453例胃癌患者胃黏膜幽门螺杆菌毒力相关基因分型及抗生素耐药性分析  

Virulence-associated genes genotypes and antibiotic resistance of Helicobacter pylori in gastric mucosa of 453 patients with gastric cancer

作　　者：李倩倩 李伟之[2] 饶秦文 吴育美[3] LI Qian-qian;LI Wei-zhi;RAO Qin-wen;WU Yu-mei(Department of Gastrointestinal Endoscopy,Baoji Hospital Affiliated to Xi′an Medical University,Baoji 721006,China;Department of Gastroenterology,the First Affiliated Hospital of Xi′an Jiao Tong University,Xi′an 710061,China;Department of Gastroenterology,Baoji Central Hospital,Baoji 721008,China)

机构地区：[1]西安医学院附属宝鸡医院胃肠镜科,陕西省宝鸡市721006 [2]西安交通大学第一附属医院消化内科,陕西省西安市710061 [3]陕西省宝鸡市中心医院消化科,宝鸡市721008

出　　处：《广西医学》2020年第12期1550-1552,共3页Guangxi Medical Journal

基　　金：陕西省科学技术研究发展计划(2014K11-02-03-13)。

摘　　要：目的分析胃癌患者胃黏膜幽门螺杆菌(Hp)的毒力相关基因分型以及抗生素耐药性。方法选取453例胃癌患者,从其胃黏膜组织中共分离62例Hp临床株。采用PCR检测Hp毒力相关基因细胞毒素相关基因A(CagA)、细胞空泡毒素A(VacA)s1、VacAs2、VacAm1、VacAm2分布情况,采用E-test法分析Hp菌株对阿莫西林、克拉霉素、甲硝唑和左氧氟沙星的耐药性。结果基因型为CagA的Hp菌株检出率最高(100%),VacAs1a、VacAs1a+VacAm1、VacAs1a+VacAm2、VacAs1a+VacAs1c+VacAm2、VacAs1c+VacAm2和VacAm1+VacAm2检出率依次为19.35%(12/62)、46.77%(29/62)、8.06%(5/62)、8.06%(5/62)、8.06%(5/62)、9.68%(6/62)。Hp对阿莫西林的耐药性最高,达79.03%(49/62),而对左氧氟沙星和四联抗生素的耐药性相对较低,分别为22.58%(14/62)和20.97%(13/62)。结论胃癌患者胃黏膜Hp菌株毒力基因最常见为CagA基因,可使用耐药性相对较低的左氧氟沙星或者抗生素四联疗法进行治疗。Objective To analyze the virulence-associated genes genotypes and antibiotic resistance of Helicobacter pylori(Hp) in gastric mucosa of gastric cancer patients. Methods A total of 453 patients with gastric cancer were enrolled, and 62 Hp clinical strains were isolated from their gastric mucosa tissues. The distribution of virulence-associated genes cytotoxin-associated gene A(CagA), vacuolating cytotoxin A(VacA)s1, VacAs2, VacAm1 and VacAm2 in Hp strains were detected by PCR, and the resistance of Hp strains to amoxicillin, clarithromycin, metronidazole or levofloxacin was analyzed by E-test assay. Results The detection rate for Hp strains with CagA genotype was the highest(100%), which were 19.35%(12/62), 46.77%(29/62), 8.06%(5/62), 8.06%(5/62), 8.06%(5/62), and 9.68%(6/62), respectively, for VacAs1 a, VacAs1 a + VacAm1, VacAs1 a + VacAm2, VacAs1 a + VacAs1 c + VacAm2, VacAs1 c + VacAm2 and VacAm1 + VacAm2. The resistance of Hp to amoxicillin was the highest, reaching 79.03%(49/62), which were relatively lower to levofloxacin and quadruple antibiotics, reaching 22.58%(14/62) and 20.96%(13/62), respectively. Conclusions CagA gene is the most common virulence gene of Hp strain in gastric mucosa of patients with gastric cancer who can be treated by levofloxacin or quadruple antibiotic therapy with relatively lower drug resistance.

关 键 词：胃癌 幽门螺杆菌 毒力相关基因 耐药性 阿莫西林 克拉霉素 甲硝唑 左氧氟沙星 

分 类 号：R735.2[医药卫生—肿瘤]