消性溃疡幽门螺杆菌的分离培养及耐药分析

目的 通过对消化性溃疡患者幽门螺杆菌的分离培养,了解幽门螺杆菌在消化性溃疡患者中的发生率,同时了解其药物的敏感性.方法 经胃镜下确认为消化性溃疡患者,取胃窦部黏膜组织进行幽门螺杆菌的分离培养,并采用K-B法对分离菌株进行药物敏感性试验.结果 141例消化性溃疡患者幽门螺杆菌的分离率为75.2%,对临床常用的呋喃唑酮、阿莫西林、左氧氟沙星、头孢呋辛及莫西沙星保持较高的敏感性,而甲硝唑和克拉霉素的耐药率相对较高.结论 幽门螺杆菌是消化性溃疡的重要发病因素,且对临床常用的抗菌药物有耐药性增高的趋势.     

咸宁地区幽门螺杆菌临床分离株耐药性分析

目的为了解咸宁地区幽门螺杆菌(Helicobacter pylori,Hp)的耐药性状况。方法从慢性胃炎(chronic gastri-tis,CG)和慢性消化性溃疡(chronic peptic ulcer,CPU)患者的胃黏膜活检组织中分离培养出156株Hp,用Kirby–Baner药敏纸片法检测Hp对甲硝唑、替硝唑、克拉霉素、阿莫西林、四环素、呋喃唑酮、利福平的耐药率,比较不同性别、区域、胃疾病之间的耐药性。结果咸宁地区Hp对甲硝唑、替硝唑、克拉霉素、阿莫西林、四环素、呋喃唑酮、利福平的耐药率分别为65.4%、41.7%、12.2%、14.1%、0、7.0%、9.7%。不同性别、区域、胃疾病之间耐药率差异无统计学意义(P﹥0.05)。结论咸宁地区Hp对甲硝唑、替硝唑的耐药性严重;对克拉霉素、阿莫西林、呋喃唑酮、利福平的耐药率较低;未发现对四环素耐药。克拉霉素和阿莫西林为本地区根除Hp感染的首选抗菌药物。     

2259例慢性胃炎患者幽门螺杆菌检出情况及耐药现状

目的研究慢性胃炎患者幽门螺杆菌检出情况及耐药现状。方法以2021年7月至2022年12月济南市某医院诊治的2259例慢性胃炎患者为研究对象,13C-尿素呼吸试验方法检出幽门螺杆菌阳性者,胃黏膜活检样本分离培养幽门螺杆菌,对常用抗菌药物甲硝唑、左氧氟沙星、阿莫西林、克拉霉素进行幽门螺杆菌体外药物敏感检测,并采用测序法检测上述抗菌药物的相关耐药基因。结果共检出幽门螺杆菌阳性839例,阳性检出率为37.14%。共分离培养出幽门螺杆菌758株,对甲硝唑、左氧氟沙星、阿莫西林、克拉霉素耐药率分别为51.98%、31.13%、1.00%、19.26%。不同性别的幽门螺杆菌阳性患者对甲硝唑、左氧氟沙星、阿莫西林、克拉霉素耐药率差异无统计学意义(P>0.05);既往使用过以上药物的幽门螺杆菌阳性患者耐药率显著高于未使用过相应药物的患者(P<0.05或P<0.01);不同年龄的幽门螺杆菌阳性患者对甲硝唑、阿莫西林耐药率差异无统计学意义(P>0.05),而对左氧氟沙星、克拉霉素耐药率差异有统计学意义(P<0.05或P<0.01)。幽门螺杆菌对甲硝唑的耐药基因为rdxA,T184G、G616A、C148T位点突变率分别为70.98%、43.01%、6.86%;幽门螺杆菌对左氧氟沙星的耐药基因为gyrA,G261G、C261A、G271A、A272G位点突变率分别为7.39%、5.80%、7.39%、3.96%;幽门螺杆菌对阿莫西林的耐药基因为pbplA,A1777G、C1667G位点突变率分别为10.03%、4.49%;幽门螺杆菌对克拉霉素的耐药基因为23SrRNA,T2182C、A2142G、A2143G位点突变率分别为34.30%、2.37%、20.32%。结论慢性胃炎患者幽门螺杆菌检出率较高,其耐药状况不容乐观,需要根据常用抗菌药物的耐药情况及相关基因检测结果采取有效的干预措施,进行耐药性检测为指导个体化根除治疗,促进幽门螺杆菌根除。     

