结节性胃炎患者难治性幽门螺杆菌感染的耐药分析和治疗  

Analysis of Drug Resistance and Treatment of Refractory Helicobacter pylori Infection in Patients With Nodular Gastritis

作　　者：年媛媛 张红杨 孟宪梅[1] 许智超 陈洪锁 江振宇[1] 武勇[1] 张静洁[1] NIAN Yuanyuan;ZHANG Hongyang;MENG Xianmei;XU Zhichao;CHEN Hongsuo;JIANG Zhenyu;WU Yong;ZHANG Jingjie(Department of Gastroenterology,the Second Affiliated Hospital of Baotou Medical College,Baotou,Inner Mongolia Autonomous Region,014030)

机构地区：[1]包头医学院第二附属医院消化内科,014030

出　　处：《胃肠病学》2021年第1期35-38,共4页Chinese Journal of Gastroenterology

基　　金：内蒙古自治区科技计划项目(2021GG0232);内蒙古自治区自然科学基金(2018MS08050,2019LH08042)。

摘　　要：背景:结节性胃炎的发生与幽门螺杆菌(Hp)感染具有直接相关性,难治性Hp感染对结节性胃炎的疗效和预后具有显著影响。目的:分析结节性胃炎难治性Hp的球形变发生率、抗菌药物耐药情况及PPI药物代谢酶CYP2C19基因多态性,以提高结节性胃炎患者难治性Hp感染的根除效果。方法:选取2019年10月—2020年11月于包头医学院第二附属医院收治的结节性胃炎难治性Hp感染患者。微需氧环境培养Hp菌株,应用免疫组化法检测Hp球形变发生情况,采用PCR法对分离出的Hp进行抗菌药物耐药基因突变位点以及宿主CYP2C19基因多态性检测。根据基因检测结果,制定个体化的治疗方案并随访根除效果,计算意向治疗根除率。结果:共入组42例难治性Hp结节性胃炎患者,其中33.3%的患者胃黏膜病理示淋巴细胞聚集。2例患者发生Hp球形变,其球形变的比例分别为20%和10%。CYP2C19快代谢型25例,中代谢型15例,慢代谢型2例。耐药基因检测示阿莫西林、克拉霉素、左氧氟沙星、呋喃唑酮、四环素、甲硝唑的耐药基因突变率分别是为4.8%、38.1%、35.7%、47.6%、42.9%和61.9%。22例(52.4%)患者对3种及以上抗菌药物产生耐药性。给予患者个体化根除方案后的意向治疗根除率为83.3%,其中二联高剂量方案的意向治疗根除率为88.9%。结论:结节性胃炎难治性Hp根除失败的首要原因是多重抗菌药物耐药,其次是CYP2C19基因多态性,Hp球形变对根除治疗的影响较小。阿莫西林耐药率显著低于其他抗菌药物,高剂量二联疗法是一种较好的Hp根除方案。Background:Nodular gastritis is directly related to Helicobacter pylori(Hp)infection.Refractory Hp infection has significant impact on the treatment efficacy and prognosis of nodular gastritis.Aims:To analyze the spheroidization and antibiotic resistance of refractory Hp and PPI drug metabolic enzyme CYP2C19 gene polymorphism in patients with nodular gastritis,so as to promote the eradication rate of refractory Hp infection in patients with nodular gastritis.Methods:Refractory Hp infection patients with nodular gastritis from Oct.2019 to Nov.2020 at the Second Affiliated Hospital of Baotou Medical College were enrolled.Hp strains were cultured in microaerophilic environment.Immunohistochemistry was used to detect Hp spheroidization.Mutation sites of antibiotic resistance genes and host CYP2C19 gene polymorphism were detected by PCR.According to the results of genetic testing,individualized therapy was given and follow up was performed,the eradication rate of intention-to-treat was calculated.Results:A total of 42 patients with refractory Hp nodular gastritis were enrolled.Among them,lymphocyte accumulation was found in 33.3%patients.Hp spheroidization was found in 2 patients,and the spheroidization rates were 20%and 10%,respectively.There were 25 intensive metabolizer,15 intermediate metabolizer and 2 poor metabolizer of CYP2C19.Antibiotic resistance gene detection showed that the drug resistance rate of amoxicillin,clarithromycin,levofloxacin,furazolidone,tetracycline,metronidazole were 4.8%,38.1%,35.7%,47.6%,42.9%and 61.9%,respectively.Twenty-two(52.4%)of the patients developed resistance to 3 or more antibiotics.The total eradication rate of intention-to-treat was 83.3%,of which high-dose dual therapy was 88.9%.Conclusions:Multi-antibiotic resistance and CYP2C19 may be the main reason for the failure of eradication of refractory Hp in nodular gastritis.Hp spheroidization has little effect on the efficacy of eradication therapy.The amoxicillin resistance rate is still significantly lower than that of other anti

关 键 词：结节性胃炎 幽门螺杆菌 抗菌药物耐药 CYP2C19 治疗 

分 类 号：R573.3[医药卫生—消化系统]