摘要
目的了解我国消化专科医师对《第六次全国幽门螺杆菌感染处理共识报告(非根除治疗部分)》(以下简称国六共识)和《2022中国幽门螺杆菌感染治疗指南》(以下简称指南)的认知和应用情况,以便后续有针对性地开展相关培训。方法结合国六共识和指南推荐条款拟定问卷内容,包括对国六共识和指南的了解和应用情况,幽门螺杆菌感染的检测、根除适应证、感染与胃肠道微生态的关系、根除治疗方案等。2023年11月1日至30日,采取方便抽样法,使用问卷星网络问卷调查平台,微信发送问卷链接的方法对全国24个省、自治区、直辖市的二级、三级医院1506名消化专科医师进行问卷调查。采用描述性方法进行统计学分析。结果共回收有效问卷1442份。消化专科医师对国六共识和指南的知晓率为83.7%(1207/1442),仔细阅读过相关内容的占47.2%(680/1442)。诊断幽门螺杆菌现症感染最常选择的方法为尿素呼气试验(97.4%,1404/1442),然而有53.3%(769/1442)的医师选择血清学试验。84.3%(1215/1442)的消化专科医师能判断出常见的根除治疗适应证。知晓率最高的根除方案是铋剂四联方案(98.5%,1421/1442),大剂量双联方案知晓率为59.1%(852/1442),仍有部分医师认为标准三联方案(31.8%,459/1442)、序贯方案(21.9%,316/1442)被指南推荐;还有20.2%(291/1442)的医师经常使用三联方案联合胃黏膜保护剂治疗。阿莫西林+克拉霉素(65.4%,943/1442)、阿莫西林+呋喃唑酮(20.1%,289/1442)是铋剂四联方案中常用的两种抗生素组合。分别有45.4%(655/1442)和46.0%(664/1442)的医师通常在铋剂四联方案治疗中使用钾离子竞争性酸阻滞剂、双倍剂量的质子泵抑制剂。对于多次根除失败的患者,再次行根除治疗时经验性使用最多的抗生素是呋喃唑酮(71.7%,1034/1442)。结论我国消化专科医师对幽门螺杆菌感染的认知和实践情况与国六共识和指南存在一定偏差,今后需开展相关宣传及培训工作,提高消化专科医师规范化诊疗幽门螺杆菌感染的能力。
Objective To investigate the knowledge and practice of the Sixth Chinese national consensus report on the management of Helicobacter pylori(H.pylori)infection(treament excluded)(referred to as sixth national consensus)and 2022 Chinese national clinical practice guideline on H.pylori eradication treatment(referred to as guideline)among gastroenterologists in China,so as to provide out relevant training in the future.Methods A questionnaire was designed according to sixth national consensus and guideline,including knowledge and practice of sixth national consensus and guideline,and the detection,indications of eradication,the relationship between infection and gastrointestinal microbiota,and eradication of H.pylori.From November 1 to 30 in 2023,the questionnaire-based survey was conducted among 1506 gastroenterologists from secondary and tertiary hospitals of 24 provinces,autonomous regions and municipalities in China with convenience sampling method using the"Questionnaire Star"online questionnaire platform and the questionnaire link was sent by WeChat.Descriptive methods were used for statistical analysis.Results A total of 1442 valid questionnaires were collected.The awareness rate of sixth national consensus and guideline of gastroenterologists was 83.7%(1207/1442),and 47.2%(680/1442)had read the relevant content in detail.Urea breath test(97.4%,1404/1442)was the most commonly used method for diagnosing current H.pylori infection,however,more than half of the physicians chose serological test(53.3%,769/1442)for the diagnosis of current infection.The common indications of H.pylori eradication could be identified by 84.3%(1215/1442)of gastroenterologists.The most well-known eradication regimen was bismuth quadruple regimen(98.5%,1421/1442),while some physicians still believed that the standard triple regimen(31.8%,459/1442)and sequential regimen(21.9%,316/1442)were recommended by the guideline.A further 20.2%(291/1442)frequently prescribed a triple regimen combined with gastric mucosal protectants and the awareness rate of high-dose dual regimen was 59.1%(852/1442).Amoxicillin+clarithromycin(65.4%,943/1442)and amoxicillin+furazolidone(20.1%,290/1442)were commonly used antibiotic combinations in bismuth quadruple therapy.Potassium-competitive acid blockers and double-dose proton pump inhibitors were commonly used in bismuth quadruple therapy by 45.4%(655/1442)and 46.0%(664/1442)of physicians,respectively.For patients with multiple failed eradications,furazolidone was the most commonly used antibiotic for re-eradication(71.7%,1034/1442).Conclusion The knowledge and practice of gastroenterologists on H.pylori infection in China deviates from the new consensus and guideline,and more publicity and training should be carried out in future to improve the ability of gastroenterologists to standardise the diagnosis and treatment of H.pylori infection.
作者
韩莹莹
李继岩
周亚妮
官佳轮
刘梅
廖家智
黎培员
Han Yingying;Li Jiyan;Zhou Yani;Guan Jialun;Liu Mei;Liao Jiazhi;Li Peiyuan(Department of Gastroenterology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Wenchang People′s Hospital,Wenchang 571300,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2024年第4期238-244,共7页
Chinese Journal of Digestion
基金
海南省自然科学基金(823QN372、821RC736)
海南省科技专项(ZDYF2022SHFZ057)。
关键词
螺杆菌
幽门
问卷调查研究
共识
指南
消化专科医师
Helicobacter pylori
Survey research
Consensus
Guideline
Gastroenterologists
作者简介
通信作者:黎培员,Email:pyli@tjh.tjmu.edu.cn,电话:027-83662831。
