Prevalence of antibiotic resistance ofHelicobacter pylori in Chinese adults: A meta-analysis
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目的 了解中国成人幽门螺杆菌对常用抗菌药物的耐药性及其趋势和地区差异。 方法 检索PubMed、Embase、知网、万方和维普2000年1月至2021年12月发表的有关中国人群中幽门螺杆菌对抗菌药物耐药的文献，采用随机效应模型分析中国成人幽门螺杆菌对常用抗菌药物的合并耐药率。按地区和样本采集时间进行亚组分析，对可能影响耐药性的因素包括年龄、性别、内镜表现进行亚组分析汇总。 结果 最终纳入157项研究，包括来自中国7个地区29个省份的197 087株幽门螺杆菌。中国成人幽门螺杆菌对甲硝唑的耐药率最高(80.5%)，对庆大霉素耐药率最低(0.9%)。东北[16.7%（95%CI：5.0%~33.3%）]地区的克拉霉素总合并耐药率≤20%，华南[11.5%（95%CI：4.3%~20.2%）]和华中[15.1%（95%CI：1.9%~37.1%）]地区的患者对左氧氟沙星合并耐药率<20%。男性幽门螺杆菌感染者对左氧氟沙星和甲硝唑的耐药率分别为25.1%和79.6%，均低于女性（χ 2=15.82和156.88,P<0.001）。≥50岁感染者对克拉霉素、左氧氟沙星和甲硝唑的耐药率分别为30.1%、28.1%和90.2%，均高于<50岁的感染者（χ 2=12.81、40.78和52.65,P<0.001）。溃疡性疾病患者对甲硝唑和阿莫西林耐药率分别为73.8%和8.8%，高于非溃疡性疾病患者（χ 2=8.34和21.44,P<0.001）。 结论 中国成人幽门螺杆菌对常用抗菌药物的耐药性不断上升，各地区耐药率有很大差异，持续耐药监测必不可少。经验根除治疗抗菌药物的选择应参考地方监测的耐药数据，同时应关注女性和≥50岁患者，并应确认患者是否患有溃疡性疾病。 Objective To assess the antibiotics resistance of Helicobacter pylori in Chinese adults and the trends and geographical differences. Methods The literatures on antibiotic resistance of Helicobacter pylori in Chinese adults published from January 2000 to December 2021 were retrieved in PubMed, Embase, CNKI, Wanfang and VIP databases. The combined resistance rates of Helicobacter pylori to commonly used antibiotics in Chinese adults were analyzed using a random-effect model. Subgroup analyses were conducted based on region and sample collection time, and factors potentially influencing resistance, including age, gender, and endoscopic findings were pooled in subgroup analyses. Results A total of 157 studies were included, covering 197 087 Helicobacter pylori strains from 29 provinces in 7 regions of China. The resistance rate of Helicobacter pylori to metronidazole in Chinese adults was the highest (80.5%), while the resistance rate to gentamicin was the lowest (0.9%). The overall combined resistance rate of clarithromycin in Northeast China[16.7% (95%CI: 5.0%-33.3%) ] was lower than or equal to 20%. The overall combined resistance rates of levofloxacin in South China [11.5% (95%CI: 4.3%-20.2%)] and Central China [15.1% (95%CI: 1.9%-37.1%)] were lower than 20%. The resistance rates to levofloxacin and metronidazole were significantly lower in male Helicobacter pylori infected individuals (25.1% and 79.6%) than in females (χ 2=15.82 and 156.88, P<0.001). Resistance rates of clarithromycin, levofloxacin and metronidazole were significantly higher in individuals aged ≥50 years (30.1%, 28.1% and 90.2%) than those in aged <50 years (χ 2=12.81, 40.78 and 52.65, P<0.001). The resistance rates inHelicobacter pylori from ulcerative disease patients to metronidazole and amoxicillin were 73.8% and 8.8%,which were higher than those in non-ulcerative disease patients(χ 2=8.34 and 21.44, P<0.001). Conclusions The antibiotic resistance of Helicobacter pylori in Chinese adults is increasing with significant regional variations in resistance rates. Continuous resistance monitoring is essential. The choice of antibiotics for empirical eradication therapy should consider local drug resistance data, as well as females, patients above 50 years, and the presence of ulcerative disease.
Objective To assess the antibiotics resistance of Helicobacter pylori in Chinese adults and the trends and geographical differences. Methods The literatures on antibiotic resistance of Helicobacter pylori in Chinese adults published from January 2000 to December 2021 were retrieved in PubMed, Embase, CNKI, Wanfang and VIP databases. The combined resistance rates of Helicobacter pylori to commonly used antibiotics in Chinese adults were analyzed using a random-effect model. Subgroup analyses were conducted based on region and sample collection time, and factors potentially influencing resistance, including age, gender, and endoscopic findings were pooled in subgroup analyses. Results A total of 157 studies were included, covering 197 087 Helicobacter pylori strains from 29 provinces in 7 regions of China. The resistance rate of Helicobacter pylori to metronidazole in Chinese adults was the highest (80.5%), while the resistance rate to gentamicin was the lowest (0.9%). The overall combined resistance rate of clarithromycin in Northeast China[16.7% (95%CI: 5.0%-33.3%) ] was lower than or equal to 20%. The overall combined resistance rates of levofloxacin in South China [11.5% (95%CI: 4.3%-20.2%)] and Central China [15.1% (95%CI: 1.9%-37.1%)] were lower than 20%. The resistance rates to levofloxacin and metronidazole were significantly lower in male Helicobacter pylori infected individuals (25.1% and 79.6%) than in females (χ 2=15.82 and 156.88, P<0.001). Resistance rates of clarithromycin, levofloxacin and metronidazole were significantly higher in individuals aged ≥50 years (30.1%, 28.1% and 90.2%) than those in aged <50 years (χ 2=12.81, 40.78 and 52.65, P<0.001). The resistance rates inHelicobacter pylori from ulcerative disease patients to metronidazole and amoxicillin were 73.8% and 8.8%,which were higher than those in non-ulcerative disease patients(χ 2=8.34 and 21.44, P<0.001). Conclusions The antibiotic resistance of Helicobacter pylori in Chinese adults is increasing with significant regional variations in resistance rates. Continuous resistance monitoring is essential. The choice of antibiotics for empirical eradication therapy should consider local drug resistance data, as well as females, patients above 50 years, and the presence of ulcerative disease.
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