幽门螺杆菌耐药基因检测在临床精准治疗中的价值

Value of Helicobacter pylori resistance gene detection in clinical precision therapy

目的调查某院胃部不适就诊患者幽门螺杆菌(Helicobacter pylori,Hp)感染情况,结合粪便Hp DNA和耐药基因检测,评估粪便样本Hp检出率及耐药基因检测后精准治疗的效果。方法2023年1—12月在宣城市中心医院消化内科收治的胃部不适患者中,选取经^(13)C-尿素呼气试验(Carbon 13 urea breath test,^(13)C-UBT)和快速脲酶试验(rapid ureas test,RUT)检测为双阳性和双阴性者作为研究对象,对其开展粪便Hp DNA检测,分析粪便Hp检测与13C-UBT+RUT检测方法的一致性;粪便Hp检测阳性且自愿进行耐药基因检测患者(试验组)依据检测结果进行精准治疗,未进行耐药基因检测的Hp感染患者(对照组)采用常规四联疗法进行治疗,比较试验组与对照组临床预后情况。结果共纳入研究对象446例,^(13)C-UBT+RUT法检出Hp双阳性170例,13C-UBT+RUT法及粪便Hp DNA检测均检出Hp阳性162例,粪便样本Hp DNA检测与^(13)C-UBT+RUT检测结果一致性较好(Kappa值=0.962,P<0.05)。纳入试验组73例,对照组89例,试验组突变株检出率为73.97%;试验组临床治愈率为90.41%(66/73),高于对照组的67.42%(60/89),差异有统计学意义(χ^(2)=12.270,P<0.05)。结论粪便样本Hp DNA检测结果准确可靠且可进行菌株耐药性检测,对临床精准用药治疗有指导价值,有利于提高患者临床治愈率。

Objective To investigate the infection status of Helicobacter pylori(Hp)in patients with stomach discomfort in Xuancheng Central Hospital,and evaluate the accuracy of fecal sample detection for Hp infection and the precision treatment effect after drug resistance gene testing combined with fecal Hp nucleic acid and drug resistance gene tests.Methods Patients with stomach discomfort admitted to the Gastroenterology Department in a hospital were included from January to December 2023.All patients underwent screening with carbon-13 urea breath test(^(13)C-UBT)and rapid urea test(RUT).Then the patients with double positive or double negative findings were included as study sub-jects,and undergone fecal Hp DNA detection.The consistency between the findings of fecal Hp detection and ^(13)C-UBT+RUT detection was analyzed.Patients with positive fecal Hp and with voluntary intention to receive resistance gene testing(experimental group)were given precision treatment based on the test results,and Hp infected victims who did not undergo resistance gene testing(control group)were treated with conventional quadruple therapy regimen.Finally,the clinical prognosis was compared between the experimental group and the control group.Results Among the 446 patients included in the study,170 were detected as Hp double positive by ^(13)C-UBT+RUT,and 162 were detected as Hp positive by^(13)C-UBT+RUT and fecal Hp DNA detection.The consistency between fecal Hp DNA detection and^(13)C-UBT+RUT detection was good in general(Kappa value=0.962,P<0.05).Seventy-three patients were finally included in the experimental group,and 89 in the control group.The detection rate of mutant strains in the experimental group was 73.97%.The clinical curative rate was 90.41%(66/73)in the experimental group,which was higher than that in the control group 67.42%(60/89).The difference was significant(χ^(2)=12.270,P<0.05).Conclusion The results of fecal Hp DNA detection are accurate and reliable,and can be used for bacterial resistance detection.This test protocol can be guiding value for precision medication in clinic,and conducive to improving the clinical curative rate for the patients.