湘南地区幽门螺杆菌耐药现状分析  

The current drug resistance analysis of Helicobacter pylori in southern Hunan

作　　者：李雅婷 刘汉雄[1] 何茜萌[1] 彭艳 李兴[1] 李衍军[1] LI Ya-ting;LIU Han-xiong;HE Xi-meng;PEN Yang;LI Xing;LI Yan-jun(Department of Endoscopy Center, the First People′s Hospital of Chenzhou City, Chenzhou 424300, China)

机构地区：[1]郴州市第一人民医院内镜中心,423000

出　　处：《现代消化及介入诊疗》2021年第12期1496-1500,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：湖南省卫生健康委科研基金(202103030567);郴州市第一人民医院院内科研项目(N2020-93)。

摘　　要：目的分析湘南地区人群幽门螺杆菌(H.pylori)分离培养株对14种抗生素的耐药特点,指导临床用药。方法回顾性选取郴州市第一人民医院2020年3月至2021年3月因上消化道症状就诊,H.pylori分离培养阳性并行药物敏感试验的患者。统计分析不同性别、年龄、不同疾病类型患者H.pylori对14种抗生素的耐药率。结果2015例患者H.pylori分离培养株对克拉霉素、甲硝唑、四环素、阿奇霉素、阿莫西林、头孢克肟、替硝唑、硫酸庆大霉素、盐酸多西环素、阿莫西林克拉维酸钾、呋喃唑酮、左氧氟沙星、利福平、司帕沙星的耐药率分别为28.24%、4.52%、4.52%、3.67%、2.63%、2.63%,2.28%、1.84%、1.79%、1.54%,1.29%、1.19%、0.69%、0.50%。660例(32.75%)仅对单种抗生素耐药;143例(7.10%)对两种抗生素耐药;60例(2.98%)对多种抗生素耐药。男性患者H.pylori分离培养株对头孢克肟的耐药率为2.5%,显著高于女性患者的1.15%(P<0.05),其它抗生素在不同性别患者中的耐药率差异无统计学意义。H.pylori分离培养株的单一、双重、多重耐药率均随着年龄的增长而增长(P<0.05)。克拉霉素和阿莫西林克拉维酸钾在萎缩性胃炎患者中的H.pylori耐药率显著高于慢性非萎缩性胃炎及消化性溃疡患者(P<0.05),其它抗生素在三组疾病类型中的耐药率差异无统计学意义。萎缩性胃炎患者H.pylori分离培养株的单一耐药率显著高于慢性非萎缩性胃炎及消化性溃疡患者,差异有统计学意义(P<0.05)。结论湘南地区H.pylori在常用抗生素中克拉霉素耐药率最高,其次为甲硝唑和四环素,而阿莫西林、呋喃唑酮、左氧氟沙星相对较低。在非常用根除方案中,阿莫西林克拉维酸钾、利福平、司帕沙星等抗生素耐药率低,可制定合适的临床方案进一步探讨根除效果。除头孢克肟外,在选择抗生素时可不考虑性别因素。老年人是H.pylori耐药及多重耐药的严重人Objective To analyze the drug resistance characteristics of Helicobacter pylori(H.pylori)isolates to 14 antibiotics in southern Hunan,and to guide the clinical use of antibiotics.Methods Patients with digestive symptoms in The First People′s Hospital of Chenzhou city from March 2020 to March 2021 who were isolated and cultured with positive H.pylori and tested for drug sensitivity were retrospectively selected.On the basis of different genders,different ages,and different type of gastric diseases,the drug resistance rates of H.pylori among 14 antibiotics were analyzed.Results A total of 2015 H.pylori strains were isolated,the drug resistance rate of H.pylori to clarithromycin,metronidazole,tetracycline,azithromycin,cefixime,tinidazole,gentamicin sulfate,doxycycline hydrochloride,amoxicillin clavulanate potassium,furazolidone,levofloxacin,rifampicin,sparfloxacin were 28.24%,4.52%,4.52%,3.67%,2.63%,2.63%,2.28%,1.84%,1.79%,1.54%,1.29%,1.19%,0.69%,0.50%.660cases(32.75%)were resistant to single antibiotic;143 cases(7.10%)were resistant to combination of two antibiotics;and 60 cases(2.98%)were resistant to combination of multiple antibiotics;The drug resistance rate of male H.pylori isolates to cefixime was 2.5%,which was significantly higher than that of female(1.15%)(P<0.05),there was no significant difference in drug resistance rates of other antibiotics in different genders.The resistance rate of H.pylori isolates to single antibiotic,two antibiotics and multiple antibiotics increased with age(P<0.05).The H.pylori drug resistance rate of clarithromycin and amoxicillin clavulanate potassium in patients with atrophic gastritis was significantly higher than that in patients with chronic non-atrophic gastritis and peptic ulcer(P<0.05),while other antibiotics showed no statistical significance in the three groups of diseases.The single drug resistance rate of H.pylori isolates from patients with atrophic gastritis was significantly higher than that of patients with chronic non-atrophic gastritis and peptic ulcer,and t

关 键 词：幽门螺杆菌 耐药性 药物敏感试验 抗生素 

分 类 号：R378.99[医药卫生—病原生物学] R962[医药卫生—基础医学]