海南省幽门螺杆菌耐药性监测

目的监测海南省幽门螺杆菌（H．pylori）菌株对甲硝唑、克拉霉素、环丙沙星、四环素、阿莫西林的耐药情况。方法采取海南省各地门诊及住院胃病的胃镜活检标本326例，在微需氧环境下培养，经生化、涂片检查，鉴定为典型的H．pylori中96例获得临床分离。应用E-test方法测定H．pylori对甲硝唑、克拉霉素、环丙沙星、四环素、阿莫西林的最低抑菌浓度（MIC，mg/L）。结果96株H．pylori菌株中，甲硝唑的耐药率为82．3％（79／96），MIC范围0．016-256mg／L；克拉霉素的耐药率为26．0％（25／96），MIC范围0．016-256mg/L；环丙沙星的耐药率为21．9％（21／96），MIC范围0．02-32mg／L；四环素的耐药率为0％（0／96），MIC范围0．016～1．5mg/L；阿莫西林的耐药率为4．2％（4／96），MIC范围0．016-8mg/L；甲硝唑和克拉霉素的同时耐药率为14．6％（14／96）。不同性别间的耐药率无明显差异（P〉0．05）。结论海南地区H．pylori对甲硝唑的耐药率（82．3％）高，对克拉霉素、环丙沙星的耐药（26．0％、21．9％）有一定的比例，对阿莫西林的耐药菌株（4．2％）也已出现，未见对四环素耐药（耐药率为0％）。     

不同抗生素耐药水平下幽门螺杆菌对黄连素的耐药特性

目的 探究台州市温岭地区幽门螺杆菌(H.pylori)对黄连素的耐药情况,为 H.pylori根除治疗的临床用药提供指导。方法 采用琼脂稀释法对 84 例 H.pylori菌株进行抗生素药敏实验,检测 6 种抗生素(克拉霉素、左氧氟沙星、甲硝唑、阿莫西林、四环素、黄连素)对H.pylori菌株的最低抑制浓度(MIC)。结果 84 例 H.pylori菌株对克拉霉素、左氧氟沙星、甲硝唑的耐药率分别为 16.67%、16.67%、54.76%,对阿莫西林及四环素均敏感。 H.pylori菌株对各种抗生素及不同浓度黄连素的耐药率在性别间比较差异均无统计学意义(P＞0.05)。菌株黄连素的耐药性与甲硝唑呈正相关(P<0.05)。随着菌株对其他抗生素耐药性增强,其对黄连素的耐药性有增强趋势。其中,黄连素对抗生素全敏感菌株的 MIC 和对单耐药、双耐药及 3 种抗生素耐药菌株的 MIC比较差异有统计学意义(P＜0.05)。结论 对于抗生素耐药率低的 H.pylori,黄连素在较低浓度下对 H.pylori具有一定的抑制或杀灭的作用,且随着浓度增大,杀菌效果越好,这为制定黄连素参与的 H.pylori治疗方案提供了科学依据。     

乌药成分异乌药内酯抗H.pylori及其抗菌谱的筛选

目的 筛选异乌药内酯的抗菌谱.方法 微量稀释法检测异乌药内酯对不同H.pylori菌株及非H.pylori菌株的最小抑菌浓度(MIC).结果 异乌药内酯对敏感和耐药H.pylori菌株的MIC均为8～16μg/ml;异乌药内酯对金黄色葡萄球菌等非H.pylori菌株的MIC均>128μg/ml.结论 异乌药内酯对H.p...     

西安地区就医人群幽门螺杆菌耐药趋势研究

目的：了解西安地区就医人群幽门螺杆菌（ H.pylori）的耐药情况及变化趋势。方法：选自西安市中心医院就诊的慢性胃炎及胃十二指肠溃疡患者,入选患者均在胃镜下距幽门5 cm处钳取1块胃黏膜组织进行了H.pylori快速尿素酶检测,阳性者另取1块组织进行 H.pylori 培养和甲硝唑、克拉霉素、阿莫西林、四环素、左氧氟沙星的药敏试验。结果：120例H.pylori阳性患者中有62例H.pylori菌株培养阳性,H.pylori对甲硝唑、阿莫西林、四环素、克拉霉素、左旋氧氟沙星的耐药率均高于2008年结果,但无统计学意义（ P＞0.05）。结论：西安地区H.pylori对甲硝唑、阿莫西林、四环素、克拉霉素、左旋氧氟沙星的耐药率较2008年高。严格掌握H.pylori根除的适应证,采取规范化治疗,合理选择抗生素是H.pylori根除治疗成功的关键。     

