幽门螺杆菌对常用抗生素的耐药性及23S rRNA基因突变位点分析  

Resistance of Helicobacter pylori to common antibiotics and analysis of 23S rRNA gene mutation

作　　者：赵云冬 宋顺佳 姜菲菲 王丹 赵潇颖 杨志平[2] Zhao Yun-dong;Song Shun-jia;Jiang Fei-fei;Wang Dan;Zhao Xiao-ying;Yang Zhi-ping(Medical Technology College of Beihua University,Jilin 132013;Affiliated Hospital of Beihua University,Jilin 132011)

机构地区：[1]北华大学医学技术学院,吉林132013 [2]北华大学附属医院,吉林132011

出　　处：《中国抗生素杂志》2023年第6期686-690,共5页Chinese Journal of Antibiotics

基　　金：吉林省教育厅“十三五”科学技术项目(No.JJKH20190657KJ,No.JJKH20180365KJ)。

摘　　要：目的检测幽门螺杆菌(Hp)对5种常见抗菌药物的耐药性,指导临床合理用药。方法收集2019年9月至2021年6月在北华大学附属医院消化内科就诊患者的胃黏膜标本165例,经13C呼气试验确诊Hp阳性,分离培养Hp。采用琼脂稀释法检测Hp对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林及利福平的耐药性。提取Hp基因组DNA,PCR扩增23S rRNA基因,将PCR产物测序分析突变特征。结果Hp药敏结果显示,165株Hp菌株对甲硝唑的耐药率最高,占90.91%(150/165),左氧氟沙星的耐药率占83.03%(137/165),克拉霉素耐药率占70.30%(116/165),阿莫西林耐药率占18.18%(30/165),利福平耐药率占16.36%(27/165)。对所有抗生素均敏感的Hp菌株占9.09%(15/165),多重耐药菌株占90.91%(150/165),其中双重耐药占28.49%(47/165),三重耐药占35.15%(58/165),四重耐药占20%(33/165),五重耐药占7.27%(12/165)。23S rRNA基因测序结果表明最常见的突变位点为A2143G,突变率为82.76%(96/116),A2142G突变率为6.03%(7/116),A2223G突变率为4.31%(5/116),但是另有8株耐药菌株未发生基因突变,占6.90%(8/116),敏感菌株均未发生基因突变。结论Hp对克拉霉素、甲硝唑和左氧氟沙星的耐药率高,对阿莫西林和利福平的耐药率较低,23S rRNA基因突变是导致克拉霉素耐药的主要原因。Objective To detect the drug resistance of Helicobacter pylori(Hp)to five common antibiotics and to guide the rational use of drugs in clinic.Methods Gastric mucosal specimens of 165 patients treated in the Department of Gastroenterology,Affiliated Hospital of Beihua University from September 2019 to June 2021 were collected.Hp positive was confirmed by 13C breath test,and Hp was isolated and cultured.The drug resistance of Hp to metronidazole,clarithromycin,levofloxacin,amoxicillin,and rifampicin was detected by the Agar dilution method.Hp genomic DNA was extracted,23S rRNA gene was amplified by PCR,and the PCR products were sequenced to analyze the mutation characteristics.Results The drug sensitivity of Hp strains showed that the resistance rates to metronidazole,levofloxacin,clarithromycin,amoxicillin,and rifampicin were 90.91%(150/165),83.03%(137/165),70.30%(116/165),18.18%(30/165),and 16.36%(27/165),respectively.Sensitivity to all antibiotics accounted for 9.09%(15/165).Multi-drug resistant strains accounted for 90.91%(150/165),among which double drug resistance accounted for 28.49%(47/165),triple drug resistance accounted for 35.15%(58/165),quadruple drug resistance accounted for 20%(33/165),and five drug resistance accounted for 7.27%(12/165).The results of 23S rRNA gene sequencing showed that the most common mutation site was A2143G,and the mutation rate was 82.76%(96/116).The mutation rate of A2142G was 6.03%(7/116),and the mutation rate of A2223G was 4.31%(5/116).However,there were no gene mutations in eight drug-resistant strains,accounting for 6.90%of the total,and no gene mutations were found in all sensitive strains.Conclusion Hp has high resistance to clarithromycin,metronidazole,and levofloxacin,but low resistance to amoxicillin and rifampicin.23S rRNA gene mutation is the main cause of clarithromycin resistance.

关 键 词：幽门螺杆菌 抗生素 耐药性 23S rRNA 

分 类 号：R978.1[医药卫生—药品] R446.5[医药卫生—药学]