胃镜下黏膜活检行幽门螺杆菌培养的耐药性与多因素分析

发布时间：2018-06-09 14:13

本文选题：幽门螺杆菌 + 抗生素耐药　；参考：《中国微创外科杂志》2015年07期

【摘要】：目的探讨北京地区胃镜下黏膜活检培养得到的幽门螺杆菌菌株耐药性情况以及影响耐药率的因素。方法对2013年4月~2014年3月820例胃镜检查快速尿素酶检测结果阳性的患者,采集胃窦及胃体部黏膜进行幽门螺杆菌培养,并对获得的幽门螺杆菌菌株进行阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、四环素、利福平药物敏感性试验。结果820例黏膜标本中,700例培养阳性,阳性率为85.4%(700/820)。总体耐药率方面,甲硝唑、左氧氟沙星、克拉霉素、利福平、四环素、阿莫西林的耐药率分别为63.9%(447/700)、54.4%(381/700)、50.1%(351/700)、18.0%(126/700)、7.3%(51/700)、3.7%(26/700)。多重耐药率方面,对全部6种抗生素敏感的菌株仅占9.9%(69/700),对单一抗生素耐药的菌株占27.1%(190/700),二重、三重、四重、五重、六重耐药率分别为29.6%(207/700)、24.3%(170/700)、7.4%(52/700)、1.6%(11/700)、0.1%(1/700)。单因素分析及多因素分析显示,克拉霉素在非溃疡性消化不良的患者中耐药率明显高于消化性溃疡的患者(χ2=11.619,P=0.001;OR=1.834,95%CI:1.366~2.424);甲硝唑耐药率在女性患者中明显高于男性患者(χ2=5.674,P=0.017;OR=1.486,95%CI:1.176~1.824);左氧氟沙星耐药率在中老年患者中明显高于青年患者(χ2=6.731,P=0.035;OR=1.204,95%CI:1.076~1.385),在女性患者中亦明显高于男性患者(χ2=6.693,P=0.010;OR=1.502,95%CI:1.181~1.786)。结论在北京地区,幽门螺杆菌对甲硝唑、克拉霉素及左氧氟沙星的耐药水平很高,对利福平的耐药率较高,对阿莫西林、四环素的耐药率较低,多重耐药情况也很严重。
[Abstract]:Objective to investigate the drug resistance of Helicobacter pylori strains cultured under gastroscopy in Beijing and the factors affecting drug resistance. Methods from April 2013 to March 2014, 820 patients with positive results of rapid urease were collected from gastric antrum and gastric body for culture of Helicobacter pylori, and amoxicillin and clarithromycin were used to culture the obtained strains of Helicobacter pylori. Metronidazole, levofloxacin, tetracycline, rifampicin drug sensitivity test. Results among 820 mucosal specimens, 700 cases were positive in culture, and the positive rate was 85.4% / 820%. In terms of overall drug resistance, metronidazole, levofloxacin, clarithromycin, rifampicin, tetracycline, amoxicillin were 63.9% 447 / 700% 54.41% 54.41% 50.1% 351,700% 18.0 126700 7 / 7 7. 3% 5 1 / 700% 5. 7% 3. 7% 3. 7%. In terms of multidrug resistance, only 9.9% of all six antibiotic sensitive strains accounted for 69 / 700%, and 27.1g / 700% for single antibiotic resistant strains, with twofold, triple, quadruple, five-fold, six-fold resistance rates 29.60.70%, 24.3170% -700% 7.34% 52700% 1.11% 700 / 700 and 0.1% 700nil / 700, respectively. Single factor analysis and multivariate analysis showed that, The drug resistance rate of clarithromycin in non-ulcerative dyspepsia patients was significantly higher than that in peptic ulcer patients (蠂 ~ 211.619 / P ~ 0.001) and metronidazole resistance rate in female patients was significantly higher than that in male patients (蠂 ~ 25.674P 0.017ORA 1.48695 CI: 1.176T 1.824m). The drug resistance rate of levofloxacin in middle-aged and elderly patients was obviously higher than that in male patients (蠂 ~ 25.674P0.017OR1.48695 CI: 1.176U 1.824m). The drug resistance rate of levofloxacin in middle-aged and elderly patients was obviously higher than that in male patients (蠂 ~ 25.6774 P 0.017). It was significantly higher in young patients than in young patients (蠂 2 / 6.731 / P 0.035 / 1.204 / 95 CI: 1.076 / 1.385). It was also significantly higher in female patients than in male patients (蠂 2 / 6.693) (蠂 ~ 2 / 6.693 / P 0.010 / 1.50 2 / 95 CI = 1.181 / 1.786). Conclusion in Beijing, the resistance of Helicobacter pylori to metronidazole, clarithromycin and levofloxacin is very high, but to rifampicin is higher, and to amoxicillin and tetracycline is low, and the situation of multidrug resistance is very serious.
【作者单位】：北京大学第三医院消化科;中国疾病预防控制中心传染病预防控制所;
【基金】：“十二五”国家支撑计划课题(2012BAI06B02)
【分类号】：R573

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