克拉霉素耐药基因型检测在幽门螺旋杆菌根除治疗中的应用  被引量:6

The significance of identification of clarithromycin resistance in Helicobacter pylori eradication therapy

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作  者:刘茜[1] 侯鹏[2] 刘文祥[2] 齐岽东 康佳蕊[1] 杨毅[1] 陆江阳[1] 

机构地区:[1]解放军总医院第一附属医院病理科,北京100048 [2]解放军总医院第一附属医院消化科,北京100048

出  处:《感染.炎症.修复》2015年第2期102-105,F0003,共5页Infection Inflammation Repair

基  金:解放军总医院临床科研扶持基金(2014FC-ZHCG-1009)

摘  要:目的:评价用实时定量荧光聚合酶链反应(RT-PCR)方法进行幽门螺旋杆菌(Hp)鉴定以及克拉霉素基因耐药性指导Hp根除治疗的临床效果。方法:采用RT-PCR方法对385例功能性消化不良患者胃窦部和胃体部组织进行Hp鉴定和克拉霉素耐药性检测,同时胃组织行改良Giemsa染色鉴定Hp。RT-PCR检测和Giemsa染色均显示Hp阳性患者采用四联疗法(枸橼酸铋钾+雷贝拉唑+阿莫西林+克拉霉素/呋喃唑酮)治疗,其中克拉霉素基因型敏感患者选用克拉霉素(BRAC方案),克拉霉素基因型耐药患者使用呋喃唑酮(BRAF方案),每日2次,疗程为7 d。治疗结束6周后,用13C呼气法检测Hp。结果:本组患者HP感染率为35.3%(136/385例),其中女性感染率为29.1%(53/182例),男性为40.9%(83/203例)。136例Hp感染者中,89例RT-PCR和Giemsa染色均阳性,41例RT-PCR方法检测阳性而Giemsa染色阴性,6例Giemsa染色阳性而RT-PCR检测阴性。136例Hp感染者中克拉霉素耐药率为37.7%,女性和男性分别为37.3%和38.0%。89例Hp感染者治疗后,BRAC和BRAF方案治疗的清除率,ITT法分析分别为98.1%和91.7%,PP法分析分别为100.0%和94.3%。结论:使用RT-PCR方法检测胃镜活检标本中Hp及其对克拉霉素的耐药性,可以有效地指导临床抗Hp治疗,显著提高Hp根除率。Objective: To evaluate clinical significance of detection of Helicobacter pylori (HP) and clarithromycin-based genotypic resistance by real time-polymerase chain reaction (RT-PCR) in HP eradication treatment. Methods: A total of 385 patients being diagnosed as functional dyspepsia were involved in the study. Tissues of antrum and corpus of stomach were harvested for the detection of HP and clarithromycin-based genotypic resistance with RT-PCR, while HP identification was simultaneously made by modified Giemsa staining. Patients with HP positive as detected by both RT-PCR and Giemsa staining were treated with quadruple therapy: bismuth potassium citrate, rabeprazole, amoxicillin, clarithromycin (BRAC, for genotypically sensitive patients) or furazolidone (BRAF, for genotypieally resistant patients), twice a day for consecutive 7 days. The eradication rate of HP was assessed by 13C-urea breath test 6 weeks after the end of the treatment. Results: The prevalence rate of HP infection in functional dyspepsia patients was 35.3% (136/385 cases), among them 29.1% for female subjects (53/182 cases) and 40.9% for males (83/203 cases). Among 136 patients with Hp infection, 89 were positively detected both by RT-PCR and Giemsa staining, 41 sample were found to be positive only by PCR, and 6 only by Giemsa staining. Overall resistance rate against clarithromycin was 37.7% (49/130 cases), and 37.3% (19/51 cases) for females and 38.0% for male counterparts (30/79 cases). Eighty-nine patients with Hp positive as detected by both PCR and Giemsa staining received quadruple therapy. Intention-to-treat analysis (ITT analysis) showed that the eradication rates of BRAC and BRAF were respectively 98.1% (52/53 cases) and 91.7% (33/36 cases), or 100.0% (52/52 cases), 94.3% (33/35 cases) as a result of per-protocol analysis (PP analysis). Conclusions: Using RT- PCR, Helicobacter pylori and clarithromycin resistance mutations in Hp isolates from gastric biopsy specim

关 键 词:幽门螺旋杆菌 克拉霉素 耐药性 根除治疗 实时定量荧光-聚合酶链反应 

分 类 号:R446.13[医药卫生—诊断学]

 

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