不同型别幽门螺杆菌的耐药性

目的观察不同型别幽门螺杆菌(Helicobacter pylori,Hp)的耐药性,为指导临床提高Hp根除率提供依据。方法对慢性胃炎、消化性溃疡和胃癌患者,应用免疫印迹法检测Hp抗体,将Hp分为Ⅰ型和Ⅱ型。取胃粘膜组织进行Hp细菌培养;采用Kirby-baner药敏纸片法对培养出的Hp进行克拉霉素、阿莫西林、甲硝唑及左氧氟沙星敏感性检测。结果Ⅰ型Hp感染组中,慢性胃炎、消化性溃疡和胃癌的发病率明显高于Ⅱ型Hp感染组(P0.05);Ⅰ型Hp在消化性溃疡和胃癌组中的感染率高于慢性胃炎组(P0.05)。Ⅰ型Hp对克拉霉素、阿莫西林及左氧氟沙星的耐药率高于Ⅱ型Hp(P0.05);Ⅰ型与Ⅱ型Hp对甲硝唑的耐药率都比较高,分别为82.9%和77.8%(P0.01),但2型之间差异无显著性。结论Ⅰ型Hp是慢性胃炎、消化性溃疡和胃癌的致病因子,对阿莫西林、克拉霉素、左氧氟沙星,尤其是甲硝唑具有耐药性。Ⅱ型Hp感染少见,且只对甲硝唑耐药明显。根据Hp分型来选择有效药物,有助于临床根除Hp感染治疗。     

西安地区就医人群幽门螺杆菌耐药状况调查

目的了解西安地区就医人群幽门螺杆菌（H．pylori）对甲硝唑、克拉霉素、阿莫西林、四环素和左氧氟沙星的耐药情况。方法采用E-test试验检测60株H．pylori对阿莫西林、克拉霉素、甲硝唑、四环素和左氧氟沙星的耐药率。结果西安地区就医人群H．pylori对阿莫西林（AM）、克拉霉素（CH）、甲硝唑（MZ）、四环素（TC）和左氧氟沙星（LE）的耐药率分别为：5．0％（3／60），33．3％（20／60），58．3％（35／60），1．7％（1／60），21．7％（13／60）。结论西安地区H．pylori对甲硝唑的耐药率较高，对克拉霉素、左氧氟沙星的耐药菌株也较为常见，阿莫西林和四环素耐药菌株较罕见。     

瑞安地区幽门螺杆菌药物敏感试验特点及其临床意义

目的了解瑞安地区幽门螺杆菌（Hp）临床分离株对常用抗幽门螺杆菌抗生素体外敏感性及耐药性,为临床根除治疗Hp感染提供依据,以指导临床用药。方法对706株Hp临床分离株采用Kirby—Bauer法行阿莫西林、克拉霉素、庆大霉素、呋喃唑酮、甲硝唑和左氧氟沙星6种抗生素药敏试验,并分析其特点。结果Hp临床分离株对阿莫西林、克拉霉素、庆大霉素、呋喃唑酮、甲硝唑和左氧氟沙星6种抗生素的耐药率分别为1．42％、20．68％、0．85％、6．23％、100．00％、12．75％。结论瑞安地区Hp对阿莫西林、庆大霉素、呋喃唑酮和左氧氟沙星有较好的敏感性,而对克拉霉素的耐药率较高,甲硝唑耐药率最高,达100％。药敏试验对临床幽门螺杆菌菌株的根治有指导作用。     