幽门螺杆菌耐药性对其根除治疗影响的研究

目的了解幽门螺杆菌（Hp）耐药菌株以及患者性别、年龄和不同临床疾病对Hp根除治疗的影响,阐明Hp根除治疗失败的主要原因。方法对因上胃肠道症状而来北京大学第一医院胃镜室接受胃镜检查的Hp培养阳性患者,采用E-试验法测定Hp菌株对甲硝唑及克拉霉素的最低抑菌浓度（MIC）。对所有人选患者采用兰索拉唑、甲硝唑和克拉霉素的三联7d疗法进行Hp根除治疗。结果共有157例患者进入本研究,并完成了治疗。Hp对甲硝唑和克拉霉素的耐药率分别为：45．9％（72／157）和18．5％（29／157）。157例接受治疗患者的Hp根除率为61．8％（97／157）,Hp根除率在不同性别、年龄及不同临床疾病患者之间差异均无统计学意义（均P〉0．05）;甲硝唑敏感菌株和耐药菌株的根除率分别为89．4％（76／85）和29．2％（21／72）（P〈0．01）。克拉霉素敏感菌株和耐药菌株的根除率分别为72．7％（93／128）和16．0％（4／29）（P〈0．01）。结论Hp对抗生素耐药是导致Hp根除治疗失败的主要原因。     

高耐药形势下如何提高幽门螺杆菌的根除率

中国是幽门螺杆菌(Helicobacter pylori,H.pylori)感染的高发地区,H.pylori对常用抗生素的耐药率高。初次治疗失败将导致耐药形势愈加严峻,增加再次治疗的难度。因此,初次治疗选择H.pylori高效根除方案至关重要。铋剂四联疗法因具有高效、安全、可提高耐药菌株的根除率的特点,已被作为我国一线H.pylori根除治疗的首选方法。临床医师应根据各地区患者抗生素耐药特点选择敏感抗生素组合,疗程为14 d。在我国,阿莫西林的耐药率低,大剂量质子泵抑制剂二联及伏诺拉生二联14 d方案在H.pylori根除的临床实践中的疗效好,可作为备选方案。此外,通过公共平台指导患者服药,提高其治疗依从性;建立各级H.pylori门诊,进一步规范H.pylori感染的诊断和根除,能有效提高H.pylori根除率。     

生姜、苦瓜、木瓜对幽门螺杆菌甲硝唑耐药株及敏感株的体外实验研究

目的:探讨生姜、苦瓜、木瓜对幽门螺杆菌(H.pylori)甲硝唑耐药株及敏感株的体外抑制作用.方法:(1)制备苦瓜、生姜、木瓜水提液;(2)琼脂稀释法检测苦瓜水提液、生姜水提液、木瓜水提液对H.pylori甲硝唑耐药株和敏感株的最低抑菌浓度(MIC),并计算MIC50、MIC75、MIC90.结果:苦瓜对H.pylori的MIC值范围为0.0048828～0.625g/ml,H.pylorj甲硝唑耐药株和敏感株对苦瓜水提液的敏感性无统计学差异;生姜对H.pylori的MIC值范围为0.01953125～1.25g/ml,H.pylori甲硝唑耐药株和敏感株对生姜水提液的敏感性无统计学差异;木瓜对H.pylori的MIC值范围为0.0136719～1.75g/ml,H.pylori甲硝唑耐药株和敏感株对木瓜水提液的敏感性无统计学差异.结论:苦瓜、生姜、木瓜水提液在体外各自对H.pylori甲硝唑耐药株及敏感株均有良好的抑菌效果.     

幽门螺杆菌耐药初探

目的:观察幽门螺杆菌(Helicobacter pylori,H.pylori)对克拉霉素、呋喃唑酮的耐药情况,初步了解克拉霉素耐药菌株为原发耐药还是继发耐药,初步探讨抗H.pylori感染失败的原因是由于原有菌株未消灭还是由于感染了新的菌株.方法:从消化性溃疡及糜烂性胃炎患者的胃黏膜中分离培养出H.pylori共21株,利用纸片法进行药物敏感试验,观察耐药情况.应用随机扩增多态性DNA分析方法,进行菌株指纹图谱分析,确定抗H.pylori治疗前后菌株的同一性.结果:(1)21株H.pylori中有8株对克拉霉素耐药,1株对呋喃唑酮耐药,耐药率分别为38.1%和4.8%.(2)3对治疗前后配对菌株中,1例为原发性耐药(持续感染),1例为继发性耐药,另有1例为新菌株感染.结论:H.pylori对克拉霉素耐药率比较高,而对呋喃唑酮高度敏感.抗H.pylori感染失败的原因与菌株对克拉霉素原发性及继发性耐药有关.     

