幽门螺杆菌克拉霉素耐药及患者CYP2C19基因型快速检测指导根除治疗的研究

发布时间：2018-05-13 19:39

本文选题：幽门螺杆菌 + 克拉霉素　；参考：《现代诊断与治疗》2016年24期

【摘要】：综合分析幽门螺杆菌(Helicobacter pylori,HP)克拉霉素耐药根除治疗感染者的临床效果。选取我院2014年10月~2015年10月拟对14C呼气试验及快速尿素酶试验检测均符合HP感染者32例,按照不同的治疗方法随机分为试验组与对照组,各16例。试验组将提取的胃粘膜组织采用实时定量荧光检测法(Real time,PCR)进行HP耐药根除治疗+患者CYP2C19基因型检测,依据不同的检测结果,制定个体化的HP根除方案;对照组直接采用阿莫西林+克拉霉素+奥美拉唑治疗。试验组的HP根除率为87.5%,对照组的HP根除率为68.75%,试验组的HP根除率显著高于对照组(P0.05);本地区人群的CYP2C19对克拉霉素基因耐药发生率为28.8%,HP的23S rRNA基因位点突变率(即HP对克拉霉素的耐药发生率)为66.7%;根据CYP2C19基因型可分为UM(快代谢型)、IM(中间代谢型)、PM(弱代谢型);试验组的UM、IM、PM的HP根除率分别为55.11%、71.26%、92.32%,UM与PM的HP根除率比较差异较大(P0.05),UM与IM的HP根除率比较差异无统计学意义(P0.05)。试验组的HP根除率比较理想,HP的根除治疗效果较为显著。
[Abstract]:Objective: to analyze the clinical effect of Helicobacter pylori (Helicobacter pylori) clarithromycin resistance eradication in the treatment of infected patients. From October 2014 to October 2015, 32 patients with HP infection were selected for 14C breath test and rapid urease test. According to different treatment methods, 32 patients were randomly divided into two groups: the experimental group and the control group, each with 16 cases. In the experimental group, the extracted gastric mucosa tissues were detected by real time fluorescence assay (Real time PCR) to detect the CYP2C19 genotypes of patients with HP resistance eradication therapy. According to different test results, individualized HP eradication scheme was established. The control group was treated with amoxicillin clarithromycin omeprazole. The eradication rate of HP was 87.5 in the trial group and 68.75 in the control group. The eradication rate of HP in the experimental group was significantly higher than that in the control group (P0.05A), and the incidence of CYP2C19 resistance to clarithromycin gene in the local population was 28.8% of the 23s rRNA gene mutation rate (that is, HP). The incidence of drug resistance to clarithromycin was 66.7%; according to the genotype of CYP2C19, it could be divided into two groups: UM (fast metabolic type imm); the HP eradication rate of UMIMPM in the test group was 55.11%, 71.26% and 92.32%, respectively. The difference between HP eradication rate of UM and PM was significant (P0.05UM and IM). There was no significant difference in HP eradication rate between the two groups (P 0.05). The eradication rate of HP in the test group was better than that in the ideal group.
【作者单位】：佛山市三水区人民医院消化内科;
【分类号】：R573.1

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