2311株分离自不同年龄段患者的幽门螺杆菌的多重耐药性分析  

Analysis of multiple drug resistance of 2311 strains of Helicobacter pylori isolated from patients of different ages

作　　者：冀子中[1] 金夏[1] 韩丰[1] 蔡陈效[1] 万里[1] 陈敏芳[1] 杨宁敏 

机构地区：[1]浙江省嘉兴市第一医院消化科,314000 [2]杭州市致远医学检验所

出　　处：《中华消化杂志》2013年第12期826-830,共5页Chinese Journal of Digestion

基　　金：浙江省省市共建医学扶植重点建设学科计划（GJJX-010-002）

摘　　要：目的了解浙江省嘉兴市地区不同年龄段H．pylori感染者的单药、多重耐药情况及对不同组合抗生素的敏感情况。方法收集2007年1月至2011年12月行胃镜检查者6280例，平均年龄为50．8岁。其中〈20岁者129例，20～〈40岁者1802例，40～60岁者3016例，〉60岁者1333例。采集胃窦黏膜进行H．pylori培养，使用甲硝唑、阿莫西林、庆大霉素、呋喃唑酮、克拉霉素及左氧氟沙星对H．pylori分离菌株进行药物敏感试验。不同午龄组患者耐药率比较采用卡方检验。结果6280份胃黏膜标本中，2311份H．pylori培养阳性（阳性率为36．80％），其中40～60岁者阳性率最高，为38．43％（1159／3016），〉60岁者阳性率最低，为33．76％（450／1333）。甲硝唑在20～％40岁年龄段的耐药率最高，达98．02％（644／657），克拉霉素在〉60岁年龄段的耐药率最高，为22．67Voo（102／450），左氧氟沙星、呋哺唑酮、阿莫西林、庆大霉素在各年龄段的耐药率均较低。586株出现了对2种抗生素混合耐药，以甲硝唑和克拉霉素混合耐药率最高，为259株（15．23％）。49株出现了对3种抗生素混合耐药，以甲硝唑、克拉霉素和左氧氟沙星混合耐药率最高，为32株（12．88％）。阿莫西林和庆大霉素组合有1691株敏感，敏感率达99．41％，阿莫西林和呋喃唑酮组合与庆大霉素和呋喃唑酮组合的敏感率均为94．24％。结论甲硝唑在各年龄段均有极高的耐药率，不宜再选用。阿莫西林和庆大霉素联合应用在不同年龄段患者均是理想的抗生素组合，对青霉素过敏的患者推荐采用庆大霉素＋呋喃唑酮组合。Objective To investigate condition of single drug or multiple drug resistance and sensitivities of different combinations of antibiotics in Helicobacter pylori （H. pylori） infected patients of different ages in Jiaxing City, Zhejiang Province. Methods From January 2007 to December 2011, a total of 6280 patients underwent gastroendoscopy examination were enrolled, the average age of them was 50.8 years old. Among them, 129 cases were less than 20 years old, 1802 cases were between 20 and 40, 3016 cases were between 40 and 60, and 1333 cases were over 60. The mucosa of gastric antrum was collected for H. pylori culture. Drug sensitivity of isolated H. pylori strains was tested with metronidazole, amoxieillin and gentamycin, furazolidone, clarithromycin and levofloxaein. ;X2 test was performed for the comparison of drug resistance among different age groups. Results Among 6280 specimens, H. pylori culture of 2311 cases was positive （positive rate 36.80%）. The positive rate of patients aged between 40 and 60 was the highest （38.43%, 1159/3016）, and that of patients over 60 was the lowest （33.76%, 450/1333）. The drug resistance rate of metronidazole in patients between 20 and 40 years reached 98.02% （644/657） and was the highest. The drug resistance rate of clarithromycin in patents over 60 years old was the highest, which was 22.67%（102/450）. The drug resistance rates of the levofloxacin, furazolidone, amoxicillin and gentamicin were low of all ages. Mixed resistance of two antibiotic appeared in 586 strains, mixed resistance rate of metronidazole and clarithromycin was the highest （259 strains, 15.23%）. Mixed resistance of three drugs appeared in 49 strains, mixed resistance rate of metronidazole, clarithromycin and levofloxacin was the highest （32 strains, 12. 88%）. A total of 1691 strains were sensitive to the combination of amoxicillin and gentamycin, the sensitive was rate 99.41%. The sensitive rate of the combination of amoxicillin and furazolidone, gentamycin and furazolidone wa

关 键 词：螺杆菌 幽门 抗药性 多种 细菌 阿莫西林 庆大霉素类 呋喃唑酮 甲硝唑 药物疗法 联合 年龄因素 

分 类 号：R446.5[医药卫生—诊断学]