北京地区幽门螺杆菌对克拉霉素的耐药情况及其耐药机制

目的：（1）确定北京地区幽门螺杆菌（Helicobacter pylori,Hp)菌株对克拉霉素的耐药情况。（2）研究幽门螺杆菌对克拉霉素耐药与23SrRNA基因点突变的关系。方法：从北京地区89例有上胃肠症状的患者取得胃活检组织,微需氧培养得到Hp,E-检验方法测定克拉霉素的最低抑菌浓度（MIC）,CTAB／NaCl方法提取敏感菌和耐药菌的DNA,用限制性片段长度多态性（PCR－RFLP）检测克拉霉素耐药菌株的点突变。结果：（1）北京地区Hp菌株对克拉霉素的耐药率是13．5％。（2）12个克拉霉素耐药的Hp菌株均存在23S rRNA基因的A2143G点突变,进行PCR－RFLP的24个敏感菌株均无23S rRNA的点突变。结论：北京地区克拉霉素耐药的Hp菌株较为常见,Hp对克拉霉素的耐药与23SrRNA基因的点突变有关。     

解脲脲原体的tetM基因与四环素类药物MIC水平的关联性研究

目的探讨目前解脲脲原体对四环素类药物的耐药性及其与tetM耐药基因的关系。方法对分离自临床妇产科和性病门诊患者的解脲脲原体49株,经鉴定确认后,采用微量肉汤稀释法检测其四环素和米诺环素的最小抑菌浓度(MIC),根据药敏结果分层随机抽取部分菌株采用PCR技术扩增四环素耐药基因tetM。结果解脲脲原体的米诺环素和四环素MIC50(50%菌株被抑制所需抗生素浓度)分别为<0.0625 mg/L和<0.125 mg/L;MIC90(90%菌株被抑制所需抗生素浓度)分别为0.125 mg/L和1 mg/L;在28株非四环素耐药的解脲脲原体菌株中,有8株检测到tetM基因tetM基因阳性组的四环素和米诺环素的MIC水平比tetM阴性组高,且差异有统计学意义(四环素:t=4.34,P=0.0001;米诺环素:t=5.90,P<0.0001)。结论在泰安地区四环素类药物可以重新作为治疗解脲脲原体感染的一线药物,尤其是米诺环素的抗菌效果较好;在非四环素耐药的解脲脲原体菌株中也存在tetM基因的携带,且影响其MIC的提高。     

Indications for treatment of Helicobacter pylori infection: a systematic overview.

OBJECTIVE: To determine (a) the advantages and disadvantages of treatment options for the eradication of Helicobacter pylori and (b) whether eradication of H. pylori is indicated in patients with duodenal ulcer, nonucler dyspepsia and gastric cancer. DATA SOURCES: A MEDLINE search for articles published in English between January 1983 and December 1992 with the use of MeSH terms Helicobacter pylori (called Campylobacter pylori before 1990) and duodenal ulcer, gastric cancer, dyspepsia and clinical trial. Six journals and Current Contents were searched manually for pertinent articles published in that time frame. STUDY SELECTION: For duodenal ulcer the search was limited to studies involving adults, studies of H. pylori eradication and randomized clinical trials comparing anti-H. pylori therapy with conventional ulcer treatment. For nonulcer dyspepsia with H. pylori infection the search was limited to placebo-controlled randomized clinical trials. DATA EXTRACTION: The quality of each study was rated independently on a four-point scale by each author. For the studies of duodenal ulcer the outcome measures assessed were acute ulcer healing and time required for healing, H. pylori eradication and ulcer relapse. For the studies of nonulcer dyspepsia with H. pylori infection the authors assessed H. pylori eradication, the symptoms used as outcome measures and whether validated outcome measures had been used. DATA SYNTHESIS: Eight trials involving duodenal ulcer met our inclusion criteria: five were considered high quality, two were of reasonable quality, and one was weak. Six trials involving nonulcer dyspepsia met the criteria, but all were rated as weak. Among treatment options triple therapy with a bismuth compound, metronidazole and either amoxicillin or tetracycline achieved the highest eradication rates (73% to 94%). Results concerning treatment indications for duodenal ulcer were consistent among all of the studies: when anti-H. pylori therapy was added to conventional ulcer treatment acute ulcers healed more rapidly. Ulcer relapse rates were dramatically reduced after H. pylori eradication. All of the studies involving nonulcer dyspepsia assessed clearance rather than eradication of H. pylori. No study used validated outcome measures. A consistent decrease in symptom severity was no more prevalent in patients in whom the organism had been cleared than in those taking a placebo. Of the studies concerning gastric cancer none investigated the effect of eradication of H. pylori on subsequent risk of gastric cancer. CONCLUSIONS: There is sufficient evidence to support the use of anti-H. pylori therapy in patients with duodenal ulcers who have H. pylori infection, triple therapy achieving the best results. There is no current evidence to support such therapy for nonulcer dyspepsia in patients with H. pylori infection. Much more attention must be paid to the design of nonulcer dyspepsia studies. Also, studies are needed to determine whether H. pylori eradication in patients with gastritis will prevent gastric cancer.     

