武威地区成年居民幽门螺杆菌感染现状、耐药性及分子流行特征调查

doi:10.12183/j.scjpm.2024.0496

摘要/Abstract

摘要： 目的调查甘肃武威地区成年居民幽门螺杆菌（Hp）感染情况并分析Hp菌株对常用抗菌药物的耐药性,进一步探讨不同毒力基因分型与耐药性的相关性。方法采用多阶段分层抽样法,于2023年9月至12月期间抽取甘肃省武威地区成年居民为研究对象,利用¹⁴C尿素呼气试验检查Hp感染情况,采集Hp感染者胃黏膜活检样本分离培养幽门螺杆菌,并利用纸片扩散法（K-B法）对Hp菌株进行5种常用抗菌药物的药敏试验,提取菌株基因组DNA,利用聚合酶链式反应（PCR）法对Hp菌株的毒力基因（cagA和vacA）进行分析检测。结果共纳入1 814名成年居民进行调查,男性935名,女性879名,平均年龄（53.2±9.3）岁;Hp感染率为69.63%（1 263/1 814）。不同年龄、BMI、文化程度、吸烟、饮酒、三餐饮食规律及饮食口味的成年居民中Hp检出率比较差异有统计学意义（P<0.05或P<0.01）。Hp感染患者共分离出1 242株Hp菌株,对5种常用抗菌药物的耐药率分别为甲硝唑（70.29%）、左氧氟沙星（50.56%）、克拉霉素（33.41%）、和四环素（9.02%）和阿莫西林（5.56%）。Hp菌株以单一耐药（55.80%）为主,其次为双重耐药（21.74%）和三重耐药（7.33%）。PCR结果显示,cagA阳性率为83.57%,而vacAs基因分型中s1型为78.66%,55.15%为m2型,i1型占比65.38%。携带vacA s1m1m2型的Hp菌株对甲硝唑耐药率明显高于vacA s1m1/m2型（P<0.01）,而cagA⁺型的左氧氟沙星耐药率明显高于cagA^-型（P<0.05）。结论甘肃武威地区Hp感染率较高,且不同Hp菌株分子分型的耐药性明显不同,提示可根据常用抗菌药物耐药情况及基因型检测结果进行合理用药。

关键词: 幽门螺杆菌, 感染, 耐药分析, 毒力基因, 分子分型

Abstract: Objective To investigate the prevalence of Helicobacter pylori （Hp） infection among adult residents in Wuwei City,Gansu Province,analyze the resistance of Hp strains to commonly used antibiotics,and further explore the correlation between different genotypes of virulence and drug resistance. Methods A multi-stage stratified sampling method was used to select adult residents in Wuwei City,Gansu Province from September to December 2023. The ¹⁴C urea breath test was used to detect Hp infection,and gastric mucosal biopsy samples of Hp infected people were collected to isolate and culture Hp. In addition,the disk diffusion method （K-B method） was used to test the susceptibility of Hp strains to five commonly used antibiotics,and genomic DNA of Hp strain was extracted. The virulence genes （cagA and vacA） of Hp strain were analyzed and detected by polymerase chain reaction （PCR）. Results A total of 1 814 adult residents were included in the survey,including 935 males and 879 females,with an average age of （53.2±9.3） years. The Hp infection rate was 69.63% （1 263/1 814）. There were significant differences in the detection rate of Hp among adult residents with different ages,BMI,levels of education,smoking and drinking habits,irregular meal patterns,and dietary preferences （P<0.05 or P<0.01）. A total of 1 242 Hp strains were isolated from Hp infected patients,and the resistance rates to five commonly used antibiotics were metronidazole （70.29%）,levofloxacin （50.56%）,clarithromycin （33.41%）,tetracycline （9.02%）,and amoxicillin （5.56%）,respectively. Single drug resistance （55.80%） was the main strain,followed by double drug resistance （21.74%） and triple drug resistance （7.33%）. The PCR results revealed that the positivity rate of cagA was 83.57%. Additionally,the genotype of vacAs was found to be 78.66% for s1,55.15% for m2,and 65.38% for i1. The resistance rate of Hp strain carrying vacA s1m1m2 to metronidazole was significantly higher than that of vacA s1m1/m2 （P<0.01）. Furthermore,it was noted that the resistance rate of levofloxacin in cagA⁺ type was significantly higher than that in cagA^- type （P<0.05）. Conclusions The infection rate of Hp was found to be high in Wuwei City,Gansu Province,and there was a significant variation in drug resistance among different Hp strains as determined by molecular subtyping. Therefore,it is recommended that eradication therapy for Hp in this region should be tailored based on historical data,the drug resistance profiles of commonly used antibiotics,and genotype test results.

Key words: Helicobacter pylori, Infection, Drug resistance analysis, Virulence genes, Molecular subtyping

中图分类号:

R181.3

王兴昌, 卢林芝, 孙丽琴, 郝志成, 秦天燕, 杨婷, 聂登琴. 武威地区成年居民幽门螺杆菌感染现状、耐药性及分子流行特征调查[J]. 华南预防医学, 2024, 50(6): 496-500.

WANG Xingchang, LU Linzhi, SUN Liqin, HAO Zhicheng, QIN Tianyan, YANG Ting, NIE Dengqin. Prevalence,drug resistance,and molecular epidemic characteristics of Helicobacter pylori infection among adult residents in Wuwei region[J]. South China Journal of Preventive Medicine, 2024, 50(6): 496-500.

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