包头地区难治性幽门螺杆菌感染患者耐药分析和治疗  

Analysis of Drug Resistance and Treatment of Patients With Refractory Helicobacter pylori Infection in Baotou Area

作　　者：彭飞 孟宪梅[1] 年媛媛 张静洁[1] 武勇[1] 江振宇[1] 王璐[1] 陈洪锁 PENG Fei;MENG Xianmei;NIAN Yuanyuan;ZHANG Jingjie;WU Yong;JIANG Zhenyu;WANG Lu;CHENHongsuo(Department of Gastroenterology,the Second Affiliated Hospital of Baotou Medical College,Baotou,Inner Mongolia Autonomous Region,014030)

机构地区：[1]包头医学院第二附属医院消化内科,014030

出　　处：《胃肠病学》2022年第8期486-489,共4页Chinese Journal of Gastroenterology

基　　金：内蒙古自治区科技计划项目(2021GG0232);内蒙古自治区科技创新引导项目。

摘　　要：背景:幽门螺杆菌(Hp)与消化性溃疡、胃癌等疾病密切相关。随着抗菌药物耐药率的上升,临床工作中多次Hp根除失败患者例数也在逐年增加,难治性Hp感染患者的治疗也成为难题。目的:探讨包头地区难治性Hp感染患者的耐药情况和有效的个体化治疗方案。方法:选取2020年1月-2021年11月就诊于包头医学院第二附属医院的难治性Hp感染患者,记录既往Hp根除失败次数。应用免疫组化法观察Hp球形变情况,基因芯片技术检测Hp抗菌药物耐药基因突变情况,PCR法检测宿主CYP2C19基因多态性。结合上述检测结果,为患者制定个体化治疗方案,并计算意向根除率。结果:共纳入159例难治性Hp感染患者,平均根除失败2.24次,10例(6.3%)发生Hp球形变。CYP2C19快代谢型91例(57.2%),中间代谢型59例(37.1%),慢代谢型9例(5.7%)。144例(90.6%)发生抗菌药物耐药基因突变,其中阿莫西林、克拉霉素、左氧氟沙星、呋喃唑酮、四环素和甲硝唑耐药基因突变率分别为27.0%、73.6%、47.2%、75.5%、53.5%、88.1%,132例(83.0%)对3种及以上抗菌药物产生耐药。既往Hp根除失败次数增加与多重耐药基因突变相关(P<0.05)。给予个体化治疗后,Hp意向根除率为75.2%。结论:单种抗菌药物耐药率高和多重耐药是本组难治性Hp感染患者根除失败的主要原因,其次是CYP2C19基因多态性,Hp球形变对根除治疗的影响较小。检测Hp球形变、宿主CYP2C19基因多态性、Hp抗菌药物耐药情况可指导患者的个体化用药,具有较好的临床应用价值。Helicobacter pylori(Hp)is closely related to peptic ulcer and gastric cancer.With the increase of antibiotic resistance,the number of patients with failed eradication of Hp in clinic has increased year by year,and the treatment of patients with refractory Hp infection has become a problem.Aims:To investigate drug resistance of patients with refractory Hp infection and effective individualized treatment in Baotou area.Methods:Patients with refractory Hp infection from January 2020 to November 2021 at the Second Affiliated Hospital of Baotou Medical College were enrolled.The number of previous Hp eradication failures was recorded.Hp spheroidization was detected by immunohistochemistry.Hp antibiotic resistance gene mutation was detected by gene microarray technology,and host CYP2C19 gene polymorphism was detected by PCR.Individualized treatment was given,and the intention⁃to⁃treat eradication rate was calculated.Results:A total of 159 patients with refractory Hp infection were enrolled,the mean failed eradication was 2.24.Hp spheroidization was found in 10 patients(6.3%).Extensive metabolizer of CYP2C19 was found in 91 cases(57.2%),intermediate metabolizer in 59 cases(37.1%)and poor metabolizer in 9 cases(5.7%).Hp antibiotic resistance gene mutation was found in 144 patients(90.6%),drug resistance rate of amoxicillin,clarithromycin,levofloxacin,furazolidone,tetracycline and metronidazole were 27.0%,73.6%,47.2%,75.5%,53.5%and 88.1%,respectively.A total of 132 patients(83.0%)developed resistance to three or more antibiotics.The number of previous Hp eradication failure was correlated to multiple drug resistance gene mutation(P<0.05).The intention⁃to⁃treat eradication rate after individualized treatment was 75.2%.Conclusions:High antibiotic resistance and multiple drug resistance are the main causes of failure of eradication of patients with refractory Hp infection.CYP2C19 gene polymorphism is the second reason.Hp spheroidization has little impact on eradication therapy.The detection of Hp spheroidization,host

关 键 词：幽门螺杆菌 球形变 CYP2C19基因多态性 抗菌药物耐药 治疗 

分 类 号：R573[医药卫生—消化系统]