幽门螺杆菌根除前及根除失败后耐药情况分析  

Analysis of drug resistance of Helicobacter pylori before eradication and after eradication failure

作　　者：李超[1] 徐晓军[1] 孔超美[1] 林惠华[1] 王维红[1] 徐娴[1] 张喜梅 张振玉[1] LI Chao;XU Xiaojun;KONG Chaomei;LIN Huihua;WANG Weihong;XU Xian;ZHANG Ximei;ZHANG Zhenyu(Department of Gastroenterology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)消化内科,江苏南京210006

出　　处：《胃肠病学和肝病学杂志》2022年第4期383-385,396,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：江苏省重点研发计划项目(BE2019614)。

摘　　要：目的研究根除前及根除失败后幽门螺杆菌(Helicobater pylori,H.pylori)对6种抗生素的耐药情况,为H.pylori经验性治疗特别是根除失败后补救治疗提供依据。方法选择2018年4月至2020年7月在我院进行胃镜检查并行H.pylori培养的1519例患者,采用Kirby-Baner(KB)药敏纸片法行克拉霉素、左氧氟沙星、阿莫西林、呋喃唑酮、甲硝唑、四环素药敏试验。结果既往未曾行H.pylori根除者中,克拉霉素耐药率为38.81%,左氧氟沙星为29.72%,阿莫西林为0.68%,呋喃唑酮为0.81%,四环素为0.27%,甲硝唑为82.09%。经过1次根除失败者中,克拉霉素耐药率为73.60%,左氧氟沙星为45.51%,阿莫西林为1.69%,呋喃唑酮为0.56%,四环素为0,甲硝唑为89.33%。经过2次根除失败者中,克拉霉素耐药率为79.57%,左氧氟沙星为63.44%,阿莫西林为2.15%,呋喃唑酮为0,四环素为0,甲硝唑为87.10%。经过3次及以上根除失败者中,克拉霉素耐药率为88.52%,左氧氟沙星为78.69%,阿莫西林为3.28%,呋喃唑酮为0.82%,四环素为0,甲硝唑为95.90%。结论克拉霉素、左氧氟沙星、甲硝唑的耐药率总体上随着根除次数增多而升高;阿莫西林、呋喃唑酮、四环素耐药率无明显变化。在临床补救治疗中,优先选择培养+药敏试验后的精准化治疗,若无条件行药敏试验,配合强效抑酸治疗,可以选择使用阿莫西林、四环素、呋喃唑酮组合的四联方案,甚至可以重复应用。Objective To study the resistance of Helicobacter pylori(H.pylori)to 6 antibiotics during before and after eradication failure,and provid the basis for empirical treatment of H.pylori,especially salvage treatment after eradication failure.Methods 1519 patients undergoing gastroscopy and H.pylori culture in our hospital from Apr.2018 to Jul.2020 were selected.The Kirby-Baner(KB)test was performed to test the susceptibility of Clarithromycin,Levofloxacin,Amoxicillin,Furazolidone,Metronidazole and Tetracycline to H.pylori.Results Among those who had not undergone H.pylori eradication in the past,the resistance rate of Clarithromycin was 38.81%,Levofloxacin was 29.72%,Amoxicillin was 0.68%,Furazolidone was 0.81%,Tetracycline was 0.27%and Metronidazole was 82.09%.The resistance rate of Clarithromycin was 73.60%,Levofloxacin was 45.51%,Amoxicillin was 1.69%,Furazolidone was 0.56%,Tetracycline was 0 and Metronidazole was 89.33%among those who failed to eradicate once.The resistance rate of Clarithromycin was 79.57%,Levofloxacin was 63.44%,Amoxicillin was 2.15%,Furazolidone was 0,Tetracycline was 0 and Metronidazole was 87.10%among those who failed to eradicate twice.The resistance rate of Clarithromycin was 88.52%,Levofloxacin was 78.69%,Amoxicillin was 3.28%,Furazolidone was 0.82%,Tetracycline was 0 and Metronidazole was 95.90%among those who failed to eradicate for 3 times or more.Conclusion The resistance rate of Clarithromycin,Levofloxacin,and Metronidazole generally increased significantly with the increase of eradication times.The resistance rate of Amoxicillin,Furazolidone,and Tetracycline do not change significantly.In clinical remedial treatment,precision treatment after drug susceptibility and training is preferred.Combining with strong acid suppression therapy,you can choose a eradication therapy that uses a combination of Amoxicillin,Tetracycline,and Furazolidone,if drug susceptibility test is simply not available.It can even be applied repeatedly.

关 键 词：幽门螺杆菌 培养及药敏 耐药 

分 类 号：R378[医药卫生—病原生物学]