摘要
目的研究宁夏地区不同年龄人群幽门螺杆菌(H.pylori)感染者对常用抗菌药物的耐药性。方法选择2021年7至12月就诊于宁夏回族自治区人民医院、宁夏中西医结合医院、固原市原州区人民医院、吴忠市人民医院、石嘴山市第二人民医院、中卫市人民医院、银川市第一人民医院消化内科H.pylori专病门诊,既往无H.pylori治疗史,经14C尿素呼气试验证实为H.pylori感染,且行胃镜检查的患者1040例。在胃镜下留取胃黏膜标本行H.pylori体外培养,获得的H.pylori菌株行H.pylori耐药表型检测。药敏试验采用Kirby-Bauer纸片琼脂扩散法。记录患者既往抗生素使用情况,分析≤44、45~59、≥60岁组患者H.pylori的原发耐药特征。统计学方法采用卡方检验。结果对1040例H.pylori感染者的胃黏膜标本行H.pylori体外培养,共获得538株H.pylori菌株,培养阳性率为51.7%,187例患者可提供既往抗生素使用史。对甲硝唑、克拉霉素、左氧氟沙星的原发耐药率高,耐药率分别为95.5%(514/538)、44.6%(240/538)、45.4%(244/538),未发现对阿莫西林、呋喃唑酮、四环素耐药;双重耐药率为36.4%(196/538),以甲硝唑+克拉霉素、甲硝唑+左氧氟沙星耐药株为主,耐药率分别为17.8%(96/538)、18.2%(98/538);三重耐药率为25.5%(137/538),均为甲硝唑+克拉霉素+左氧氟沙星耐药株。既往使用过喹诺酮类、大环内酯类药物的H.pylori感染者对左氧氟沙星、克拉霉素的原发耐药率分别达到了60.9%(28/46)和63.4%(83/131),高于未使用过相应药物患者的耐药率[41.8%(59/141)和39.3%(22/56)],差异均有统计学意义(χ^(2)=5.05、9.23,P=0.023、0.002)。≤44、45~59、≥60岁组患者的甲硝唑耐药率分别为94.2%(163/173)、95.5%(231/242)、97.6%(120/123),差异无统计学意义(P>0.05)。≤44、45~59、≥60岁组患者的左氧氟沙星耐药率分别为34.7%(60/173)、48.3%(117/242)、54.5%(67/123),差异有统计学意义(χ^(2)=12.95,P=0.002);其中≤44岁组患者左氧氟沙星耐药率低于45~59、≥60岁组患者,差异均有统计学意义(χ^(2)=7.70、11.49,P=0.006、0.001)。≤44、45~59、≥60岁组患者的克拉霉素耐药率分别为36.4%(63/173)、50.4%(122/242)、44.7%(55/123),差异有统计学意义(χ^(2)=8.00,P=0.018);≤44岁组患者的克拉霉素耐药率低于45~59岁组患者,差异有统计学意义(χ^(2)=8.00,P=0.005)。≤44岁、45~59和≥60岁组患者克拉霉素+左氧氟沙星双重耐药率分别为49.7%(86/173)、70.2%(170/242)、45.5%(56/123),差异有统计学意义(χ^(2)=27.63,P<0.001);其中45~59岁组患者的克拉霉素+左氧氟沙星双重耐药率高于≤44和≥60岁组患者,差异均有统计学意义(χ^(2)=18.00、21.13,均P<0.001)。结论宁夏地区不同年龄人群H.pylori感染者对甲硝唑、左氧氟沙星、克拉霉素的原发耐药率高,推荐进行以耐药性检测为指导的个体化根除治疗。
Objective To investigate the antibiotics resistance of patients with Helicobacter pylori(H.pylori)infection of different age in Ningxia.Methods From July to December 2021,a total of 1040 patients with H.pylori infection confirmed by 14C-urea breath test who had no history of H.pylori treatment and underwent gastroscopy were selected from the H.pylori special outpatient clinics from Ningxia Hui Autonomous Region People′s Hospital,Ningxia Hospital of Integrated Traditional Chinese and Western Medicine,Yuanzhou District People′s Hospital of Guyuan,Wuzhong People′s Hospital,the Second People′s Hospital of Shizuishan,People′s Hospital of Zhongwei,Yinchuan First People′s Hospital.Gastric mucosa specimens were obtained under gastroscopy and cultured for H.pylori in vitro.Harvested H.pylori were detected for H.pylori drug resistance phenotype.Kirby-Bauer disk diffusion method was used to detect antibiotic sensitivity.Previous use of antibiotics of patients were recorded.The characteristics of primary drug resistance of people≤44,45 to 59,and≥60 years old were analyzed.Chi-square test was used for statistical analysis.Results A total of 538 H.pylori strains were obtained from 1040 gastric mucosa specimens cultured in vitro,with a positive rate of 51.7%.A total of 187 patients could provide information on history of antibiotics usage.The primary drug resistance rates of metronidazole,clarithromycin and levofloxacin were high,which were 95.5%(514/538),44.6%(240/538)and 45.4%(244/538),respectively;however drug resistance of amoxicillin,furazolidone and tetracycline were not found.The double drug resistance rate was 36.4%(196/538),mainly resistant to metronidazole and clarithromycin or metronidazole and levofloxacin,the drug resistance rates were 17.8%(96/538),18.2%(98/538),respecitively.The triple drug