药敏试验在三联疗法根除幽门螺杆菌中的作用  

Role of Drug Sensitivity Test in the Triple Therapy for Eradication of Helicobacter pylori

作　　者：周家华 霍惠峰 吴明 蒋晓渠[2] 

机构地区：[1]上海海员医院消化内科,200080 [2]上海市第一人民医院分院消化内科

出　　处：《胃肠病学》2010年第6期358-360,共3页Chinese Journal of Gastroenterology

摘　　要：背景：近年幽门螺杆菌（H．pylori）对硝基咪唑类和大环内酯类抗生素的耐药率快速增高，导致目前推荐的H．p？tori根除方案疗效降低。目的：观察体外实验中Hpylori对甲硝唑和克拉霉素的敏感性，评估药敏试验基础上的个体化治疗方案能否提高根除率。方法：对260例连续Hpylori阳性患者的内镜胃窦部活检标本行H．pylori培养和药敏试验。患者随机分为两组，A组（n=135）使用奥美托唑、甲硝唑和克拉霉素治疗10d，B组（n=125）在药敏试验的基础上接受10d个体化治疗。治疗结束1个月后．根据14C-尿素呼气试验结果评价根除率。结果：共248例患者（A组129例，B组119例）完成治疗和疗效评价，甲硝唑、克拉霉素单一和联合耐药率分别为31．0％、11．7％和3．6％。A组按方案（PP）分析和意向治疗（ITT）分析的H．pylori根除率分别为82．9％和79．3％，B组分别为98.3％和93．6％，B组根除率显著高于A组（P〈0．01）。结论：药敏试验基础上的个体化治疗可有效提高H．pylori的根除率。Background： The efficacy of regimens recommended for Helicobacter pylori （H. pylari） eradication is declining because of the rapid increase of its resistance to nitroimidazoles and macrolides. Aims： To observe the in vitro H. pylori sensitivity to metronidazole and clarithromycin, and to evaluate whether the individualized regimen based on antibiotic sensitivity test can improve the eradication rate of H. pylori infection. Methods： Endoscopic biopsy specimens from gastric antrum of 260 consecutive H. pylari-positive patients were used for H. pylori culture and antibiotic sensitivity test. Patients were randomly allocated to two groups. Group A （n=135） were treated with triple therapy containing omeprazole, metronidazole and clarithromycin for 10 days, and group B （n=125） were treated with the individualized regimen based on antibiotic sensitivity test for 10 days. The eradication rates were evaluated by 14C-urea breath test one month after completion of treatment. Results： A total of 248 patients （129 in group A, 119 in group B） had completed a course of treatment and evaluation. Resistance rates to metronidazole, clarithromycin and to both drugs were 31.0%, 11.7% and 3.6%, respectively. The per protocol （PP） and intention-to-treat （ITT） eradication rates of group A were 82.9% and 79.3%, respectively, and the corresponding eradication rates of group B were 98.3% and 93.6%, respectively, significantly higher than those of group A （P〈0.01）. Conclusions： The individualized therapy based on antibiotic sensitivity test can improve the eradication rate of H. pylari infection.

关 键 词：螺杆菌 幽门 抗药性 微生物敏感性试验 

分 类 号：R57[医药卫生—消化系统]