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目的了解舟山群岛地区幽门螺杆菌(Hp)感染的现状及其对甲硝唑、克拉霉素、阿莫西林等耐药情况。方法对舟山市第三人民医院2006年5月至2007年5月因胃肠道症状于胃镜室检查的2 047例患者胃黏膜进行Warthin-Starry染色检测幽门螺杆菌感染情况,并且对临床分离的185株幽门螺杆菌进行药敏试验,通过Kirby-ba-ner药敏纸片法检测Hp对甲硝唑、克拉霉素、阿莫西林等药物的敏感性。通过χ2检验进行统计分析,P<0.05为差异有统计学意义。结果Hp总感染率为31.90%,其中浅表性胃炎31.12%、萎缩性胃炎31.03%、消化性溃疡42.06%、胃癌54.54%。对就诊患者进行各年龄组比较显示61~70岁年龄组Hp感染率最高为64.10%,P<0.01。男性和女性患者Hp感染率分别为32.96%、30.62%,差异无统计学意义。Hp耐药结果显示:对抗生素的单药耐药率分别为:克拉霉素为28.1%、阿莫西林为32.4%、甲硝唑为99.4%。Hp菌株对抗生素的多重耐药率为:阿莫西林+甲硝唑的双重耐药率最高为33.0%,克拉霉素+甲硝唑于其次为27.0%,克拉霉素+阿莫西林最低为17.8%。克拉霉素+阿莫西林+甲硝唑三重耐药率为17.3%。各抗生素的单药耐药率与患者的性别比较差异无统计学意义,P>0.05。结论舟山群岛地区Hp总感染率低于全国平均水平,但是,耐药情况明显高于全国平均水平,耐药菌株产生的问题必须引起足够的重视。
Objective To investigate the status of Helicobacter pylori (Hp) infection and its resistance to metronidazole, clarithromycin and amoxicillin in Zhoushan Archipelago. Methods Wushan-Starry stain was used to detect Helicobacter pylori infection in gastric mucosa of 2 047 patients with gastrointestinal symptoms in gastroscopy room from May 2006 to May 2007 in Zhoushan Third People’s Hospital. The clinical isolates 185 strains of Helicobacter pylori susceptibility testing, Kirby-ba-ner susceptibility disk method for the detection of Hp on metronidazole, clarithromycin, amoxicillin and other drugs sensitivity. By χ2 test for statistical analysis, P <0.05 for the difference was statistically significant. Results The overall infection rate of Hp was 31.90%, including 31.12% of superficial gastritis, 31.03% of atrophic gastritis, 42.06% of peptic ulcer and 54.54% of gastric cancer. The comparison of the patients in different age groups showed that the highest infection rate of Hp in 61 ~ 70 age group was 64.10%, P <0.01. Hp infection rates in male and female patients were 32.96% and 30.62%, respectively, with no significant difference. Hp resistance results showed that the single drug resistance rate to antibiotics were: clavamiccin 28.1%, amoxicillin 32.4%, metronidazole 99.4%. The multidrug resistance rates of Hp strains to antibiotics were as follows: the highest rate of double drug resistance of amoxicillin + metronidazole was 33.0%, the rate of clarithromycin + metronidazole was 27.0%, the lowest of clarithromycin + amoxicillin was 17.8%. Clarithromycin + amoxicillin + metronidazole triple resistance rate of 17.3%. There was no significant difference in the single drug resistance rate between each antibiotic and the patient’s gender, P> 0.05. Conclusion The overall infection rate of Hp in Zhoushan Archipelago is lower than the national average, however, the drug resistance is obviously higher than the national average level. The problems caused by drug-resistant strains must be given enough attention.