CAJ | 학술논문

目的了解浙江省嘉兴市地区不同年龄段H.pylori感染者的单药、多重耐药情况及对不同组合抗生素的敏感情况.方法收集2007年1月至2011年12月行胃镜检查者6280例,平均年龄为50.8岁.其中＜20岁者129例,20～＜40岁者1802例,40～60岁者3016例,＞60岁者1333例.采集胃窦黏膜进行H.pylori培养,使用甲硝唑、阿莫西林、庆大霉素、呋喃唑酮、克拉霉素及左氧氟沙星对H.pylori分离菌株进行药物敏感试验.不同年龄组患者耐药率比较采用卡方检验.结果 6280份胃黏膜标本中,2311份H.pylori培养阳性(阳性率为36.80％),其中40～60岁者阳性率最高,为38.43％(1159/3016),＞60岁者阳性率最低,为33.76％(450/1333).甲硝唑在20～＜40岁年龄段的耐药率最高,达98.02％(644/657),克拉霉素在＞60岁年龄段的耐药率最高,为22.67％(102/450),左氧氟沙星、呋喃唑酮、阿莫西林、庆大霉素在各年龄段的耐药率均较低.586株出现了对2种抗生素混合耐药,以甲硝唑和克拉霉素混合耐药率最高,为259株(15.23％).49株出现了对3种抗生素混合耐药,以甲硝唑、克拉霉素和左氧氟沙星混合耐药率最高,为32株(12.88％).阿莫西林和庆大霉素组合有1691株敏感,敏感率达99.41％,阿莫西林和呋喃唑酮组合与庆大霉素和呋喃唑酮组合的敏感率均为94.24％.结论甲硝唑在各年龄段均有极高的耐药率,不宜再选用.阿莫西林和庆大霉素联合应用在不同年龄段患者均是理想的抗生素组合,对青霉素过敏的患者推荐采用庆大霉素+呋喃唑酮组合.
목적 료해절강성가흥시지구불동년령단H.pylori감염자적단약、다중내약정황급대불동조합항생소적민감정황.방법 수집2007년1월지2011년12월행위경검사자6280례,평균년령위50.8세.기중＜20세자129례,20～＜40세자1802례,40～60세자3016례,＞60세자1333례.채집위두점막진행H.pylori배양,사용갑초서、아막서림、경대매소、부남서동、극랍매소급좌양불사성대H.pylori분리균주진행약물민감시험.불동년령조환자내약솔비교채용잡방검험.결과 6280빈위점막표본중,2311빈H.pylori배양양성(양성솔위36.80％),기중40～60세자양성솔최고,위38.43％(1159/3016),＞60세자양성솔최저,위33.76％(450/1333).갑초서재20～＜40세년령단적내약솔최고,체98.02％(644/657),극랍매소재＞60세년령단적내약솔최고,위22.67％(102/450),좌양불사성、부남서동、아막서림、경대매소재각년령단적내약솔균교저.586주출현료대2충항생소혼합내약,이갑초서화극랍매소혼합내약솔최고,위259주(15.23％).49주출현료대3충항생소혼합내약,이갑초서、극랍매소화좌양불사성혼합내약솔최고,위32주(12.88％).아막서림화경대매소조합유1691주민감,민감솔체99.41％,아막서림화부남서동조합여경대매소화부남서동조합적민감솔균위94.24％.결론 갑초서재각년령단균유겁고적내약솔,불의재선용.아막서림화경대매소연합응용재불동년령단환자균시이상적항생소조합,대청매소과민적환자추천채용경대매소+부남서동조합.
Objective To investigate condition of single drug or multiple drug resistance and sensitivities of different combinations of antibiotics in Helicobacter pylori (H.pylori) infected patients of different ages in Jiaxing City,Zhejiang Province.Methods From January 2007 to December 2011,a total of 6280 patients underwent gastroendoscopy examination were enrolled,the average age of them was 50.8 years old.Among them,129 cases were less than 20 years old,1802 cases were between 20 and 40,3016 cases were between 40 and 60,and 1333 cases were over 60.The mucosa of gastric antrum was collected for H.pylori culture.Drug sensitivity of isolated H.pylori strains was tested with metronidazole,amoxicillin and gentamycin,furazolidone,clarithromycin and levofloxacin.x2 test was performed for the comparison of drug resistance among different age groups.Results Among 6280 specimens,H.pylori culture of 2311 cases was positive (positive rate 36.80％).The positive rate of patients aged between 40 and 60 was the highest (38.43％,1159/3016),and that of patients over 60 was the lowest (33.76％,450/1333).The drug resistance rate of metronidazole in patients between 20 and 40 years reached 98.02％ (644/657) and was the highest.The drug resistance rate of clarithromycin in patents over 60 years old was the highest,which was 22.67％(102/450).The drug resistance rates of the levofloxacin,furazolidone,amoxicillin and gentamicin were low of all ages.Mixed resistance of two antibiotic appeared in 586 strains,mixed resistance rate of metronidazole and clarithromycin was the highest (259 strains,15.23 ％).Mixed resistance of three drugs appeared in 49 strains,mixed resistance rate of metronidazole,clarithromycin and levofloxacin was the highest (32 strains,12.88％).A total of 1691 strains were sensitive to the combination of amoxicillin and gentamycin,the sensitive was rate 99.41％.The sensitive rate of the combination of amoxicillin and furazolidone,gentamycin and furazolidone was both 94.24％.Conclusions Metronidazole presented high drug resistance of all ages,and should not be chosen.The combination use of amoxicillin and gentamicin is the ideal antibiotic combination for different ages.The combination of gentamycin and furazolidone is recommended for patients who are allergic to penicillin.