无锡某院幽门螺杆菌筛查人群感染流行病学及耐药性

目的 探讨幽门螺杆菌感染的流行病学特点,为预防幽门螺杆菌感染提供依据。方法 选择2016年1月-2021年6月于无锡市第二中医医院行幽门螺杆菌检查的患者,收集性别、年龄基本资料和¹³C-尿素呼气试验、幽门螺杆菌药敏培养结果。结果 幽门螺杆菌感染率为54.34%(3872/7131),<60岁患者随着年龄增大感染率逐渐上升。对430例幽门螺杆菌培养的药敏结果分析发现,对一种及以上抗生素耐药的菌株检出率达97.67%(420/430),对两种及以上抗生素耐药的菌株检出率为68.14%(293/430)。单药耐药情况,甲硝唑在各年度、各年龄段中的耐药率均极高,阿莫西林、四环素、呋喃唑酮的耐药率均较低。组合药物耐药情况,各年度、各年龄段均以四环素与呋喃唑酮的组合耐药率最低。其次为四环素、呋喃唑酮分别与阿莫西林组合。幽门螺杆菌的平均根除率为82.39%。结论 幽门螺杆菌的感染率较高。高耐药率、多重耐药菌增加了根除幽门螺杆菌的难度。各年龄段对甲硝唑的耐药率均极高,不宜选用。针对60岁以上的老年人根除幽门螺杆菌时克拉霉素、左氧氟沙星不宜选用。四环素、呋喃唑酮和阿莫西林三者...     

兰州市幽门螺杆菌临床分离株耐药性分析

目的 调查甘肃省兰州市临床分离幽门螺杆菌(Hp)对常用抗生素的耐药状况,为临床治疗提供依据.方法 收集患者胃粘膜标本,分离培养和鉴别Hp,采用Kirby-Bauer纸片法检测Hp对阿莫西林、克拉霉素、甲硝唑、呋喃唑酮和左氧氟沙星的耐药性.结果 从197例患者中分离出81株Hp,阳性率41.12%,性别与年龄差异无统计学意义(P>0.05);消化性溃疡患者的阳性率(56.25%)高于慢性胃炎患者(P<0.05);Hp对阿莫西林、克拉霉素、甲硝唑、呋喃唑酮和左氧氟沙星的耐药率依次为3.70%,7.41%,67.90%,3.70%和6.17%.结论 兰州市流行的Hp对甲硝唑耐药率高,不应作为治疗Hp的一线药物;呋喃唑酮、阿莫西林等应作为治疗Hp感染的主要药物.     

阿莫西林与克拉霉素三联治疗幽门螺杆菌的疗效比较

目的比较阿莫西林与克拉霉素三联治疗幽门螺杆菌(Hp)的疗效。方法选取2014年1月至2014年12月我院收治的Hp感染的慢性胃炎和消化性溃疡患者162例为研究对象,并将患者随机分为两组各81例。阿莫西林组采用阿莫西林+甲硝唑+胶体果胶铋治疗,克拉霉素组采用克拉霉素+甲硝唑+胶体果胶铋治疗。比较两组患者的临床疗效及Hp根除情况。结果阿莫西林组症状缓解率为88.89%,显著高于克拉霉素组的76.54%,差异具有统计学意义(P<0.05)。阿莫西林组和克拉霉素组Hp根除率分别为88.89%和76.54%,两组Hp根除率比较差异具有统计学意义(P<0.05)。结论阿莫西林联合甲硝唑和胶体果胶铋治疗幽门螺杆菌感染疗效优于克拉霉素。     

奥美拉唑、左氧氟沙星、阿莫西林联合抗幽门螺杆菌80例

目的:评价奥美拉唑、左氧氟沙星、阿莫西林联合抗幽门螺杆菌的临床疗效。方法:收集幽门螺杆菌感染的消化性溃疡患者,随机分为两组。治疗组给予奥美拉唑、左氧氟沙星、阿莫西林联合用药;对照组给予奥美拉唑、克拉霉素、甲硝唑联合治疗。比较分析两组治疗前后的症状体征改变情况、幽门螺杆菌根除情况、不良反应发生情况。结果:治疗组治愈率91.25%,不良反应率5%,幽门螺杆菌根除率89%;对照组治愈率85%,不良反应率15%,幽门螺杆菌根除率78%。结论:奥美拉唑、左氧氟沙星联合阿莫西林治疗消化性溃疡疗效显著,不良反应小,幽门螺杆菌根除率高,值得临床推广应用。     

