胃窦胃体联合培养和荧光定量PCR应用于幽门螺杆菌检测的优劣  

Comparison of combined culture of gastric antrum/body and fluorescence quantitative PCR in detection of Helicobacter pylori

作　　者：张小磊 张军[1] 钮萍萍 蒋海根[1] 蔡旭华[1] 董梁 丁建[1] 唐涛[1] 朱伟华[1] 刘春燕[1] 左飞[1] 施杰民[1] 钟婧[2] Zhang Xiaolei;Zhang Jun;Niu Pingping;Jiang Haigen;Cai Xuhua;Dong Liang;Ding Jian;Tang Tao;Zhu Weihua;Liu Chunyan;Zuo Fei;Shi Jiemin;Zhong Jing(Department of Gastroenterology,Huzhou Central Hospital,Affiliated Central Hospital of Huzhou University,Huzhou 313000,Zhejiang,China;Huzhou Central Hospital,Huzhou Key Laboratory of Molecule Medicine,Affiliated Central Hospital of Huzhou University,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市中心医院,湖州师范学院附属中心医院消化内科,浙江湖州313000 [2]湖州市中心医院,湖州师范学院附属中心医院分子医学重点实验室,浙江湖州313000

出　　处：《国际流行病学传染病学杂志》2020年第6期501-504,共4页International Journal of Epidemiology and Infectious Disease

基　　金：湖州市科学技术局公益性研究应用项目 (2018GYB32,2017GY39)。

摘　　要：目的了解胃窦胃体联合培养和荧光定量PCR(qPCR)法在临床幽门螺杆菌(Hp)诊断和耐药检测中的应用价值。方法收集湖州市中心医院2018年7月至2019年3月接受胃镜检查的384例患者胃窦胃体黏膜组织,进行Hp分离培养及常用抗菌药物的药敏试验,并提取患者胃窦处样本的DNA,采用qPCR法进行Hp核酸检测及其对左氧氟沙星和克拉霉素耐药性的检测。结果胃窦胃体联合培养Hp阳性检出率(147例,38.28%),与qPCR对Hp阳性检出率(164例,42.71%)比较差异无统计意义(P>0.05)。qPCR对左氧氟沙星和克拉霉素耐药菌的检出率(56.10%和57.93%)均高于联合培养(42.18%和36.73%)(χ2=6.009和13.950,P均<0.05)。qPCR与胃窦胃体联合培养对左氧氟沙星耐药菌检出不一致率为43.48%,对敏感菌检出的不一致率为36.11%;对克拉霉素耐药菌检出不一致率为52.63%,对敏感菌检出的不一致率为30.43%。结论临床采用胃窦胃体联合培养的方法将极大地提高Hp的检出率;胃窦单部位qPCR在临床Hp感染的诊断中有一定优越性。qPCR和分离培养法对于Hp左氧氟沙星、克拉霉素耐药菌的检出率的不一致性高,Hp耐药性检测仍应以分离培养方法为准。Objective To investigate the clinical values of combined culture of gastric antrum/body and fluorescence quantitative PCR(qPCR)in diagnosis of Helicobacter pylori(Hp)and drug resistance.Methods Hp cultivation and drug resistance tests to the commonly used antibiotics were carried out with the samples of gastric antrum and gastric body collected from 384 patients in Huzhou Central Hospital from July 2018 to March 2019.Hp DNA was extracted from the biopsy specimen of the patients’gastric antrum,and Hp nucleic acid and its resistance to levofloxacin and clarithromycin were detected by qPCR.Results The positive detection rate of Hp by combined culture of gastric antrum and gastric body(147 cases,38.28%)had no significant difference with that by qPCR(164 cases,42.71%)(P>0.05).The drug resistance rates of Hp to levofloxacin and clarithromycin by qPCR(56.10%and 57.93%)were higher than those by combined culture(42.18%and 36.73%)(χ2=6.009 and 13.950,P both<0.05).The inconsistency rates of detection of levofloxacin-resistant and sensitive Hp between qPCR and combined culture method were 43.48%and 36.11%,respectively.The inconsistency rates of detection of clarithromycin-resistant and sensitive Hp were 52.63%and 30.43%,respectively.Conclusions The combined culture of gastric antrum and gastric body greatly improves the positive detection rate of Hp,and qPCR method for gastric antrum has superiority in the diagnosis of Hp infection.The qPCR method and the isolation culture method have high inconsistency on drugs resistance of Hp to levofloxacin and clarithromycin,and it should still be relied on the isolation culture method to evaluate the drug resistance of Hp.

关 键 词：螺杆菌 幽门 细菌分离培养 荧光定量PCR 耐药 

分 类 号：R573[医药卫生—消化系统] R446.6[医药卫生—内科学] R440[医药卫生—临床医学]