非侵入性方法检测幽门螺杆菌耐药性的价值  

Value of noninvasive methods for detecting drug resistance of Helicobacter pylori

作　　者：张之丽 孟钰 刘振宇 彭瑶 钟海燕 刘璐 徐龙 ZHANG Zhili;MENG Yu;LIU Zhenyu;PENG Yao;ZHONG Haiyan;LIU Lu;XU Long(Department of Gastroenterology,Affiliated Shenzhen University General Hospital,Guangdong Province,Shenzhen 518000,China;Marshall Biomedical Engineering Laboratory of Shenzhen University,Guangdong Province,Shenzhen 518000,China)

机构地区：[1]深圳大学总医院消化内科,广东深圳518000 [2]深圳大学马歇尔生物医学工程实验室,广东深圳518000

出　　处：《中国当代医药》2023年第33期16-20,26,共6页China Modern Medicine

基　　金：广东省深圳市科技计划项目(JCYJ20190808111610984)。

摘　　要：目的评价非侵入性方法检测幽门螺杆菌(Hp)耐药性的临床应用价值。方法选取深圳大学总医院2022年1月至5月呼气试验(UBT)及快速尿素酶试验(RUT)检测双阳性的56例患者为研究对象,取其胃黏膜进行Hp培养并行药敏试验,同时取其胃黏膜、唾液、粪便进行多靶点耐药基因检测。结果对56份Hp感染样本进行检测及培养,PCR法复检阳性者有42例(75%),培养阳性者有40例(71.4%),培养及PCR法证实Hp均阳性共39例(69.64%)。以Hp培养法为金标准,PCR法鉴定Hp阳性的灵敏度为97.50%、特异度为81.25%、一致率为92.85%。药敏试验提示本研究的耐药情况为甲硝唑(94.87%)>克拉霉素(30.77%)>左氧氟沙星(25.64%)>阿莫西林(2.56%)>四环素(0%)和呋喃唑酮(0%)。以药敏试验为金标准,巢式PCR法对胃黏膜、粪便、唾液分别行多靶点耐药基因检测,预测Hp对克拉霉素耐药性的灵敏度为58.30%、27.27%、27.27%,特异度为96.30%、100.00%、100.00%,一致率为79.49%、78.38%、78.95%;预测Hp对左氧氟沙星耐药性的灵敏度为20.00%、0%、0%,特异度为86.21%、96.55%、96.67%,一致率为69.23%、77.78%、77.78%;预测Hp对阿莫西林耐药性的灵敏度均为0%,特异度为100.00%、94.87%、100.00%,一致率为97.44%、94.87%、97.44%;预测四环素Hp对耐药性,灵敏度均为0%,特异度及一致率均为100.00%;预测Hp对甲硝唑耐药性的灵敏度为100.00%、78.79%、100.00%,特异度均为0%,一致率为84.87%、76.47%、94.59%。以药敏实验为金标准,巢式PCR法对胃黏膜中Hp耐药基因检测,预测Hp对呋喃唑酮耐药性的灵敏度均为0%,特异度为64.10%。结论胃黏膜组织行巢式PCR法多靶点耐药基因检测,预测Hp对克拉霉素耐药一致率较高,有一定临床使用价值。在无法获得胃黏膜时,粪便和唾液行克拉霉素多靶点耐药基因检测预测Hp耐药性仍有一定意义。Objective To evaluate the value of non-invasive methods for detecting drug resistance in Helicobacter pylori(Hp)for clinical application.Methods Fifty-six patients with double-positive urea breath test(UBT)and rapid urease test(RUT)from Shenzhen University General Hospital from January to May 2022 were selected as the study objects,and their gastric mucosa was taken for Hp culture and concurrent drug susceptibility test,while their gastric mucosa,saliva and feces were taken for multi-target drug resistance gene detection.Results A total of 56 gastric mucosa samples were tested and cultured,and 42 cases(75%)were positive by PCR and 40 cases(71.4%)were positive by culture.39 cases(69.64%)were positive by both culture and PCR.With Hp culture as the gold standard,the sensitivity of the PCR method for detection Hp positivity was 97.50%,the specificity was 81.25%,and the concordance rate was 92.85%.The drug susceptibility test indicated that the drug resistance of this study was Metronidazole(94.87%)>Clarithromycin(30.77%)>Levofloxacin(25.64%)>Amoxicillin(2.56%)>Tetracycline(0%)and Furazolidone(0%).With drug sensitivity test as the gold standard,Nest-PCR was used to detect multi-target drug resistance genes in gastric mucosa,feces and saliva,respectively,and the sensitivity to predict the resistance of Hp to Clarithromycin was 58.30%,27.27%,27.27%,and the specificity was 96.30%,100.00%,100.00%.The consistency rates were 79.49%,78.38%and 78.95%.The sensitivity of Hp to Levofloxacin resistance was 20.00%,0%,0%,the specificity was 86.21%,96.55%,96.67%,and the agreement rate was 69.23%,77.78%,77.78%.The sensitivity of Hp to Amoxicillin resistance was 0%,the specificity was 100.00%,94.87%,100.00%,and the agreement rate was 97.44%,94.87%,97.44%.The sensitivity of Hp to Tetracycline resistance was 0%,the specificity and the agreement rate was 100%.The sensitivity of Hp to Metronidazole resistance was 100%.00,78.79%,100.00%,and the specificity was 0%,and the agreement rate was 84.87%,76.47%,94.59%.With drug sensitivity test as

关 键 词：幽门螺杆菌 多靶点耐药基因 药敏试验 荧光聚合酶链式反应 

分 类 号：R446[医药卫生—诊断学]