Antibiotic resistance in Helicobacter pylori

OBJECTIVE: To describe antibiotic resistance patterns in Helicobacter pylori. DESIGN: Culture and antibiotic sensitivity testing of antral and gastric body biopsy samples from patients having gastroscopy. PARTICIPANTS: Consecutive consenting patients aged 18 years or more presenting for gastroscopy from 1 July 1998 to 30 June 1999. Setting: An open-access gastroscopy service at an urban university tertiary hospital. MAIN OUTCOME MEASURES: Number of H. pylori isolates showing resistance to antibiotics; correlates of such resistance with demographic and clinical information. RESULTS: Of 1580 patients undergoing endoscopy, 434 agreed to participate in the study. 108 (24.9%) had positive cultures for H. pylori, and 88 of these isolates (81%) were available for further testing. Resistance to metronidazole and clarithromycin was detected in 36% and 11%, respectively. No resistance was found to tetracycline or amoxycillin. Metronidazole resistance was commoner in younger patients (P = 0.0004) and macrolide resistance was commoner in those born outside Australia or New Zealand (P = 0.03). CONCLUSIONS: We found substantial resistance to metronidazole, and emerging clarithromycin resistance, but complete susceptibility to amoxycillin, tetracycline, gentamicin and cefaclor. These factors may influence the effectiveness of presently recommended eradication regimens.     

宁波地区幽门螺杆菌耐药谱分析及敏感抗生素的筛选

正幽门螺杆菌(helicobacter pylori,HP)是慢性活动性胃炎、消化性溃疡、胃癌及胃黏膜相关淋巴组织(MALT)淋巴瘤的主要致病因素,而且与多种心血管疾病、缺铁性贫血、原发性血小板减少性紫癜等疾病有关。HP胃炎京都共识提出除非有抗衡因素(如伴存疾病的限制、社区高再感染率、医疗资源优先度安排等),否则所有HP感染者都应该接受根除治疗[1]。我国成年人HP感染率达到40~60%。本研究在胃镜     

Eradication of Helicobacter pylori: therapies and clinical implications.

This review presents a critical evaluation of the role of Helicobacter pylori eradication in the management of peptic ulcer disease and non-ulcer dyspepsia. On current evidence, H. pylori eradication therapy seems likely to emerge as the most rational and cost-effective treatment for duodenal ulcer. The role of H. pylori eradication in the treatment of gastric ulcer and non-ulcer dyspepsia is unclear and requires further study. The emerging problem of antibiotic resistance in H. pylori is of major clinical importance and a prime cause of treatment failure. There is increasing evidence of a link between H. pylori and gastric cancer but it is premature to recommend large-scale eradication of H. pylori as a valid strategy for the primary prevention of gastric cancer. The search continues for the ideal H. pylori eradication regimen.     

Effect of Helicobacter pylori eradication on peptic ulcer healing.

In a prospective study designed to assess the effect of Helicobacter pylori eradication on peptic ulcer healing, 85 consecutive patients with H. pylori-positive peptic ulcer disease were treated with a triple therapy regimen consisting of colloidal bismuth subcitrate 120 mg four times daily for 28 days, with metronidazole 400 mg three times daily and tetracycline 500 mg three times daily for the first seven days of treatment. H. pylori status was assessed by CLO test and histology at least four weeks after completing therapy. Of 75 patients (88%) H. pylori-negative after therapy, 69 (92%) had healed ulcers compared with only five of 10 patients (50%) who remained H. pylori-positive (p = 0.003). Cigarette smoking had no significant effect on ulcer healing. Our results suggest that H. pylori eradication may accelerate ulcer healing and provide further evidence that an effective helicobactericidal regimen is the treatment of choice in H. pylori-positive peptic ulcer.     

