2009－2019年浙江省温岭地区幽门螺杆菌耐药情况分析

王国平; 张忠臣; 金玲肖; 江文军; 张建中

doi:10.3784/j.issn.1003-9961.2020.11.016

引用本文: 王国平, 张忠臣, 金玲肖, 江文军, 张建中. 2009—2019年浙江省温岭地区幽门螺杆菌耐药情况分析[J]. 疾病监测. DOI: 10.3784/j.issn.1003-9961.2020.11.016 shu

Citation: Guoping Wang, Zhongchen Zhang, Lingxiao Jin, Wenjun Jiang and Jianzhong Zhang. Analysis on drug resistance of Helicobacter pylori in Wenling, Zhejiang, 2009–2019[J]. Disease Surveillance. DOI: 10.3784/j.issn.1003-9961.2020.11.016 shu

2009－2019年浙江省温岭地区幽门螺杆菌耐药情况分析

王国平 ^{1

,} ,
张忠臣 ¹ ,
金玲肖 ¹ ,
江文军 ¹ ,
张建中 ^{2

,

,}

1.
温岭市第一人民医院，浙江台州 317500
2.
中国疾病预防控制中心传染病预防控制所，北京 102206

作者简介: 王国平，男，浙江省温岭市人，副主任医师，从事消化内镜、消化内科工作，Email：52616442@qq.com;

通信作者: 张建中, zhangjianzhong@icdc.cn

摘要: 目的分析2009 — 2019年浙江省温岭地区不同年龄组人群幽门螺杆菌（HP）的耐药情况，为HP个体化治疗提供参考依据。方法收集2009 — 2019年浙江省温岭地区胃镜检查患者胃黏膜标本，分离HP菌株，进行阿莫西林、左氧氟沙星、克拉霉素及甲硝唑耐药性测定，并以每10岁为一个年龄组进行分层，分析HP在不同年龄组人群的耐药情况以及不同年龄组人群耐药率的变化趋势。结果共收集95448例胃镜检查患者胃黏膜标本，HP分离株28774株，温岭地区HP对阿莫西林、克拉霉素、左氧氟沙星、甲硝唑的平均耐药率为0.37%、23.52%、30.62%和3.61%。克拉霉素和左氧氟沙星的耐药率随着年龄增加而上升。 20岁以下年龄组人群对甲硝唑、克拉霉素和左氧氟沙星的耐药率增速较其他年龄组快。结论温岭地区HP抗菌药物耐药情况较为严重，低、高年龄组人群HP耐药率增加显著，应重点关注。

关键词:

幽门螺杆菌 /
抗菌药物 /
耐药

English

Drug resistance of Helicobacter pylori in Wenling, Zhejiang, 2009–2019

1.
Department of Gastroenterology, the First People's Hospital of Wenling, Taizhou 317500, Zhejiang, China
2.
National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China

Corresponding author: Jianzhong Zhang, zhangjianzhong@icdc.cn

Received Date: 2020-07-01
Available Online: 2020-11-30

Abstract: ObjectiveTo analyze the drug resistance of Helicobacter pylori (H.pylori)in different age groups in Wenling, Zhejiang province, from 2009 to 2019, and provide reference for individualized treatment of H. pylori infection.MethodsThe gastric mucosal samples of patients undergoing gastroscopy from 2009 to 2019 were collected, H. pylori strains were isolated, and the strains’ drug resistances to amoxicillin, levofloxacin, clarithromycin and metronidazole were detected. The antibiotic resistance rates and trends of H. pylori in different age groups divided by 10 years old were analyzed.ResultsA total of 95 448 gastric mucosal samples from patients undergoing gastroscopy were collected, in which 28 774 H. pylori strains were isolated. The average resistance rates of H. pylori to amoxicillin, clarithromycin, levofloxacin, and metronidazole in Wenling were 0.37%, 23.52%, 30.62% and 3.61%, respectively. The resistance rates to clarithromycin and levofloxacin increased with age. The resistance rate to metronidazole, clarithromycin and levofloxacin in people aged <20 years increased faster compared with other age groups.ConclusionThe antibiotic resistance of H. pylori in Wenling was relatively serious, and the resistance rates in young and old age groups increased significantly, indicating that special attention should be paid to it.

Key words:

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图 1 2009－2019年温岭地区不同年龄组患者的耐药率

Figure 1. Resistance rates of different age groups cases in Wenling, 2009–2019

下载: 全尺寸图片幻灯片

图 2 2009－2019年温岭地区不同年龄组患者的耐药率变化趋势

Figure 2. Trends in antibiotic resistance rates in different age groups in Wenling, 2009–2019

下载: 全尺寸图片幻灯片

表 1 抗菌药物溶液配制

Table 1. Preparation of antibiotic solution

抗菌药物	母液溶剂	母液浓度（μg/ml）	稀释液溶剂	稀释液浓度（μg/ml）	耐药性临界点（μg/ml）
克拉霉素	甲醇	10 00l	蒸馏水	10	1
左氧氟沙星	蒸馏水	2 000	蒸馏水	20	2
甲硝唑	二甲基亚砜	8 000	蒸馏水	80	8
阿莫西林	PBS，pH6.0， 0.1 mol/L	2 000	蒸馏水	20	2

下载: 导出CSV

表 2 2009－2019年温岭地区各年龄组幽门螺杆菌感染病例数

Table 2. Case numbers of H. pylori infection in different age groups in Wenling, 2009–2019

年龄组（岁）	各年度感染病例数
年龄组（岁）	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	总计
≤20	4	1	2	11	9	42	62	53	53	50	78	365
21～	11	4	9	36	60	201	375	358	360	409	511	2334
31～	20	14	24	119	137	380	702	599	686	710	1054	4445
41～	28	14	82	277	275	669	1259	989	991	914	1222	6720
51～	15	10	81	403	408	695	1601	1349	1321	1098	1129	8110
61～	3	6	38	219	281	289	787	972	1070	927	743	5335
71～	4	4	5	24	47	52	160	160	256	238	194	1144
81～88	0	0	0	0	4	3	10	7	10	11	13	58
合计	85	53	241	1089	1221	2331	4956	4487	4747	4357	4944	28511

下载: 导出CSV

表 3 2009－2019年温岭地区幽门螺杆菌对4种常用抗菌药物的耐药率（%）

Table 3. Resistance rates of H. pylori to 4 commonly used antibiotics in Wenling, 2009–2019

年份	左氧氟沙星	克拉霉素	阿莫西林	甲硝唑	年份	左氧氟沙星	克拉霉素	阿莫西林	甲硝唑
2009	8.24	11.76	0.00	100.00	2016	30.65	22.29	0.00	86.17
2010	24.53	24.53	0.00	88.68	2017	37.56	25.92	1.27	91.53
2011	25.81	17.34	0.00	96.77	2018	33.26	27.26	0.93	94.93
2012	19.19	14.05	0.00	98.53	2019	37.73	32.83	0.08	94.74
2013	15.06	10.07	0.00	96.07	合计	30.62	23.52	0.37	93.61
2014	23.74	17.56	0.04	97.78	χ²值	45.140	31.016	6.835	36.968
2015	24.79	18.46	0.00	96.18	P值	0.000	0.001	0.741	0.000