宁夏地区不同年龄人群幽门螺杆菌的耐药性分析  

Analysis of drug resistance of Helicobacter pylori in different age groups in Ningxia

作　　者：苏小明 邓燕红 杨伟 金丽娟 雍和礼 石瑞春 祁海龙[5] 刘建国 胡建平[7] 呼圣娟 Su Xiaoming;Deng Yanhong;Yang Wei;Jin Lijuan;Yong Heli;Shi Ruichun;Qi Hailong;Liu Jianguo;Hu Jianping;Hu Shengjuan(Department of Gastroenterology,the Third Clinical Medical College of Ningxia Medical University,Ningxia Hui Autonomous Region People′s Hospital,Yinchuan 750002,China;Department of Gastroenterology,Ningxia Hospital of Integrated Traditional Chinese and Western Medicine,Yinchuan 750002,China;Department of Gastroenterology,Yuanzhou District People′s Hospital of Guyuan,Guyuan 756099,China;Department of Gastroenterology,Wuzhong People′s Hospital,Wuzhong 751199,China;Department of Gastroenterology,the Second People′s Hospital of Shizuishan,Shizuishan 750003,China;Department of Gastroenterology,People′s Hospital of Zhongwei,Zhongwei 755099,China;Department of Gastroenterology,Yinchuan First People′s Hospital,Yinchuan 750010,China)

机构地区：[1]宁夏医科大学第三临床医学院宁夏回族自治区人民医院消化内科,银川750002 [2]宁夏中西医结合医院消化内科,银川750002 [3]固原市原州区人民医院消化内科,固原756099 [4]吴忠市人民医院消化内科,吴忠751199 [5]石嘴山市第二人民医院消化内科,石嘴山750003 [6]中卫市人民医院消化内科,中卫755099 [7]银川市第一人民医院消化内科,银川750010

出　　处：《中华消化杂志》2022年第11期757-763,共7页Chinese Journal of Digestion

基　　金：宁夏回族自治区重点研发计划重大项目(2019BFG02003);宁夏回族自治区重点研发计划(2021BEG02025)。

摘　　要：目的研究宁夏地区不同年龄人群幽门螺杆菌(H.pylori)感染者对常用抗菌药物的耐药性。方法选择2021年7至12月就诊于宁夏回族自治区人民医院、宁夏中西医结合医院、固原市原州区人民医院、吴忠市人民医院、石嘴山市第二人民医院、中卫市人民医院、银川市第一人民医院消化内科H.pylori专病门诊,既往无H.pylori治疗史,经14C尿素呼气试验证实为H.pylori感染,且行胃镜检查的患者1040例。在胃镜下留取胃黏膜标本行H.pylori体外培养,获得的H.pylori菌株行H.pylori耐药表型检测。药敏试验采用Kirby-Bauer纸片琼脂扩散法。记录患者既往抗生素使用情况,分析≤44、45~59、≥60岁组患者H.pylori的原发耐药特征。统计学方法采用卡方检验。结果对1040例H.pylori感染者的胃黏膜标本行H.pylori体外培养,共获得538株H.pylori菌株,培养阳性率为51.7%,187例患者可提供既往抗生素使用史。对甲硝唑、克拉霉素、左氧氟沙星的原发耐药率高,耐药率分别为95.5%(514/538)、44.6%(240/538)、45.4%(244/538),未发现对阿莫西林、呋喃唑酮、四环素耐药;双重耐药率为36.4%(196/538),以甲硝唑+克拉霉素、甲硝唑+左氧氟沙星耐药株为主,耐药率分别为17.8%(96/538)、18.2%(98/538);三重耐药率为25.5%(137/538),均为甲硝唑+克拉霉素+左氧氟沙星耐药株。既往使用过喹诺酮类、大环内酯类药物的H.pylori感染者对左氧氟沙星、克拉霉素的原发耐药率分别达到了60.9%(28/46)和63.4%(83/131),高于未使用过相应药物患者的耐药率[41.8%(59/141)和39.3%(22/56)],差异均有统计学意义(χ^(2)=5.05、9.23,P=0.023、0.002)。≤44、45~59、≥60岁组患者的甲硝唑耐药率分别为94.2%(163/173)、95.5%(231/242)、97.6%(120/123),差异无统计学意义(P>0.05)。≤44、45~59、≥60岁组患者的左氧氟沙星耐药率分别为34.7%(60/173)、48.3%(117/242)、54.5%(67/123),差异有统计学意义(χ^(2)=12.95,P=0.002);其中Objective To investigate the antibiotics resistance of patients with Helicobacter pylori(H.pylori)infection of different age in Ningxia.Methods From July to December 2021,a total of 1040 patients with H.pylori infection confirmed by 14C-urea breath test who had no history of H.pylori treatment and underwent gastroscopy were selected from the H.pylori special outpatient clinics from Ningxia Hui Autonomous Region People′s Hospital,Ningxia Hospital of Integrated Traditional Chinese and Western Medicine,Yuanzhou District People′s Hospital of Guyuan,Wuzhong People′s Hospital,the Second People′s Hospital of Shizuishan,People′s Hospital of Zhongwei,Yinchuan First People′s Hospital.Gastric mucosa specimens were obtained under gastroscopy and cultured for H.pylori in vitro.Harvested H.pylori were detected for H.pylori drug resistance phenotype.Kirby-Bauer disk diffusion method was used to detect antibiotic sensitivity.Previous use of antibiotics of patients were recorded.The characteristics of primary drug resistance of people≤44,45 to 59,and≥60 years old were analyzed.Chi-square test was used for statistical analysis.Results A total of 538 H.pylori strains were obtained from 1040 gastric mucosa specimens cultured in vitro,with a positive rate of 51.7%.A total of 187 patients could provide information on history of antibiotics usage.The primary drug resistance rates of metronidazole,clarithromycin and levofloxacin were high,which were 95.5%(514/538),44.6%(240/538)and 45.4%(244/538),respectively;however drug resistance of amoxicillin,furazolidone and tetracycline were not found.The double drug resistance rate was 36.4%(196/538),mainly resistant to metronidazole and clarithromycin or metronidazole and levofloxacin,the drug resistance rates were 17.8%(96/538),18.2%(98/538),respecitively.The triple drug resistance rate was 25.5%(137/538),all of the strains were metronidazole,clarithromycin and levofloxacin resistant strains.The primary drug resistance rates to levofloxacin and clarithromycin in patients with H

关 键 词：幽门螺杆菌 抗生素 抗药性 不同年龄 14C呼气试验 

分 类 号：R446.5[医药卫生—诊断学]