腹型过敏性紫癜合并消化道出血患儿幽门螺杆菌感染情况及耐药性分析

Analysis of Helicobacter pylori infection and drug resistance in children with abdominal type allergic purpura complicated with gastrointestinal bleeding

目的 探析腹型过敏性紫癜(anaphylactoid purpura, HSP)合并消化道出血患儿幽门螺杆菌(Hp)感染情况及耐药性。方法 选取河北省儿童医院接诊的58例腹型HSP合并消化道出血患儿及58例未发生消化道出血患儿为研究对象。采集两组患儿外周静脉血,进行Hp的分型检测。依据Hp感染情况将腹型HSP合并消化道出血患儿分为Hp阳性组与阴性组,对比两组患儿的血清炎症细胞因子水平、免疫功能及胃镜下表现。取腹型HSP合并消化道出血Hp阳性患儿胃黏膜组织进行Hp培养鉴定及药敏试验。结果 58例腹型HSP合并消化道出血患儿中,Hp感染率为63.79%(37/58),58例未发生消化道出血组患儿中,Hp感染率为43.10%(25/58),两组患儿Hp感染率差异有统计学意义(χ^(2)=4.989,P<0.05)。消化道出血患儿中,Ⅰ型Hp感染率为51.72%(30/58),Ⅱ型Hp感染率为6.90%(4/58),中间型Hp感染率为5.17%(3/58)。未发生消化道出血患儿中,Ⅰ型Hp感染率为29.31%(17/58),Ⅱ型Hp感染率为3.45%(2/58),中间型Hp感染率为10.34%(6/58)。两组患儿的Ⅰ型Hp感染率差异有统计学意义(χ^(2)=6.045,P<0.05),Ⅱ型Hp、中间型Hp感染率差异无统计学意义(χ^(2)=0.703,1.084,P>0.05)。Hp阳性腹型HSP合并消化道出血患儿血清IL-6、IL-8、TNF-α水平均显著高于Hp阴性腹型HSP合并消化道出血患儿。Hp阳性腹型HSP合并消化道出血患儿CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平低于Hp阴性腹型HSP合并消化道出血患儿。Hp阳性腹型HSP合并消化道出血患儿胃镜下黏膜改变明显者占比为67.57%(25/37),Hp阴性腹型HSP合并消化道出血患儿胃镜下黏膜改变明显者占比为33.33%(7/21)。37例Hp阳性腹型HSP合并消化道出血患儿,共检出37株Hp。7株对四种抗菌药物均敏感;12株为单一抗菌药物耐药,主要为甲硝唑耐药;10株为双重抗菌药物耐药,主要为甲硝唑+克拉霉素;8株为三重抗菌药物耐药,为甲硝唑+阿莫西林+克拉霉素。结论 腹型HSP合并消化道出血患儿的Hp感染率升高,阳性患儿的血清炎症细胞因子水平、免疫功能发生显著改变。Hp对甲硝唑的耐药率较高,对阿莫西林的耐药率较低。

Objective To explore Helicobacter pylori infection and drug resistance in children with abdominal type allergic purpura complicated with gastrointestinal bleeding. Methods 58 children with abdominal type allergic purpura complicated with gastrointestinal bleeding and 58 children without gastrointestinal bleeding who were treated at Hebei Children's Hospital were selected as the study subjects. Peripheral venous blood were collected from two groups of pediatric patients for typing detection of H. pylori. According to the prevalence of H. pylori infection, children with abdominal type allergic purpura complicated with gastrointestinal bleeding were divided into a H. pylori positive group and a negative group.The serum inflammatory cytokine levels, immune function, and endoscopic manifestations of the two groups of children were compared.The gastric mucosal tissue of a child with abdominal type allergic purpura complicated with gastrointestinal bleeding and H. pylori positive were taken for H. pylori culture identification and drug sensitivity testing. Results Among 58 children with abdominal type allergic purpura complicated with gastrointestinal bleeding, the H. pylori infection rate was 63.79%(37/58).Among the 58 children without gastrointestinal bleeding, the H. pylori infection rate was 43.10%(25/58). The difference in H. pylori infection rates between the two groups of children had statistical significance(χ^(2)=4.989,P<0.05). Among children with gastrointestinal bleeding, the infection rate of type I H. pylori was 51.72%(30/58),type II H. pylori was 6.90%(4/58),and the infection rate of intermediate H. pylori was 5.17%(3/58). Among children who did not experience gastrointestinal bleeding, the infection rate of type I H. pylori was 29.31%(17/58),type II H. pylori was 3.45%(2/58),and the infection rate of intermediate H. pylori was 10.34%(6/58). The difference in the infection rates of type I H. pylori between the two groups of children was statistically significant(χ^(2)=6.045,P<0.05),while the difference in infection rates of type II and intermediate H. pylori was not statistically significant(χ^(2)=0.703,1.084,P>0.05).The serum levels of IL-6,IL-8,and TNF-α in children with H. pylori positive abdominal type allergic purpura complicated with gastrointestinal bleeding were significantly higher than those in children with H. pylori negative abdominal type allergic purpura complicated with gastrointestinal bleeding, and the difference was statistically significant. The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in children with H. pylori positive abdominal type allergic purpura complicated with gastrointestinal bleeding were lower than those in children with H. pylori negative abdominal type allergic purpura complicated with gastrointestinal bleeding, and the difference was statistically significant(P<0.05). 67.57%(25/37) of children with H. pylori positive abdominal type allergic purpura complicated with gastrointestinal bleeding showed significant mucosal changes under gastroscopy, while 33.33%(7/21) of children with H. pylori negative abdominal type allergic purpura complicated with gastrointestinal bleeding showed significant mucosal changes under gastroscopy. A total of 37 strains of H. pylori were detected in 37 children with abdominal type allergic purpura and gastrointestinal bleeding who were positive for H. pylori. 7 strains were sensitive to all four antibiotics;12 strains were resistant to single antibiotics, mainly metronidazole;10 strains were resistant to dual antibiotics, mainly metronidazole+clarithromycin;8 strains were resistant to triple antibiotics, mainly metronidazole+amoxicillin+clarithromycin. Conclusion The infection rate of H. pylori in children with abdominal type allergic purpura combined with gastrointestinal bleeding increases, and the serum inflammatory cytokine levels and immune function of positive children undergo significant changes. H. pylori had a higher resistance rate to metronidazole and a lower resistance rate to amoxicillin.