三联疗法根除幽门螺杆菌治疗对肠道微生态的影响

Effect of eradicating Hp on the intestinal microecosystem

目的 探讨抗幽门螺杆菌 (Hp)治疗对患者肠道菌群状态 (肠道微生态 )及耐药性的影响。方法 分别称取 6 0例患者治疗前后新鲜粪便 0 .5 g ,选择肠道菌群中具代表性的 4种需氧菌和 6种厌氧菌分别进行需氧和厌氧培养 ,从培养出的菌落中挑选相同的菌株进行治疗前后药敏试验。结果 ( 1)治疗后肠道菌群中肠杆菌、葡萄球菌、拟杆菌、双歧杆菌、消化球菌、梭菌、乳杆菌、真杆菌均较治疗前明显降低 (P <0 .0 5 ) ;( 2 )治疗后肠道菌群中大肠埃希氏菌、消化链球菌、赛氏葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、产气真杆菌等对庆大霉素、红霉素、环丙沙星、特美丁、头孢噻肟钠等药耐药率明显增加 ,且存在多重耐药 (P <0 .0 5 ) ;( 3)治疗后超广谱 β 内酰氨酶阳性的消化链球菌、表皮葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、赛氏葡萄球菌等较治疗前分别增加 2 6 .2 %、33 .3 %、2 8.6 %、35 .3 %、2 8.6 %。结论 三联抗Hp治疗后肠道菌群失调、耐药菌株的增加、传播与扩散对广大人群存在潜在危险。

Objective To study the effect of eradicating Helicobacter pylori (Hp) on the intestinal flora behavior and the antimicrobial resistance of bacteria.Methods The fresh stool specimens of 60 patients with positive Hp were collected before and after the eradicating treatment. Four aerobes and six anaerobes representing the intestinal flora were cultivated for antimicrobial sensitive test.Results (1) The population of Enterobacterium,Peptococcus, Staphylococcus, Fusobacterium, Bacteroides, Lactobacillus, Eubacterium and Bifid bacterium were decreased after the treatment(P<0.05). (2) The antimicrobial resistance of Escherichia coli, Peptostreptococcu, S. sciuri, F.prausnitzii, S.pneumo/virgrp and E.aerofaciens to gentamicin, erythromycin, ciprofloxacin, ticar/clavulanic acid and cefotaxime increased after the treatment(P<0.05). (3) The positive rates of β-Lactamase in Peptostreptococcu, Staph.Epidermidis, Fuso.Prausnitzii, Str.Pneumo/Virgrp and Staph.Sciuri had been stepped-up about 26.2%, 33.3%, 28.6%, 35.3% and 28.6%, respectively.Conclusion A potential danger of the intestinal dysbacteriosis, diffusion and transmission of the antimicrobial resistance strains might be resulted from the eradicating Hp.