依据药物敏感试验根除幽门螺杆菌的临床疗效随访  

Antimicrobial susceptibility testing for Helicobacter pylori treatment: A follow-up study on clinical effects

作　　者：韩丰[1] 冀子中[1] 金夏[1] 万里[1] 蔡陈效[1] 陈一鹏[1] 陈红亚[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,浙江省嘉兴市314000 [2]杭州致远医学检验所,浙江省杭州市310009

出　　处：《世界华人消化杂志》2016年第5期808-814,共7页World Chinese Journal of Digestology

基　　金：浙江省省市共建医学扶植重点建设学科计划基金资助项目;No.GJJX010-002;嘉兴市科技计划基金资助项目;No.2013AY21055~~

摘　　要：目的:在幽门螺杆菌(Helicobacter pylori,H.pylori)感染的患者中,根据药物敏感试验选择治疗方案与常规一线治疗方案进行临床疗效优劣的随访.方法:在浙江省嘉兴市第一医院内镜室行胃镜检查的患者中,胃镜检查时取材标本2块,分别送检常规组织病理学检查及组织切片染色检测及H.pylori的分离、培养、鉴定:其中H.pylori培养结果阳性的纳入治疗组,仅组织切片染色检测H.pylori阳性纳入对照组.治疗组根据药敏试验结果治疗10 d,对照组根据标准一线治疗方案治疗10d.治疗结束4 wk后的患者进行复查,任选一种复查方式(H.pylori培养或组织切片染色或14C呼气试验),三项之一阴性者可判断H.pylori根除.结果:H.pylori培养结果阳性的纳入治疗组(n=4680),仅组织切片染色检测H.pylori阳性纳入对照组(n=3505).治疗组根据药敏试验结果选用2种敏感度最高值抗生素参与的四联疗法治疗,对照组选用常规四联疗法,治疗结束4 wk后复查评估根除率.最终,治疗组的根除率为91.18%,比对照组根除率73.07%高,且差异有统计学意义(P<0.05).结论:依据H.pylori的药物敏感试验选择的治疗方案明显优于标准一线治疗方案.AIM： To evaluate and compare the clinical efficacy of Helicobacter pylori（H. pylori） treatment based on antimicrobial susceptibility testing and common first-line treatment.METHODS： Two gastric mucosa biopsies were taken from patients undergoing gastroscopy, one for histopathological and histological staining, and the other for H. pylori isolation, culture and identification. Cases that were positive for both culture and staining were included into a treatment group, and those staining positive only were included into a control group. The treatment group were treated based on antimicrobial susceptibility testing, and the control group were treated with standard first-line therapies. Both groups were treated for 10 d and H. pylori examination（bacterial culture, histological staining or 14C-Urea breath test） was conducted 4 wk after therapy. H. pylori was considered eradicated when one of the three examinations had negative results.RESULTS： In this study, 4680 cases were included into the treatment group and 3505 cases were included into the control group. In the treatment group, quadruple therapy containing two most sensitive antibiotics was applied. In the control group, common quadruple therapy was used. Finally, H. pylori eradication rate was evaluated, which was significantly higher in the treatment group（91.18%） than in the control group（73.07%）（P〈0.05）.CONCLUSION： H. pylori treatment based on antimicrobial susceptibility testing is significantly superior to common first-line therapy.

关 键 词：幽门螺杆菌 药物敏感试验 根除率 临床疗效 

分 类 号：R57[医药卫生—消化系统]