慢性胃炎活检组织幽门螺杆菌感染菌株耐药性及相关耐药基因与毒力基因

Helicobacter pylori isolates from biopsy tissues of gastric mucosa of chronic gastritis patients,drug resistance,drug resistance genes and virulence genes

目的分析慢性胃炎活检组织幽门螺杆菌感染情况、耐药性及相关耐药基因、毒力基因特征.方法将2020年10月—2022年11月于龙游县中医医院接受胃镜检查的598例慢性胃炎患者纳入研究,根据胃黏膜活检结果幽门螺杆菌感染情况,其中132例纳入感染组,466例纳入未感染组;分析两组一般资料,幽门螺杆菌对常用抗菌药物的耐药情况、幽门螺杆菌耐药基因以及幽门螺杆菌毒力基因.结果两组年龄、性别、体质量指数(BMI)、慢性炎性程度、肠化以及上皮内瘤变比较差异无统计学意义;幽门螺杆菌对甲硝唑耐药率较高>80%,对呋喃唑酮、四环素、阿莫西林耐药率较低均<20%;幽门螺杆菌耐药株23S核糖体核糖核苷酸(23S rRNA)基因A2143G位点、脱氧核糖核酸促旋酶A亚单位(gyrA)基因N87K位点突变比例更高(P<0.05);132株幽门螺杆菌中毒力基因细胞毒素相关基因A(CagA)、细胞空泡毒素Asla(VacAsla)+细胞空泡毒素Am1(VacAm1)、VacAs1a的检出率位居前三位,分别为100.00%、46.97%、18.94%.结论胃黏膜幽门螺杆菌菌株对甲硝唑的耐药率较高,对呋喃唑酮、四环素、阿莫西林耐药率较低,23S rRNA、gyrA相关耐药基因突变是导致抗菌药物耐药的主要原因,毒力基因最常见为CagA基因,筛选这些基因可能有助于防止抗菌药物耐药性及选择合适的抗菌药物根除幽门螺杆菌.

OBJECTIVE To analyze characteristics of Helicobacter pylori infection,drug resistance,related resist-ance genes and virulence genes in gastric mucosa.METHODS A total of 598 patients with chronic gastritis who re-ceived gastroscopy in Longyou County Traditional Chinese Medicine Hospital from Oct 2020 to Nov 2022 were in-cluded in the study.According to the results of gastric mucosa biopsy,they were divided into the infection group with132 cases and the uninfected group with 466 cases.General data of the two groups were analyzed,and drug re-sistance of H.pylori to commonly used antibiotics,drug-resistant genes and virulence genes of H.pylori were analyzed.RESULTS There were no significant differences in age,sex,body mass index(BMI),degree of chronic inflammation,intestinal metaplasia and proportion of intraepithelial neoplasia between the two groups.The drug resistance rate of H.pylori to metronidazole was higher than 80%,and the drug resistance rates to furazolidone,tetracycline and amoxicillin were lower than 20%.The rates of mutation at A2143G of 23S ribosomal ribonucleic acid(23S rRNA)gene and N87K of deoxyribonucleic acid gyrase subunit A(gyrA)gene were higher in drug-re-sistant H.pylori strains(P<0.05).The detection rates of H.pylori virulence genes cytotoxin-associated gene A(CagA),vacuola-ting cytotoxin A sla(VacA s1a)+vacuola-ting cytotoxin A m1(VacAml)and VacA s1a in 132 strains were top 3,accounting for 100.00%,46.97%and 18.94%,respectively.CONCLUSION The drug re-sistance rate of H.pylori strains of gastric mucosa to metronidazole is higher than that to furazolidone,tetracy-cline and amoxicillin.The main cause of antibiotic resistance is related to the mutations of drug resistance genes,such as 23S rRNA and gyrA.The most common virulence gene is CagA gene.Screening of these mutations might help the clinic to prevent antibiotic resistance and select appropriate antibiotics to eradicate H.pylori.