湖州地区幽门螺杆菌耐药情况分析

目的：调查分析浙江省湖州地区不同性别不同年龄人群中幽门螺杆菌感染及对抗生素的耐药情况。方法对湖州市中心医院2013年9月至2015年12月收集的23771份胃镜检查患者的胃黏膜样本进行幽门螺杆菌分离培养，并用平板掺入法对幽门螺杆菌进行药敏试验，对药敏的结果进行统计学分析。结果23771份胃黏膜样本中共分离培养出幽门螺杆菌菌株9106株，分离培养阳性率为38.30%，其中男性阳性率为39.72%，高于女性的36.90%，差异有统计学意义（χ2=20.046，P<0.01）。湖州地区幽门螺杆菌对克拉霉素的平均耐药率为20.60%（1876株），左氧氟沙星的平均耐药率为26.86%（2446株），甲硝唑的平均耐药率为95.43%（8690株），30岁以上人群的耐药率均呈现明显的增长，左氧氟沙星的增长幅度最大。女性人群幽门螺杆菌对克拉霉素和左氧氟沙星的耐药率分别为22.41%和30.14%，均高于男性人群，差异有统计学意义（χ2=17.029和46.285，P均<0.01）。结论本地区对克拉霉素、左氧氟沙星和甲硝唑均有非常高的耐药率，应重视菌株的分离培养和耐药性检测，治疗过程中应考虑性别和年龄的耐药性差异。     

浙江人群幽门螺杆菌cagA/vacA优势基因型和不同基因型混合感染的调查

目的　了解消化性溃疡和慢性胃炎患者感染的幽门螺杆菌 (Hp)cagA vacA优势基因型及不同基因型Hp感染、混合感染与疾病的关系。 方法　选择胃窦、胃体双份活检标本均培养出Hp的 42例慢性胃炎 (CG)和 3 6例消化性溃疡 (PU )患者作为研究对象 ,采用聚合酶链反应 (PCR)检测156份Hp分离株的cagA基因、vacA基因的信号区 (s)和中间区 (m )亚型 ,分析Hp基因型及多株Hp混合感染在CG和PU中的分布。结果　胃窦标本cagA基因的检测中 78例患者中有 75例 (96.2 % )为cagA阳性 ,相应的胃体标本中 ,76例患者 (97.4% )为cagA阳性 ,有 1例 (1.3 % )患者胃窦、胃体检出cagA状态不一的Hp混合菌株。在胃窦标本的vacA基因分型中 ,s1a m1、s1a m2、s1a m1b、s1a m1b m2 4种vacA基因型在 78例患者中所占比例分别为 6.4% (5 78)、55.1% (43 78)、2 6.9% (2 1 78)和 1.3 % (1 78) ,多株混合感染为 3 .8% (3 78) ;而相应的胃体标本中 ,前述四种vacA基因型所占比例依次为 6.4% (5 78)、53 .8% (42 78)、2 5.6% (2 0 78)和 3 .8% (3 78) ,多株混合感染为 5.1% (4 78)。cagA+ s1a m2和cagA+ s1a m1b在胃窦标本中占 51.3 % (40 78)和 2 6.9% (2 1 78) ,而在相应的胃体标本中占 52 .6% (41 78)和 2 5.6% (2 0 78)。少量胃窦、胃体     

Peptic ulcer disease in south Ethiopia is strongly associated with Helicobacter pylori.

