232例幽门螺杆菌耐药性及药敏试验结果分析研究  

Analysis of the antibiotic resistance and antibiotic susceptibility test results of 232 cases of Helicobacter pylori

作　　者：孟旨毅 孟宪梅[1] 王璐[1] 张静洁[1] 年媛媛 武勇 王冬雪 MENG Zhiyi;MENG Xianmei;WANG Lu;ZHANG Jingjie;NIAN Yuanyuan;WU Yong;WANG Dongxue(Department of Gastroenterology,the Second Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou,Inner Mongolia,014030,China)

机构地区：[1]内蒙古科技大学包头医学院第二附属医院消化内科,内蒙古包头014030

出　　处：《中国中西医结合消化杂志》2025年第2期156-162,共7页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：内蒙古自治区科技计划项目(No:2021GG0232)。

摘　　要：目的:探讨包头市幽门螺杆菌(Helicobacter pylori,Hp)的耐药情况,为临床治疗提供指导。方法:分析2020年1月—2022年12月于包头医学院第二附属医院13C尿素呼气试验阳性患者232例,进行胃黏膜组织Hp分离、药敏试验及耐药基因鉴定。结果:慢性非萎缩性胃炎伴糜烂为最常见诊断。甲硝唑突变率最高(90.52%),阿莫西林突变率最低(25.86%)。女性对左氧氟沙星耐药基因突变率高于男性(P<0.05),年龄越大,Hp对克拉霉素和左氧氟沙星的耐药基因突变率越高(P<0.05)。四重耐药基因突变率最高(34.91%),六重耐药基因突变率最低(7.55%)。2020—2022年,克拉霉素的耐药基因突变比例逐年上升,左氧氟沙星则总体呈下降趋势。甲硝唑耐药率最高(94.20%),未见阿莫西林、呋喃唑酮、四环素耐药。CYP2C19基因多态性中快代谢型最多(49.57%)。克拉霉素A2143G突变率最高(79.66%)。Hp对克拉霉素(Kappa=0.797,符合率93.85%,P<0.001)和左氧氟沙星(Kappa=0.869,符合率93.55%,P<0.001)的基因型和表型上具有较好的一致性。结论:包头地区Hp耐药性较高,本研究可为临床根除Hp提供用药指导。Objective To investigate the antibiotic resistance of Helicobacter pylori(Hp)in Baotou City and provide guidance for clinical treatment.Methods A total of 232 patients with positive 13C-urea breath test results who visited Baotou Medical College's Second Affiliated Hospital from January 2020 to December 2022 were analyzed.The study involved the isolation of Hp from gastric mucosal tissue,antibiotic sensitivity testing,and identification of resistance genes.Results The most common diagnosis was chronic non-atrophic gastritis with erosion.The mutation rate for metronidazole was highest(90.52%),while the mutation rate for amoxicillin was the lowest(25.86%).Females had a higher mutation rate for levofloxacin resistance genes than males(P<0.05).As age increased,the mutation rates for clarithromycin and levofloxacin resistance genes increased(P<0.05).The highest rate of mutations was observed in quadruple resistance genes(34.91%),and the lowest in sextuple resistance genes(7.55%).From 2020 to 2022,the mutation rate for clarithromycin resistance genes increased annually,while levofloxacin showed an overall decreasing trend.Metronidazole had the highest resistance rate(94.20%),with no resistance observed for amoxicillin,furazolidone,and tetracycline.In CYP2C19 polymorphism,the rapid metabolizer type was most common(49.57%).Clarithromycin A2143G mutation rate was highest(79.66%).There was a good consistency between the genotype and phenotype of HP resistance to clarithromycin(Kappa=0.797,agreement rate 93.85%,P<0.001)and levofloxacin(Kappa=0.869,agreement rate 93.55%,P<0.001).Conclusion Hp antibiotic resistance is high in Baotou City.This study provides guidance for Hp eradication in this region.

关 键 词：幽门螺杆菌 耐药 基因型 表型 根除率 

分 类 号：R573[医药卫生—消化系统]