老年人幽门螺杆菌对抗菌药物的耐药性研究  

Antibiotic Resistance of Helicobacter Pylori in Older Patients

作　　者：高阳[1] 张建广[1] 邵佩 李晓露[2] 王丽波[2] Gao Yang;Zhang Jianguang;Shao Pei;Li Xiaolu;Wang Libo(Department of Gastroenterology,the First Hospital of Jilin University,Changchun 130021,China;Department of Pediatric Gastroenterology,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院胃肠内科,长春130021 [2]吉林大学第一医院小儿消化科,长春130021

出　　处：《国际老年医学杂志》2020年第3期137-140,共4页International Journal of Geriatrics

基　　金：吉林省科技发展重点科技攻关项目(20170204051SF);吉林省科技发展计划项目(20170623092TC-10)。

摘　　要：目的探究老年患者的幽门螺杆菌(Hp)基因类型及对抗菌药物耐药情况。方法收集吉林大学第一医院内镜中心就诊的71例老年患者胃黏膜活检样本,快速尿素酶检测阳性标本进行Hp DNA扩增,检测VacA(细胞空泡毒素)基因类型,并对阿莫西林、克拉霉素、左氧氟沙星、甲硝唑、四环素相关耐药基因进行检测。结果Hp DNA扩增阳性率为66.2%。VacA基因型s1为100%,m1为42.6%,m2为57.4%,s1m2基因型消化性溃疡的患者(12例)明显多于s1m1基因型(2例),差异有统计学意义(P<0.05)。非萎缩性胃炎、萎缩性胃炎、胃息肉、胃癌的发生与不同基因分型之间差异无统计学意义(P>0.05)。对抗菌药物敏感的Hp占14.9%,耐药的占85.1%,多重耐药的占63.8%,耐药率为克拉霉素70.2%,左氧氟沙星46.8%,甲硝唑27.7%,四环素23.4%,阿莫西林2.1%。结论吉林省内老年人Hp的VacA基因型以s1m2居多,s1m2基因型消化性溃疡发生率高于s1m1基因型。本中心Hp以多重耐药为主,且对单种抗菌药物耐药率高,耐药率从高到低依次为克拉霉素,左氧氟沙星,甲硝唑,四环素,阿莫西林。Objective To study the Helicobacter pylori(Hp)gene type and antibiotic resistance in older patients.Methods 71 gastric mucosal biopsy samples of older patients in endoscopy center of the First Hospital of Jilin University were collected.Hp DNA amplification was performed to detect the VacA(cell vacuolating toxin)gene type in the samples with positive rapid urease test.Amoxicillin,clarithromycin,levofloxacin,metronidazole and tetracycline-related resistance genes were detected.Results The positive rate of Hp DNA amplification in gastric mucosa samples was 66.2%.100%of Hp positive samples(47 cases)was VacA genotype s1 which included 42.6%with m1and 57.4%with m2.The number of peptic ulcer patients(12 cases)with s1m2 genotype were significantly more than that with s1m1 genotype(2 cases)(P<0.05).There were no significant differences on genotypes between the diseases which included non-atrophic gastritis,atrophic gastritis,gastric polyps and gastric cancer(P>0.05).Antibiotic sensitive Hp accounted for 14.9%.Drug resistant Hp accounted for 85.1%.Multidrug resistant Hp accounted for 63.8%.The rate of drug resistance was 70.2%for clarithromycin,46.8%for levofloxacin,27.7%for metronidazole,23.4%for tetracycline,and 2.1%for amoxicillin,respectively.Conclusion The VacA genotype of Hp in the elderly in Jilin province is mostly s1m2,and the incidence of peptic ulcer with s1m2 genotype is higher than that with s1m1 genotype.Hp in this endoscopy center is mainly multi-drug resistant,and has a high resistance rate to a single antibacterial drug.The drug resistance rate is clarithromycin,levofloxacin,metronidazole,tetracycline,amoxicillin in order from high to low.

关 键 词：幽门螺杆菌 抗菌药物 耐药性 老年人 

分 类 号：R573[医药卫生—消化系统]