胃镜下黏膜活检行幽门螺杆菌培养的耐药性与多因素分析  

Analysis of Antibiotic Resistance of Helicobacter Pylori Isolates Cultured from Endoscopic Gastric Mucosal Samples

作　　者：张越溪[1] 周丽雅[1] 宋志强[1] 张建中[2] 何利华[2] 丁钰[1] 白鹏[1] 

机构地区：[1]北京大学第三医院消化科,北京100191 [2]中国疾病预防控制中心传染病预防控制所,北京102206

出　　处：《中国微创外科杂志》2015年第7期577-582,共6页Chinese Journal of Minimally Invasive Surgery

基　　金："十二五"国家支撑计划课题(2012BAI06B02)

摘　　要：目的探讨北京地区胃镜下黏膜活检培养得到的幽门螺杆菌菌株耐药性情况以及影响耐药率的因素。方法对2013年4月-2014年3月820例胃镜检查快速尿素酶检测结果阳性的患者,采集胃窦及胃体部黏膜进行幽门螺杆菌培养,并对获得的幽门螺杆菌菌株进行阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、四环素、利福平药物敏感性试验。结果820例黏膜标本中,700例培养阳性,阳性率为85.4%（700/820）。总体耐药率方面,甲硝唑、左氧氟沙星、克拉霉素、利福平、四环素、阿莫西林的耐药率分别为63.9%（447/700）、54.4%（381/700）、50.1%（351/700）、18.0%（126/700）、7.3%（51/700）、3.7%（26/700）。多重耐药率方面,对全部6种抗生素敏感的菌株仅占9.9%（69/700）,对单一抗生素耐药的菌株占27.1%（190/700）,二重、三重、四重、五重、六重耐药率分别为29.6%（207/700）、24.3%（170/700）、7.4%（52/700）、1.6%（11/700）、0.1%（1/700）。单因素分析及多因素分析显示,克拉霉素在非溃疡性消化不良的患者中耐药率明显高于消化性溃疡的患者（χ^2=11.619,P=0.001;OR=1.834,95%CI：1.366-2.424）;甲硝唑耐药率在女性患者中明显高于男性患者（χ^2=5.674,P=0.017;OR=1.486,95%CI：1.176-1.824）;左氧氟沙星耐药率在中老年患者中明显高于青年患者（χ^2=6.731,P=0.035;OR=1.204,95%CI：1.076-1.385）,在女性患者中亦明显高于男性患者（χ^2=6.693,P=0.010;OR=1.502,95%CI：1.181-1.786）。结论在北京地区,幽门螺杆菌对甲硝唑、克拉霉素及左氧氟沙星的耐药水平很高,对利福平的耐药率较高,对阿莫西林、四环素的耐药率较低,多重耐药情况也很严重。Objective To determine the resistance patterns of Helicobacter pylori（ H. pylori） strains isolated from patients in Beijing and to explore the influencing factors of antibiotic resistance. Methods From April 2013 to March 2014,Helicobacter pylori culture from mucosa samples of gastric antrum and body of stomach was carried out in 820 RUT positive patients examined by gastroscopy. Resistance to amoxicillin,clarithromycin,metronidazole,levofloxacin,tetracycline,and rifampicin was tested. Results Of the 820 specimens,700 were positive（ 85. 4%）. The overall antibiotic resistance rates of isolates obtained were 63. 9%（ 447 /700）,54. 4%（ 381 /700）,50. 1%（ 351 /700）,18. 0%（ 126 /700）,7. 3%（ 51 /700）,and 3. 7%（ 26 /700） with respect to metronidazole,levofloxacin,clarithromycin,rifampicin,tetracycline,and amoxicillin,respectively. Multiple drug resistance rate of susceptible to all tested antibiotics was 9. 9%（ 69 /700）,with a mono resistance rate of 27. 1%（ 190 /700）,double resistance rate of29. 6%（ 207 /700）,triple resistance rate of 24. 3%（ 170 /700）,quadruple resistance rate of 7. 4%（ 52 /700）,quintuple resistance rate of 1. 6%（ 11 /700）,and sextuple resistance rate of 0. 1%（ 1 /700）,respectively. Single factor analysis showed that the resistance rate of clarithromycin in patients with non ulcer dyspepsia was significantly higher than that in patients with peptic ulcer（ χ^2= 11. 619,P = 0. 001,OR = 1. 834,95% CI： 1. 366-2. 424）. The resistance rate of metronidazole in female patients was significantly higher than in male patients（ χ^2= 5. 674,P = 0. 017,OR = 1. 486,95% CI： 1. 176-1. 824）. The resistance rate of levofloxacin in middle-aged and elderly patients was significantly higher than that in young patients（ χ^2= 6. 731,P = 0. 035,OR =1. 204,95% CI： 1. 076-1. 385）,and in female patients was significantly higher than in male patients（ χ^2= 6. 693,P = 0. 010,OR =1. 502,95% CI： 1. 181-1. 786）. The results of the multivariate analy

关 键 词：幽门螺杆菌 抗生素耐药 北京 

分 类 号：R573[医药卫生—消化系统]