Helicobacter pylori infection was detected in 93% of 174 patients with a peptic ulcer compared with 63% of 116 patients with normal findings (chi 2 = 37.3; P < 0.001) in a cohort of 834 consecutive patients examined by gastroscopy in Yirga Alem Hospital in south Ethiopia. Fourteen patients were given 14 days' treatment with metronidazole 500 mg t.i.d., doxycycline 100 mg b.i.d. and bismuth subnitrate mixture 150 mg q.i.d. Of 10 patients who returned for follow-up, only 2 patients were free from H. pylori and cured. Nineteen strains of H. pylori from 19 consecutive patients in the same hospital were tested for resistance in vitro against metronidazole, doxycycline and ampicillin. All but 1 were highly resistant to metronidazole; 2 were fully and 14 intermediate resistant against doxycycline. All strains were fully sensitive in vitro to ampicillin. Thus, peptic ulcer was strongly associated with H. pylori in south Ethiopia, but eradication of the infection was hampered by antibiotic resistance.     

104株幽门螺杆菌插入序列IS605、IS606的分布

目的 筛查中国5地区幽门螺杆菌（Hp）插入序列IS605、IS606的分布。方法 选取来自北京、福建、云南、沈阳、香港等地共104株Hp，用PCR及染色体打点杂交的方法筛查IS605、IS606的分布，并对其分布特点进行分析。结果 中国5地区Hp菌株IS605的阳性率为40%，IS606的阳性率为18%。云南菌株IS605的阳性率有高于其他地区的趋势，不同地区IS606的分布差异无显著性。不同临床诊断结果分离的菌株IS605、IS606的分布差异无显著性。IS605的两个开码读框ORFA、ORFB共存。结论 中国5地区Hp菌株广泛存在IS605、IS606，且IS605的分布可能与菌株分离个体的地理位置有关。     

应用PCR-RFLP方法鉴定幽门螺杆菌菌株

本文建立了一种准确、方便、易于重复的幽门螺杆菌（ＨＰ）菌株鉴定的ＰＣＲ－ＲＦＬＰ方法。应用该法检测３５株来自不同患者的ＨＰ临床分离菌株、４０份来自不同患者的ＨＰ－ＤＮＡ阳性的胃粘液标本, 显示独特的ＲＦＬＰ图谱;检测来自５名ＨＰ感染患者隧和治疗中的胃粘液标本１０份、３名ＨＰ感染复转阳性的患者治疗和治疗后胃粘液标本６份５名患者治疗前和治疗中的双份标本显示同样的图谱,而３名ＨＰ感染复转阳性患者中,２名     

Detection of CagA protein in strains of Helicobacter pylori isolated from patients with gastritis and gastric ulcer disease

A total of 156 Helicobacter pylori strains isolated from adult patients (81 men, 75 women) with diagnosis of gastritis (43 strains GAS) and gastric ulcer (113 strains GU) were analyzed for the production of CagA protein by quantitative and qualitative immunoblot methods. 80% of gastric ulcer group strains (84% in men, 73% in women) produced CagA protein, while in the gastritis patients group only 63% of strains were CagA protein positive (59% in men, 65% in women). Quantitative production was estimated by CagA index (mean production of CagA protein in CagA positive strains) in both groups of strains GAS and GU in men and women. Strains of GU group were shown to be higher producers (index CagA 2.42) as compared to GAS group (2.09). Index CagA was higher in strains isolated from men (index CagA 2.54) than is strains from women (index CagA 2.13). CONCLUSION: CagA production has been proved in 75% of analysed Helicobacter pylori strains. CagA positive strains were more frequent in gastric ulcer disease patients, slightly higher in the male than in the female patients. Strains isolated from men, irrespective of diagnosis (GAS and GU), are higher producers of CagA protein.     

胃癌相关幽门螺杆菌蛋白图谱特征初步分析

目的：寻找幽门螺杆菌(Hp)与胃癌相关蛋白。方法：利用双向电泳分离Hp的全菌蛋白，应用ImageMaster2Dv3．1软件对3株分离自胃癌患者的Hp菌株、1株胃癌动物模型菌株及9株分离自非胃癌患者的Hp菌株的蛋白图谱进行比较，对目的蛋白进行基质辅助激光解析及电离飞行时间质谱分析，应用Mascot软件进行蛋白搜库。结果：发现3种蛋白可能与胃癌相关，经肽指纹图谱鉴定，一种为配基神经氨酸胞苷酰基转移酶，其Mowse分值为79，序列覆盖率为32％，另两种蛋白在现有的质谱库中无明确匹配蛋白存在。结论：配基神经氨酸胞苷酰基转移酶可能为与胃癌相关的Hp特异蛋白，另两种为新发现的可能与胃癌相关的Hp特异蛋白，其相关机制尚待进一步阐明。     

