454例幽门螺杆菌耐药性及药敏试验个性化诊疗效果分析  

Effect of personalized diagnosis and treatment by drug resistance and drug susceptibility testing in 454 cases of Helicobacter pylori

作　　者：张志镒 吴正奇 郜恒骏[2] 卢林芝 秦天燕 赵光源 李世华 谢春芳 王星华 ZHANG Zhiyi;WU Zhengqi;GAO Hengjun;LU Linzhi;QIN Tianyan;ZHAO Guangyuan;LI Shihua;XIE Chunfang;WANG Xinghua(Department of Gastroenterology,Wuwei Cancer Hospital,Wuwei,Gansu 733000,China;Institute of Digestive Diseases,Tongji University School of Medicine/Chinese Helicobacter pylori Molecular Medicine Center,Shanghai 201321,China)

机构地区：[1]甘肃省武威肿瘤医院消化科,甘肃武威733000 [2]同济大学医学院消化疾病研究所/中国幽门螺杆菌分子医学中心,上海201321

出　　处：《重庆医学》2022年第17期2922-2925,2931,共5页Chongqing medicine

基　　金：国家重点研发计划项目(2017YFC0908302)。

摘　　要：目的分析武威市幽门螺杆菌(HP)耐药及个性化诊疗根除HP情况,为临床诊疗提供参考依据。方法选取2019年1月至2020年6月甘肃省武威肿瘤医院就诊检查^(14)C呼气试验阳性的454例患者为研究对象,胃镜获取胃黏膜组织进行分离培养、药敏试验及耐药基因突变检测,按照药敏试验结果给予个性化诊疗方案进行HP根除治疗,对检测结果及根除情况进行分析。结果HP对阿莫西林的耐药率最低(15.61%),甲硝唑的耐药率最高(98.31%);多重耐药中双重耐药比例最高(35.44%);6种抗生素基因突变检测中,甲硝唑耐药基因突变率达100.00%,其次是克拉霉素(68.81%),基因突变率最低的是阿莫西林(25.06%);HP对左氧氟沙星、克拉霉素、阿莫西林的基因突变率女性高于男性(P<0.05),而不同年龄段HP对6种抗生素的基因突变率比较,差异无统计学意义(P>0.05)。采用个性化诊疗方案,HP的根除率达72.69%,其中首次进行根除者根除率高于复治患者,差异有统计学意义(P<0.05)。结论武威市HP耐药性偏高,个性化诊疗可提高HP根除率。Objective To analyze the drug resistance of Helicobacter pylori(HP)and the eradication of HP by personalized diagnosis and treatment in Wuwei City,so as to provide a reference for clinical diagnosis and treatment.Methods A total of 454 patients who had a positive ^(14)C breath test in Gansu Wuwei Tumour hospital from January 2019 to June 2020 were collected.The gastric mucosal tissues obtained by gastroscopy were separated and cultured,drug sensitivity test and drug resistance gene mutation detection.According to the results of drug sensitivity test,the personalized diagnosis and treatment plan was given for HP eradication treatment,and the test results and eradication situation were analyzed.Results HP had the lowest resistance rate to amoxicillin(15.61%)and metronidazole has the highest resistance rate(98.31%).Among the multi-drug resistance,the double resistance rate was the highest,accounting for 35.44%.Among the six types of antibiotic gene mutation detection,the mutation rate of metronidazole resistance gene reached 100.00%,followed by the clarithromycin resistance gene mutation rate of 68.81%,and the lowest gene mutation rate was amoxicillin(25.06%).The genetic mutation rate of HP against levofloxacin,clarithromycin,and amoxicillin in female was higher than that in male(P<0.05),and there was no statistically significant difference in the genetic mutation rates of HP to six antibiotics between different age groups(P>0.05).With a personalized diagnosis and treatment plan,the eradication rate of HP reached 72.69%.Among them,the eradication rate of the first eradication patients was higher than that of the retreatment patients,the difference was statistically significant(P<0.05).Conclusion HP resistance is high in Wuwei city,personalized diagnosis and treatment can increase the eradication rate of HP.

关 键 词：幽门螺杆菌 耐药 基因突变 根除率 胃癌 

分 类 号：R459.9[医药卫生—治疗学]