Drug resistance of Helicobacter pylori in 120 patients with digestive tract diseases in Northern Anhui Province
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摘要:
目的 分析安徽省皖北地区幽门螺杆菌(Helicobacter pylori, HP)对常用抗生素的耐药情况及影响因素，了解该地区幽门螺杆菌耐药谱，为指导该地区选择根除幽门螺杆菌的最佳治疗方案提供依据。 方法 选取2020年1月—2021年6月在蚌埠医学院第一附属医院门诊就诊并行13C-尿素呼气试验或14C-尿素呼气试验阳性及快速尿素酶试验阳性的患者120例。采用微需氧培养技术分离培养和鉴别HP。应用幽门螺杆菌药敏检测试剂盒法检测HP对阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、呋喃唑酮的耐药情况，进一步比较分析不同性别、年龄、疾病类别患者中分离出的幽门螺杆菌对以上抗生素的耐药状况。 结果 从120例患者中培养出55株幽门螺杆菌，培养阳性率为45.83%。不同性别、年龄患者间HP的培养阳性率差异无统计学意义(均P>0.05)，消化性溃疡患者中HP的培养阳性率显著高于胃炎和胃癌患者(均P < 0.017)。HP对阿莫西林、克拉霉素、甲硝唑、左氧氟沙星和呋喃唑酮的耐药率分别为3.64%、27.27%、65.45%、30.91%和1.82%。不同性别、年龄和疾病种类患者的HP耐药水平差异无统计学意义(均P>0.05)。 结论 安徽省皖北地区HP菌株对甲硝唑、克拉霉素、左氧氟沙星耐药率高，对阿莫西林、呋喃唑酮耐药率低，已有多重耐药菌株出现，选用抗生素根除HP时尽量选用敏感抗生素用于经验性治疗。 Abstract:Objective To investigate the drug resistance of Helicobacter pylori (HP) to commonly used antibiotics and its influencing factors in Northern Anhui Province, understand the drug resistance spectrum of HP in this area, and provide a basis for the selection of the best treatment plan for eradication of HP. Methods A total of 120 patients who were positive for both 13C-urea breath test (or 14C-urea breath test) and rapid urease test in the First Affiliated Hospital of Bengbu Medical College from January 2020 to June 2021 were selected. HP was isolated and identified by microaerobic culture. The drug resistance of HP to amoxicillin, clarithromycin, metronidazole, levofloxacin and furazolidone was detected using the HP drug sensitivity detection kit method, and the drug resistance of HP isolated from patients with different genders, ages and disease categories to the above antibiotics was further compared and analysed. Results A total of 55 strains of HP were cultured from 120 patients with a positive rate of 45.83%. There was no significant difference in the HP culture positive rate among patients of different genders and ages (P>0.05), and the positive rate of HP culture in peptic ulcer patients was significantly higher than that in gastritis and gastric cancer patients (P < 0.017). The drug resistance rates of HP to amoxicillin, clarithromycin, metronidazole, levofloxacin and furazolidone were 3.64%, 27.27%, 65.45%, 30.91% and 1.82%, respectively. There were no statistically significant differences in HP resistance levels among different genders, age stages and disease types (all P>0.05). Conclusion The resistance rate of HP strains to metronidazole, clarithromycin and levofloxacin is high in Northern Anhui Province, but the resistance rate to amoxicillin and furazolidone is low. When antibiotics are used to eradicate HP in Northern Anhui Province, sensitive antibiotics are used for empirical treatment as far as possible. -
Key words:
- Helicobacter pylori /
- Antibiotic /
- Resistance level /
- Treatment plan
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表 1 不同性别、年龄和疾病类型的消化道疾病患者HP的分离情况
Table 1. Isolation of HP in patients with digestive tract diseases of different sex, age and disease types
项目 类别 HP阳性数(株) HP阴性数(株) 阳性率(%) 统计量 P值 性别 0.068a 0.794 男性 30 37 44.78 女性 25 28 47.17 年龄(岁) 0.056b 0.972 ≤30 7 9 43.75 31~50 19 23 45.24 ≥51 29 33 46.77 疾病类型 20.843a ＜0.001 胃炎 24 51 32.00 消化性溃疡 29 9 76.32 胃癌 2 5 28.57 注：a为χ2值，b为H值。疾病类型两两比较采用Bonferroni校正，P < 0.017为差异有统计学意义：胃炎组与消化性溃疡组比较，χ2=19.889，P＜0.001；胃炎与胃癌组比较，χ2＜0.001，P=0.999；消化性溃疡组与胃癌组比较，χ2=6.287，P=0.012。 
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表 2 HP分离株对5种抗生素的耐药情况[株(%)]
Table 2. Resistance of Hp isolates to 5 antibiotics[plant(%)]
抗生素 敏感 中介 耐药 阿莫西林 50(90.91) 3(5.46) 2(3.64) 克拉霉素 35(63.64) 5(9.09) 15(27.27) 甲硝唑 13(23.64) 6(10.91) 36(65.45) 左氧氟沙星 33(60.00) 5(9.09) 17(30.91) 呋喃唑酮 51(92.73) 3(5.46) 1(1.82)
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表 3 不同性别、年龄和疾病类型的消化道疾病患者间HP对5种抗生素的耐药情况(例)
Table 3. Resistance of HP to 5 Antibiotics among patients with digestive tract diseases of different genders, Ages and disease types (cases)
项目 阿莫西林 克拉霉素 甲硝唑 左氧氟沙星 呋喃唑酮 耐药 敏感 耐药 敏感 耐药 敏感 耐药 敏感 耐药 敏感 性别 男性 2 28 8 22 20 10 9 21 1 29 女性 0 25 7 18 15 9 8 17 0 25 统计量 0.122a 0.102a 0.255a P值 0.495 0.912 0.750 0.873c 0.999c 年龄(岁) ≤30 1 6 2 5 4 3 2 5 0 7 31~50 0 19 5 14 13 6 6 13 0 19 ≥51 1 28 8 21 19 10 9 20 1 28 统计量 2.931b 0.016b 0.283b 0.022b 0.897b P值 0.231 0.992 0.868 0.989 0.639 疾病类型 胃炎 1 23 6 18 16 8 7 17 0 24 消化性溃疡 1 28 8 21 18 11 9 20 1 28 胃癌 0 2 1 1 2 0 1 1 0 2 P值 0.999c 0.762c 0.708c 0.892c 0.999c 注：a为χ2值，b为H值; c为采用Fisher精确检验。
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