慢性阻塞性肺疾病患者幽门螺杆菌耐药状况研究

摘要

目的 研究慢性阻塞性肺疾病(COPD)感染幽门螺杆菌(Hp)患者对常用抗菌药物的耐药状况及四联抗Hp疗法的临床疗效.方法 收集2012年8月至2014年12月该院住院及门诊确诊的Hp感染患者180例,其中COPD患者(COPD组)与非COPD患者(对照组)各90例.所有患者胃镜下取胃窦部黏膜组织进行Hp培养、鉴定,观察各组对克拉霉素、甲硝唑、阿莫西林、左氧氟沙星、呋喃唑酮的耐药情况;此外,根据不同的给药方案将两组均分为A、B、C 3个亚组,分别给予包含阿莫西林+克拉霉素(A组)、阿莫西林+左氧氟沙星(B组)、阿莫西林+呋喃唑酮(C组)的3种四联方案,比较临床疗效.结果 对照组患者感染Hp菌株对克拉霉素的、甲硝唑、阿莫西林、左氧氟沙星的耐药率分别为21.11%、55.56%、3.33%、5.56%,而COPD组患者感染Hp菌株对上述抗菌药物的耐药率依次为26.67%、57.78%、7.78%、16.67%,两组均未发现对呋喃唑酮耐药的Hp菌株;两组左氧氟沙星及总双重耐药率比较,差异均有统计学意义(P<0.05).对照组3个亚组应用3种四联方案的根除率分别为A组90.0%、B组96.7%、C组100.0%,而COPD组分别为86.7%、80.0、96.7%;两组采用B组方案的患者Hp根除率比较,差异有统计学意义(P<0.05).结论 COPD患者感染Hp对左氧氟沙星耐药率有增高趋势,应谨慎使用,包含阿莫西林+呋喃唑酮的四联方案可作为COPD患者初次Hp根除治疗的优选方案.%Objective To study the resistance status of helicobacter pylori (HP) to commonly used antibacterial drugs as well as clinical effects of quadruple therapy in the patients with chronic obstructive pulmonary disease (COPD) infected by Hp.Methods A total of 180 cases of patients with Hp infection in the inpatient department and outpatient department of our hospital from August 2012 to December 2014 were collected,including 90 cases of COPD (COPD group) and 90 cases of non-COPD (control group).The gastric antrum mucosal tissues in all cases were taken for conducting Hp culture and identification.The resistance situation to clarithromycin,metronidazole,amoxicillin,levofloxacin and furazolidone in each group was observed.In addition,the two groups were equally divided into subgroup A,B and C according to different medication schemes:which were given 3 kinds of quadruple medication scheme containing amoxicillin and clarithromycin (group A),amoxicillin and levofloxacin (group B) and amoxicillin and furazolidone (group C).Then the clinical effects were compared.Results The resistance rate of infected Hp strains to clarithromycin in the control group was 21.11%;which to metronidazole was 55.56%;which to amoxicillin was 3.33%;which to levofloxacin was 5.56%,while which in the COPD group were in turn 26.67%,57.78%,7.78% and 16.67% respectively.No strain was found to be resistant to furazolidone in the two groups.There was statistically significant difference in the resistance to levofloxacin and double antibiotic resistance between the two groups (P<0.05).The eradication rates for using 3 kinds of quadruple therapy in 3 subgroups of control group were 90.0% in the group A,96.7% in the group B and 100.0% in the group C,while which in the COPD group were 86.7%,80.0% and 96.7% respectively;the Hp eradication rate for adopting the group B scheme had statistical difference between the two groups (P<0.05).Conclusion The resistance rate of COPD patient affected by Hp to levofloxacin has an increasing trend,so its use should be cautious.The quadruple scheme containing amoxicillin+furazolidone can serve as the preferred scheme for the initial Hp eradication therapy in COPD patients affected by Hp.