微生态制剂在抗幽门螺杆菌治疗中的作用

幽门螺杆菌(Hp)与多种疾病有关,尤其是胃肠道疾病,例如慢性胃炎、消化性溃疡、胃黏膜相关组织淋巴瘤、胃癌等。多种抗生素联合质子泵抑制剂是抗Hp治疗的主要方法,但由于抗生素耐药性的增加,导致标准抗Hp治疗对Hp根除率明显下降,且治疗过程中不良反应较多,复发率较高。微生态制剂的研发,为抗Hp治疗提供了新的思路,在提高根除率及减少药物不良反应方面优势显著。     

发酵乳增效治疗幽门螺杆菌的Meta分析

目的：系统评价发酵乳联合常规治疗方案清除幽门螺杆菌(Helicobacter pylori,H. pylori)感染的临床疗效。 方法：通过检索Pubmed,Embase,中国知网,中国生物医学文献数据库,万方知网和维普等数据库,收集各数据库建库至2015年2月间与发酵乳辅助治疗H. pylori感染相关研究的随机试验或半随机对照试验,分析根除率与不良反应发生率的合并RR值,并进行亚组、敏感性分析和发表偏倚检测。结果：共纳入9项(1 644例)研究,发酵乳联合常规根除疗法与单独常规根除疗法H. pylori根除率分别为79.5%和67.0%,其合并RR为1.186(95%CI: 1.118~1.257)。总不良反应发生率的合并RR为0.706(95%CI: 0.373~1.340)。结论：益生菌可提高常规疗法对H. pylori的根除率,但不能有效降低不良反应的发生风险。     

大蒜油抑制幽门螺杆菌感染BALB/c小鼠实验研究

目的：研究大蒜油对BALB／c小鼠感染H．pylori根除治疗作用，探索新的理想的抗H．pylori药物。方法：将建立H．pylori感染BALB／c小鼠模型60只分成3组，阴性药物对照组（20只）、大蒜油治疗组（20只）和感染模型对照组（20只）；另取无H．pylori感染BAIB／c小鼠20只为正常对照组，治疗1、4周后分别抽取10只剖杀，取其胃粘膜组织进行快速尿素酶实验、细菌学培养和组织病理学Warthin-Starry银染，观察小鼠H．pylori感染率、根除率和胃内定植情况。结果：大蒜油治疗组1周后有6只小鼠胃内的H．pylori被根除，根除率为60％（6／10），1个月后有7只小鼠胃内的H．pylori被根除，根除率为70％（7／10），两批小鼠总的根除率为65％（13／20），阴性药物对照组及感染模型对照组的小鼠胃内均有H．pylori生长；而无H．pylori感染的正常对照组未见H．pylori生长。结论：大蒜油治疗H．pylori感染小鼠疗效显著（根除率为65％）。无明显毒副反应。     

Comparison of invasive and noninvasive methods for the diagnosis and evaluation of eradication of Helicobacter pylori infection in children

BACKGROUND: Acquisition of Helicobacter pylori infection occurs mainly during childhood. To study the events associated with H. pylori colonization in children it is important to have reliable diagnostic methods. Our objective was to validate invasive and noninvasive tests for diagnosis of H. pylori infection in children before and after antimicrobial treatment. METHODS: Before treatment, invasive rapid urease test (RUT) culture and histology, as well as the noninvasive carbon-13 urea breath test (13C-UBT) and serology were validated in 59 children. The gold standard for H. pylori infection was any of three positives of the five tests. After antimicrobial treatment culture, histology, and 13C-UBT were validated in 43 children to determine eradication. The gold standard for eradication was negative in all three tests. RESULTS: For primary diagnosis, RUT was the most sensitive and specific test, followed by 13C-UBT, which performed better than serology, culture, and histology. Concordance tests also showed that RUT and 13C-UBT performed better. For determination of eradication, 13C-UBT and histology were better than culture, which showed poor sensitivity. CONCLUSIONS: RUT performed better for primary diagnosis. However, as endoscopy might not be indicated in most children, 13C-UBT could be the test of choice for diagnosis of H. pylori infection both before and after eradication treatment.