摘要
目的探索宁夏地区幽门螺杆菌(Hp)对左氧氟沙星和克拉霉素耐药率及耐药基因的常见突变方式,评估其表型与基因型耐药的一致性。方法横断面研究。回顾性选取2020年2月至2022年5月宁夏地区14家医院确诊为Hp感染的患者。从Hp感染患者的胃活检标本中分离到Hp菌株,进行表型药敏试验和耐药基因的检测,分析宁夏地区Hp对左氧氟沙星和克拉霉素耐药率及耐药基因常见突变方式;采用符合率和Kappa系数评估表型与基因型耐药的一致性。结果共分离培养1942株Hp,感染者中,男1069例(55.0%),女873例(45.0%),年龄(50.0±12.5)岁(15~86岁)。宁夏地区Hp对左氧氟沙星和克拉霉素耐药率分别为42.1%(818/1942)和40.1%(779/1942),双重耐药率为22.8%(443/1942)。其中来自女性患者的Hp菌株对左氧氟沙星和克拉霉素耐药率均较男性高(左氧氟沙星:50.4%(440/873)比35.4%(378/1069);克拉霉素:44.4%(388/873)比36.6%(391/1069),均P<0.001)。与左氧氟沙星耐药有关的GyrA基因突变中,除了Asn87Thr外,第87和91位氨基酸突变率在耐药菌株和敏感菌株间的差异均有统计学意义(均P<0.001)。Hp菌株对左氧氟沙星(Kappa=0.834,P<0.001)和克拉霉素(Kappa=0.829,P<0.001)的耐药性在表型和基因型上具有良好的一致性。结论宁夏地区Hp对左氧氟沙星和克拉霉素的耐药严重,基因型和表型耐药具有良好的一致性。
Objective To explore the rate of Helicobacter pylori(Hp)resistance to levofloxacin and clarithromycin and the common mutation patterns of resistance genes in Ningxia,and to assess the concordance between phenotypic resistance and genotypic resistance.Methods Cross‑sectional study.Patients diagnosed with Hp infection in 14 hospitals in Ningxia region from February 2020 to May 2022 were retrospectively selected.Hp strains were isolated from gastric biopsy specimens of Hp‑infected patients and subjected to phenotypic drug sensitivity testing and detection of resistance genes to analyze the rate of Hp resistance to levofloxacin and clarithromycin and the common mutation patterns of resistance genes in Ningxia region;and the concordance rate and Kappa concordance test were used to assess the concordance between phenotypic resistance and genotypic resistance.Results A total of 1942 Hp strains were isolated and cultured,and among the infections,1069 cases(55.0%)were male and 873 cases(45.0%)were female,aged(50.0±12.5)years(15‑86 years).The rates of Hp resistance to levofloxacin and clarithromycin in Ningxia were 42.1%(818/1942)and 40.1%(779/1942),respectively,and the rate of dual resistance to both was 22.8%(443/1942).The rate of resistance to levofloxacin and clarithromycin of Hp strains from female patients was higher than in male patients(levofloxacin:50.4%(440/873)vs 35.4%(378/1069);clarithromycin:44.4%(388/873)vs 36.6%(391/1069),both P<0.001).Among the GyrA gene mutations associated with levofloxacin resistance,the differences in mutation rate of amino acid at positions 87 and 91 were statistically significant in both drug‑resistant and sensitive strains(both P<0.001),except for Asn87Thr.Hp strains were statistically significant for levofloxacin(Kappa=0.834,P<0.001)and clarithromycin(Kappa=0.829,P<0.001)had good concordance in resistance at the phenotypic and genotypic levels.Conclusion The resistance of Hp to levofloxacin and clarithromycin in Ningxia region is severe,and there is good consistency between genotypic and phenotypic resistance.
作者
杜丽梦
呼圣娟
陈仙梅
邓燕红
雍和礼
石瑞春
刘建国
曹贞子
游颜杰
刘彦霞
马守成
马林科
李小非
李雪梅
侯建彬
冶正财
桑田
曹瑛
刘晗
魏晓霞
胡爱丽
李艳玲
郜恒骏
Du Limeng;Hu Shengjuan;Chen Xianmei;Deng Yanhong;Yong Heli;Shi Ruichun;Liu Jianguo;Cao Zhenzi;You Yanjie;Liu Yanxia;Ma Shoucheng;Ma Linke;Li Xiaofei;Li Xuemei;Hou Jianbin;Ye Zhengcai;Sang Tian;Cao Ying;Liu Han;Wei Xiaoxia;Hu Aili;Li Yanling;Gao Hengjun(Department of Gastroenterology,the Third Clinical Medical College of Ningxia Medical University,Ningxia Hui Autonomous Region People′s Hospital,Yinchuan 750002,China;Department of Gastroenterology,Wuzhong People′s Hospital,Wuzhong 751199,China;Department of Gastroenterology,Tongji Hospital,Tongji University,Institute of Digestive Disease,School of Medicine,Tongji University,Shanghai 200120,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第28期2163-2167,共5页
National Medical Journal of China
基金
宁夏回族自治区重点研发计划(2019BFG02003、2021BEG02025)
宁夏回族自治区科技惠民专项(2022CMG03039)
关键词
螺杆菌
幽门
基因型耐药
表型耐药
左氧氟沙星
克拉霉素
一致性
Helicobacter pylori
Genotypic resistance
Phenotypic resistance
Levofloxacin
Clarithromycin
Consistency
