摘要
目的调查闽浙边界地区上消化道症状者幽门螺杆菌(Hp)耐药情况及其与临床特征的关系,探讨克拉霉素耐药菌株23S rRNA基因及左氧氟沙星耐药菌株gyrA基因的突变特性。方法选择2019年10月至2020年1月闽浙边界地区417例因上消化道症状于福建中医药大学附属福鼎医院消化内镜中心行胃镜检查及胃黏膜活体组织检查者,行Hp菌株分离、培养和鉴定。使用6种抗菌药物对Hp菌株进行药物敏感度体外实验,分析单药、双重及三重耐药情况,并探讨Hp耐药情况与患者年龄的关系。随机选取50株克拉霉素耐药菌株和50株左氧氟沙星耐药菌株,采用PCR法和Sanger测序法分析耐药相关基因23S rRNA和gyrA的突变情况。结果247株Hp菌株的总体耐药率为98.8%,其中甲硝唑的耐药率(96.4%)最高,其次为左氧氟沙星(45.7%),克拉霉素的耐药率达40.9%,未发现阿莫西林、呋喃唑酮和四环素耐药菌株。Hp菌株对左氧氟沙星的耐药率、对甲硝唑和左氧氟沙星的双重耐药率,以及对甲硝唑、左氧氟沙星和克拉霉素的三重耐药率均随年龄增长呈升高趋势(P均<0.05)。50株克拉霉素耐药菌株均发生23S rRNA基因V区突变,共发现4种突变类型,其中A2143G的突变率为100%,T2182C的突变率为60%,A2302G的突变率为24%,G2864A的突变率为98%。50株左氧氟沙星耐药菌株均发生gyrA基因喹诺酮类药物耐药决定区(QRDR)突变,突变位置是第87位和第91位氨基酸。结论闽浙边界地区Hp菌株对克拉霉素耐药的主要原因可能是23S rRNA基因的A2143G突变和T2182C突变,而A2302G突变和G2864A突变可能与该地区克拉霉素高耐药率相关;该地区Hp菌株对左氧氟沙星耐药的主要原因可能是gyrA基因第87位和第91位氨基酸突变。
Objective An attempt is made in this paper to investigate the antibiotic resistance and clinical features of patients infecting Helicobacter Pylori(Hp)with upper gastrointestinal symptoms in the border area of Fujian and Zhejiang province,and explore the mutation characteristics of the 23S rRNA gene related with clarithromycin resistance and the gyrA gene related with levofloxacin resistance.Methods A total of 417 patients with upper gastrointestinal symptoms who did gastroscope inspection in the Department of Endoscopy Center of Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine in the border area of Fujian and Zhejiang province between October 2019 and January 2020 were selected.The gastric mucosa biopsy was conducted via gastroscopes and the Hp was isolated,identified,and cultured.Six types of common antibiotics were used to analyze the sensitivity of isolated Hp strains in vitro to analyze the resistance of Hp to mono,double,and triple-antibiotic.Fifty clarithromycin-resistant strains and fifty levofloxacin-resistant strains were randomly selected to conduct PCR amplification,Sanger sequencing,and analysis for the 23S rRNA gene and gyrA gene related to drug resistance.Results The overall resistance rate of 247 Hp strains is 98.8%,and the resistance rates of metronidazole,levofloxacin,and clarithromycin are 96.4%,45.7%,and 40.9%,respectively.No strains are resistant to furazolidone,amoxicillin,and tetracycline.The levofloxacin resistance rate increases with age(P<0.05).The resistance rate of metronidazole and levofloxacin double-antibiotic increases with age(P<0.05).The resistance rate of metronidazole,levofloxacin,and clarithromycin triple-antibiotic has a positive correlation with age(P<0.05).Fifty clarithromycin resistant strains have mutations in the 23S rRNA gene V region,and 4 mutation types are found.The incidences of A2143G,T2182C,A2302G,and G2864A mutations are 100%,60%,24%,and 98%.Fifty levofloxacin resistant strains have mutations in QRDR of the gyrA gene,and mutations o
作者
吴以龙
谢晶晶
黄丽静
夏宁宁
江志俊
黄兆许
陈津津
WU Yilong;XIEJingjing;HUANG Lijing;XIA Ningning;JIANG Zhijun;HUANG Zhaoxu;CHEN Jinjin(Department of Gastroenterology,Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuding 355200,China)
出处
《国际消化病杂志》
CAS
2023年第2期114-120,共7页
International Journal of Digestive Diseases
基金
福建省卫生健康科研人才培养项目(2019-CX-50)。
