南京地区幽门螺杆菌耐药现状及近5年变化趋势  

Analysis of current status and trend of Helicobacter pylori antibiotics resistance over 5 years in Nanjing area

作　　者：姜宗丹[1] 张振玉[1] 王志 冉丹 汪志兵[1] 徐晓军[1] 王维红[1] 林惠华[1] 徐娴[1] 孔超美[1] 张予蜀[1] JIANG Zongdan;ZHANG Zhenyu;WANG Zhi;RAN Dan;WANG Zhibing;XU Xiaojun;WANG Weihong;LIN Huihua;XU Xian;KONG Chaomei;ZHANG Yushu(Department of Gastroenterology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)消化科

出　　处：《胃肠病学和肝病学杂志》2020年第2期168-171,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：2019年江苏省重点研发计划专项资金(BE2019614)

摘　　要：目的调查南京地区幽门螺杆菌(Helicobacter pylori,H.pylori)对多种抗生素的耐药现状及近5年变化趋势,为本地区根除H.pylori经验性用药提供依据。方法于2017年7月至2019年7月收集经呼气试验或快速尿素酶试验证实为H.pylori阳性的736例患者胃黏膜组织标本行H.pylori分离培养,采用Kirby-Baner(KB)药敏纸片法行药敏试验。并将其结果与2014年5月至2015年5月H.pylori药敏检测结果进行比较。结果药敏试验显示,2017年7月至2019年7月H.pylori对阿莫西林、克拉霉素、左氧氟沙星、呋喃唑酮、四环素和甲硝唑的耐药率分别为3.80%、42.53%、25.95%、1.49%、1.08%、84.78%。2017年7月至2019年7月接受初次根除与非初次根除H.pylori对阿莫西林、克拉霉素、左氧氟沙星、呋喃唑酮、四环素和甲硝唑的耐药率分别为2.53%vs 7.65%、33.82%vs 68.85%、18.63%vs 48.09%、0.72%vs 3.83%、0.72%vs 2.19%、82.64%vs 91.26%。与2014年5月至2015年5月相比,甲硝唑增幅最大,由2014年5月至2015年5月的60.5%升至近期84.78%,其次为克拉霉素,从29.5%升至42.53%,左氧氟沙星从14.7%升至25.95%,差异均有统计学意义(P<0.05)。结论本地区H.pylori感染者初次根除时对阿莫西林、呋喃唑酮、四环素耐药率较低。对于非初次根除患者,临床医师应结合地区耐药率、个人抗生素暴露史、经济效益比、药物不良反应、药物可获得性等多方面综合考虑。Objective To investigate the current status and trend of Helicobacter pylori(H.pylori)antibiotics resistance over 5 years in Nanjing area.Methods From Jul.2017 to Jul.2019,736 gastric mucosal specimens from patients with positive H.pylori confirmed by breath test or rapid urease test were collected for isolation and identify H.pylori.Drug sensitivity was tested by Kirby-Baner(KB)method.The results were compared with the results of H.pylori susceptibility test from May 2014 to May 2015.Results Drug susceptibility test showed that the resistance rates of H.pylori to Amoxicillin,Clarithromycin,Levofloxacin,Furazolidone,Tetracycline and Metronidazole were 3.80%,42.53%,25.95%,1.49%,1.08%and 84.78%,respectively from Jul.2017 to Jul.2019.The resistance rates of H.pylori(for the first time vs not the first time)to Amoxicillin,Clarithromycin,Levofloxacin,Furazolidone,Tetracycline and Metronidazole were 2.53%vs 7.65%,33.82%vs 68.85%,18.63%vs 48.09%,0.72%vs 3.83%,0.72%vs 2.19%,82.64%vs 91.26%respectively from Jul.2017 to Jul.2019.Compared with the period from May 2014 to May 2015,the increase of Metronidazole was the most obvious,from 60.5%in the period from May 2014 to May 2015 to 84.78%in the near future,followed by Clarithromycin from 29.5%to 42.53%,and Levofloxacin from 14.7%to 25.95%.The difference was statistically significant(P<0.05).Conclusion The drug resistance rate of H.pylori to Amoxicillin,Furazolidone and Tetracycline is lower when they were first eradicated in Nanjing area.For non-primary eradication patients,clinicians should take into account regional drug resistance rate,personal antibiotic exposure history,economic benefit ratio,adverse drug reactions,drug availability and other aspects.

关 键 词：幽门螺杆菌 抗生素耐药 南京地区 

分 类 号：R378[医药卫生—病原生物学] R573[医药卫生—基础医学]