云南省三个民族人群幽门螺杆菌甲硝唑耐药调查

目的 调查和分析云南省不同民族幽门螺杆菌(H.pylori)菌株对甲硝唑耐药的流行情况。方法 用E-test方法检测109株H.pylori菌株(汉族人群分离33株、白族31株、纳西族45株)对甲硝唑的敏感性。结果 云南地区甲硝唑耐药率为67.89％。汉族、白族、纳西族H.pylori对甲硝唑耐药率在统计学上差异无显著性。云南地区和三个民族H.pylori菌株的甲硝唑耐药率在年龄、上消化道疾病的分布上差异无显著性;但在性别方面,汉族男性组甲硝唑耐药率为50.00％,低于女性组的90.91％(X~2=5.304,P=0.027);而白族和纳西族中性别在H.pylori对甲硝唑耐药率上差异无显著性。结论 云南地区H.pylori对甲硝唑耐药率高,汉族、白族、纳西族在选择治疗H.pylori感染的抗生素时,可以忽略民族间的差异。     

Molecular typing of Helicobacter pylori isolates from asymptomatic, ulcer and gastritis patients by urease gene polymorphism.

The gastric-adapted bacterium Helicobacter pylori plays an important role in gastritis and ulcer disease, but no phenotypic typing scheme presently exists for this organism. With a view to the development of genotypic typing, we have compared isolates of H. pylori from gastritis or ulcer patients with those from subjects exhibiting no disease. Variation was analysed at the urease genes, ureA and ureCD, by employing PCR-generated probes in genomic Southern blot hybridizations. Whilst ureA restriction fragments provided a fourfold subgrouping of strains, ureCD fragments were considerably more discriminatory. Twenty-four combined ureACD profiles were generated with Hind III, subdividing the 64 strains into 11 types and 13 single profiles. The most prevalent profile (UI) was found in 33% of strains, almost all from gastritis or ulcer patients. On the other hand strains isolated from asymptomatic individuals had the most diverse ureACD profiles. A key finding from this set of isolates was that strains of H. pylori associated with general gastroduodenal disease were genetically more homogeneous than strains carried by people without disease symptoms.     

How accurate is the culture of Helicobacter pylori in a clinical setting? An appraisal

AIM: The trend towards increasing prevalence of Helicobacter pylori (H. pylori) antibiotic resistance may jeopardize the efficacy of most regimens. Culture of the bacterium, the useful method able to address therapy, is influenced by various factors. Thus, validation of the procedure is fundamental. Most studies have been carried out in microbiological settings, while only few have been conducted in clinical frames. We evaluated the accuracy of culture for detection of H. pylori in a clinical dedicated laboratory. METHODS: Forty-six patients (28 females, 18 males, mean age 56+/-4.7 years) were included. Thirty experienced failure to H. pylori eradication after at least 3 courses of treatment. The control group included 16 subjects suffering from gastroesophageal reflux disease and negativity for H. pylori infection. Diagnostic strategy was based on histology, culture testing, serology and 13C-urea breath test. A patient was considered infected if 2 tests were positive. A commercial culture medium in microaerophilic atmosphere was utilized. RESULTS: Out of 30 positive specimens, culture correctly identified 29. In 1 case, no growth of micro-organisms occurred. In the control group, bacterial culture accurately identified all negative samples. One of them indicated growth but neither aspect nor confirmation tests identified H. pylori. Sensitivity was 96.7%, specificity 100%, and accuracy 97.8%. Positive and negative predictive values were 100% and 94.1%, respectively. CONCLUSIONS: Culture of H. pylori is a feasible method and provides a good level of diagnostic accuracy even in a clinical setting by following international guidelines combined with training of specialized personnel.