胃癌高发区武威市人群幽门螺杆菌抗生素耐药性分子诊断研究
Molecular diagnosis of Helicobacter pylori antimicrobial resistance in the population of Wuwei City,China,an area with a high incidence of gastric cancer
卢林芝 1李世华 1赵光源 1刘金殿 1宁秀梅 1王星华 1王兴昌 1秦天燕1
作者信息
- 1. 甘肃省武威肿瘤医院消化科(甘肃省武威市 733000)
- 折叠
摘要
目的:本研究旨在通过分析幽门螺杆菌(Helicobacter pylori,HP)抗生素耐药性的分子特征,为临床根除HP合理用药提供分子生物学依据.方法:收集 2019年 2月至 2023年 11月在甘肃省武威肿瘤医院检查14C呼气试验阳性的 1 144例患者的临床资料.采用扩散法药敏实验、耐药基因检测实验、一代测序法进行CYP2C19基因多态性检测,分析HP抗生素耐药性及相关分子生物学特性.结果:在 6种抗生素中,甲硝唑的耐药率和耐药基因(rdxA)突变率最高,分别为 92.00%和 86.12%,阿莫西林的耐药率和耐药基因(Pbp1)突变率最低,分别为 11.78%和 37.11%;;CYP2C19等位基因出现频率快代谢型占 46.77%,中等代谢型占 44.58%,慢代谢型占 8.65%;免疫组织化学发生球形变 148例(18.55%).常规治疗方案用药的HP根除率低于个性化诊疗方案根除率(χ2=8.627,P=0.003);首次接受耐药分子诊断结果治疗方案的根除者根除率要高于复治患者(χ2=6.242,P=0.012).结论:胃癌高发区武威市人群对阿莫西林抗生素耐药率较低;通过耐药分子生物学诊断结果,可有效提高HP根除率,并为临床合理用药提供参考依据.
Abstract
Objective:To analyze the molecular characteristics of antibiotic resistance in Helicobacter pylori(HP)and provide a molecular bio-logical basis for clinical eradication of HP by means of rational antibiotic use.Methods:From February 2019 to November 2023,1,144 pa-tients at the Gansu Wuwei Cancer Hospital who tested positive for HP using the 14C-urea breath test were enrolled in the study.Antibiotic resistance and related molecular characteristics of HP,and CYP2C19 polymorphisms in the patients were detected by diffusion drug suscept-ibility testing,drug resistance gene testing,and next-generation sequencing,respectively.Results:Among the six antibiotics assessed,the resistance rate and the prevalence of resistance genes(rdxA)were highest for metronidazole(92.00%and 86.12%,respectively),and lowest for amoxicillin(Pbp1)(11.78%and 37.11%,respectively).The prevalence of CYP2C19 alleles showed that 46.77%,44.58%,and 8.65%of par-ticipants were fast,medium,and slow metabolizers,respectively.Of the participants,148(18.55%)had immunohistochemical sphericity.The eradication rate of HP lower using conventional treatment regimens than that using personalized treatment regimens(χ2=8.627,P=0.003).The HP eradication rate was higher among patients with a first diagnosis of drug resistancebased on molecular testing,than that in patients undergoing retreatment(χ2=6.242,P=0.012).Conclusions:The prevalence of amoxicillin-resistant HP is low in Wuwei City,which has a high incidence of gastric cancer.Molecular diagnosis of antimicrobial resistance could improve the HP eradication rate and provide a refer-ence for rational use of antibiotics in clinical practice.
关键词
幽门螺杆菌/CYP2C19基因/胃癌/耐药性Key words
Helicobacter pylori(HP)/CYP2C19 gene/gastric cancer/drug resistance引用本文复制引用
基金项目
甘肃省科技计划项目(23JRRH0008)
出版年
2024
NETL
NSTL
万方数据