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。

DRUG-RESISTANCE OF DIFFERENT TYPES OF HELICOBACTER PYLORI STRAINS

Objective To investigate the drug-resistance of different types of Helicobacter pylori（Hp） strains,in order to provide the basis for guiding clinical eradication treatment for Hp infection.Methods Bacteria of gastric mucosa tissue in patients with chronic gastritis,peptic ulcer,and gastric cancer were cultured and biochemically tested for Hp identification.The drug-sensitivity tests were determined by Kirby-banner method in each Hp positive patient.The serum antibody was detected by immunoblotting to identify the classification of Hp.Results The incidence of gastritis,peptic ulcer,and gastric cancer in Type Ⅰ Hp infection group was significantly higher than in Type Ⅱ Hp infection group（P0.05）.The positive rate of Type Ⅰ Hp infection in peptic ulcer or gastric cancer patients was significantly higher than in chronic gastritis patients（P0.05）.The drug-resistance ratio to kalamycin,amoxicillin,and levofloxacin in Type Ⅰ Hp infection group was higher than in Type Ⅱ Hp infection group（P0.05）,whereas the drug resistance ratio to metronidazole was high in both types of Hp infection groups（82.9%,77.8% respctively）.Conclusion Type Ⅰ Hp infection is one of the pathogenic factors of gastric diseases.Drug-resistance to levofloxacin,kalamycin,amoxicillin especially metronidazole is found in Type Ⅰ Hp bacteria strains.Infection of Type Ⅱ Hp which is highly resistant only to metronidazole is not commonly seen.To select effective drug based on Hp typing is conducive to clinical eradication therapy for Hp infection.