resistance rate was 25.5%(137/538),all of the strains were metronidazole,clarithromycin and levofloxacin resistant strains.The primary drug resistance rates to levofloxacin and clarithromycin in patients with H.pylori infection who had previous history of quinolones and macrolides were 60.9%(28/46)and 63.4%(83/131),respectively;which were higher than those of patients who had not used corresponding drugs(41.8%,59/141 and 39.3%,22/56),and the differences were statistically significant(χ^(2)=5.05 and 9.23,P=0.023,0.002).The drug resistance rates of metronidazole of≤44,45 to 59,and≥60 years old group were 94.2%(163/173),95.5%(231/242)and 97.6%(120/123),respectively,and the differences were not significant(P>0.05).The single drug resistance rates of levofloxacin of≤44,45 to 59,and≥60 years old group were 34.7%(60/173),48.3%(117/242)and 54.5%(67/123),respectively,and the differences were statistically significant(χ^(2)=12.95,P=0.002).The levofloxacin resistance rate of≤44 years old group was lower than that of 45 to 59,and≥60 years old group,and the differences were statistically significant(χ^(2)=7.70 and 11.49,P=0.006,0.001).The single drug resistance rates of clarithromycin of≤44,45 to 59,and≥60 years old group were 36.4%(63/173),50.4%(122/242)and 44.7%(55/123),respectively,and the differences were statistically significant(χ^(2)=8.00,P=0.018).The clarithromycin resistance rate of≤44 years old group was lower than 45 to 59 years old group,and the difference was statistically significant(χ^(2)=8.00,P=0.005).Dual drug resistance rates of levofloxacin and clarithromycin of≤44,45 to 59 and≥60 years old group were 49.7%(86/173),70.2%(170/242),45.5%(56/123),and the difference was statistically significant(χ^(2)=27.63,P<0.001).The resistance rate of clarithromycin and levofloxacin in 45 to 59 years old group was higher than that in≤44 and≥60 years old group,and the difference was statistically significant(χ^(2)=18.00 and 21.13,both P<0.001).Conclusions Primary drug resistance rates to metronidazole,levofloxacin and clarithromycin are high in patients with H.pylori infection of different ages in Ningxia.Individualized eradication therapy guided by drug resistance test is recommended.
作者
苏小明
邓燕红
杨伟
金丽娟
雍和礼
石瑞春
祁海龙
刘建国
胡建平
呼圣娟
Su Xiaoming;Deng Yanhong;Yang Wei;Jin Lijuan;Yong Heli;Shi Ruichun;Qi Hailong;Liu Jianguo;Hu Jianping;Hu Shengjuan(Department of Gastroenterology,the Third Clinical Medical College of Ningxia Medical University,Ningxia Hui Autonomous Region People′s Hospital,Yinchuan 750002,China;Department of Gastroenterology,Ningxia Hospital of Integrated Traditional Chinese and Western Medicine,Yinchuan 750002,China;Department of Gastroenterology,Yuanzhou District People′s Hospital of Guyuan,Guyuan 756099,China;Department of Gastroenterology,Wuzhong People′s Hospital,Wuzhong 751199,China;Department of Gastroenterology,the Second People′s Hospital of Shizuishan,Shizuishan 750003,China;Department of Gastroenterology,People′s Hospital of Zhongwei,Zhongwei 755099,China;Department of Gastroenterology,Yinchuan First People′s Hospital,Yinchuan 750010,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2022年第11期757-763,共7页
Chinese Journal of Digestion
基金
宁夏回族自治区重点研发计划重大项目(2019BFG02003)
宁夏回族自治区重点研发计划(2021BEG02025)。
作者简介
通信作者:呼圣娟,Email:hsj.judy@163.com,电话:0951-5920562。
