virulence genes were not correlated with the eradication rate of standard triple regimen(P>0.05).Conclusions Standard triple therapy is not suitable for the eradication of H.pylori in children in Chongqing area,and individualized treatment based on drug sensitivity test is a better choice.