2008-2014年间北京地区幽门螺杆菌耐药变迁分析  

Analysis on antibiotic resistance changes of Helicobacter pylori in Beijing,2008-2014

作　　者：何利华[1] 周丽雅[2] 刘国栋[1] 宋志强[2] 顾一心[1] 林三仁[2] 张建中[1] He Lihua;Zhou Liya;Liu Guodong;Song Zhiqiang;Gu Yixin;Lin Sanren;Zhang Jianzhong(State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China;Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]中国疾病预防控制中心传染病预防控制所,传染病控制国家重点实验室,感染性疾病诊治协同创新中心,北京102206 [2]北京大学第三医院消化科,北京100191

出　　处：《疾病监测》2018年第4期285-288,共4页Disease Surveillance

基　　金：国家科技支撑计划(No.2007BAD4B02,2012BAI06B02)~~

摘　　要：目的分析北京地区2008-2014年幽门螺杆菌(HP)耐药的变化情况。方法分别收集2008年5月至2010年10月和2013年3月至2014年1月北京地区接受胃镜检查的HP感染者的胃黏膜标本,对分离获得的HP菌株经系统鉴定后,采用E-test方法进行甲硝唑(MZ)、阿莫西林(AC)、克拉霉素(CH)、左氧氟沙星(LE)、莫西沙星(MX)、利福平(RI)、四环素(TC)、庆大霉素(GM)8种抗菌药物的耐药性检测,并进行对比分析。结果分别收集到461份(A组)和1 848份(B组)胃黏膜标本,标本进行培养后获得412和1 483株HP菌株,菌株分离率分别为89.37%和80.25%。对A组中的412株和B组中随机选择的607株HP菌株进行耐药性检测的结果显示,2013年后HP对CH、LE、MX和RI耐药率明显上升,MZ耐药率略下降,AC、TC和GM耐药率仍保持较低水平。对CH、LE、MX和RI的菌株最低抑菌浓度(MIC)分布特征进行比较发现,2013年后HP的MIC水平不论是敏感菌株还是耐药菌株,都有明显升高。结论 2013年后北京地区HP菌株对CH、LE、MX和RI的耐药率呈上升趋势,同时表现为敏感菌株和耐药菌株MIC的明显增高,是造成HP根除率显著下降的关键因素,对HP耐药判断折点的调整势在必行。Objective To analyze the changes of the antibiotic resistance of Helicobacter pylori in Beijing during 2008-2014.Methods Gastric mucosa specimens were collected from the H. pylori infected patients who received gastroscopy in Beijingfrom May 2008 to October 2010 and from March 2013 to January 2014 respectively. After the systematic identification of isolated H. pylori strains,the resistances of the strains to 8 kinds of antibiotics,i. e. metronidazole（MZ）,amoxicillin（AC）,clarithromycin（CH）,levofloxacin（LE）,moxifloxacin（MX）,rifampicin（RI）,tetracycline（TC）and gentamycin（GM）,were tested with E-test. The results of the two groups were compared and analyzed.ResultsA total of 461 and 1 848 gastricmucosa specimens were collected from the two groups of the patients（A and B）,and 412 strains（89.37%）and 1 483 strains（80.25%）of H. pylori were isolated in group A and B respectively. The drug resistance test results of the 412 strains of group A and the 607 strains randomly selected in group B showed that the resistant rate of H. pylori to clarithromycin,levofloxacin,moxifloxacin and rifampicin increased significantly after 2013,the resistant rate to metronidazole decreased slightly,and theresistant rates to amoxicillin,tetracycline and gentamycin were still low. The minimal inhibitory concentration（MIC）analysisindicated that the MICs of clarithromycin,levofloxacin,moxifloxacin and rifampicin to both drug sensitive and drug resistantH. pylori strains were significantly higher after 2013.ConclusionThe resistant rates of H. pylori strains to clarithromycin,levofloxacin,moxifloxacin and rifampicin were in increase in Beijing after 2013,and the MICs of the antibiotics to both drugsensitive and drug resistant H. pylori strains increased obviously,resulting in the marked decrease of clinical H. pylorieradication rate. It is imperative to adjust the breakpoints to evaluate the drug resistance of H. pylori.

关 键 词：幽门螺杆菌 最低抑菌浓度 耐药 北京地区 

分 类 号：R573.6[医药卫生—消化系统]