中国北京地区幽门螺杆菌抗生素耐药十年变迁

Gao W,Cheng H,Hu F,Li J,Wang L,Yang G,et al.The evolution
of Helicobacter pylori antibiotics resistance over10years in Beijing,China. Helicobacter2010;15(5):460–6.
The Evolution of Helicobacter pylori Antibiotics Resistance Over10Years in Beijing,China
中国北京地区幽门螺杆菌抗生素耐药十年变迁
OBJECTIVES:
To evaluate Helicobacter pylori antibiotics resistance evolution from2000to 2009to amoxicillin,clarithromycin,metronidazole,tetracycline,levofloxacin and moxifloxacin in Beijing,China.
评价幽门螺杆菌对如下几种抗生素的耐药性在中国北京从2000年到2009年十年间的变化情况，抗生素的种类包括阿莫西林,克拉霉素,甲硝唑、四环素、左氧氟沙星和莫西沙星。

METHODS:
A total of374H.pylori strains isolated from374subjects who had undergone upper gastrointestinal endoscopy from2000to2009were collected and examined by E-test method for antibiotics susceptibility.
从2000年到2009年十年间共收集了374株幽门螺杆菌菌株，这些菌株是从经历了上消化道内窥镜检查的374名受试者内镜活检标本中分离得到的，并采用E 实验的方法对其抗生素的敏感性进行了检测。

RESULTS:
The average antibiotics resistance rates were0.3%(amoxicillin),37.2% (clarithromycin),63.9%(metronidazole),1.2%(tetracycline),50.3% (levofloxacin)and61.9%(moxifloxacin).Overall resistance to clarithromycin, metronidazole,and fluoroquinolone increased annually(from14.8to65.4%, 38.9to78.8%,and27.1to63.5%,in2000or2006-2007to2009,respectively). The secondary resistance rates were much higher than primary rates to these antibiotics,which also increased annually in recent10years.
这些菌株的平均抗生素耐药率分别是0.3%(阿莫西林),37.2%(克拉霉
素),63.9%(甲硝唑),1.2%(四环素),50.3%(左氧氟沙星)和61.9%(莫西沙星)。

克拉霉素、甲硝唑和氟喹诺酮类抗生素的耐药率整体上呈逐年增加的趋势(在2000年或2006-2007年至2009年间,这些菌株对这三种抗生素的耐药率分别从14.8%上升至65.4%,从38.9%上升至65.4%,从27.1%上升至63.5%)。

细菌对这些抗生素继发耐药率远高于原发耐药率,近10年也呈逐年增加的趋势。

CONCLUSIONS:
The trend of clarithromycin,metronidazole,and fluoroquinolone resistance of H.pylori increased over time and the resistance to amoxicillin and tetracycline was infrequent and stable in Beijing.Clarithromycin,metronidazole,and fluoroquinolone should be used with caution for H.pylori eradication treatment.
北京地区，幽门螺旋杆菌对克拉霉素、甲硝哒唑和氟喹诺酮类抗生素的耐药率呈现随着时间的推移而升高的趋势，而对阿莫西林和四环素耐药的菌株则不常见，其耐药率也较稳定。

在北京地区欲对幽门螺杆菌进行根除治疗时，应该谨慎使用克拉霉素、甲硝唑和氟喹诺酮类抗生素。

Keywords:
∙Helicobacter pylori;
∙antibiotic resistance;
∙amoxicillin;
∙clarithromycin;
∙metronidazole;
∙tetracycline;
∙levofloxacin;
∙Moxifloxacin
关键词：幽门螺杆菌，抗生素耐药，阿莫西林，克拉霉素，甲硝唑，四环素，左氧氟沙星，莫西沙星
Introduction
简介
Helicobacter pylori is a Gram-negative flagellated spiral bacteria.
幽门螺旋杆菌是一种革兰氏阴性带有鞭毛的螺旋菌。

Infection with H.pylori is mainly acquired in childhood.
幽门螺旋杆菌感染主要发生在童年时期。

H.pylori infection is recognized as a causal factor in the pathogenesis of chronic gastritis,peptic ulcer,gastric cancer,and gastric MALT lymphoma.
幽门螺杆菌感染被认为是慢性胃炎、消化性溃疡、胃癌和胃MALT淋巴瘤发病机制中的一个必然因素。

H.pylori eradication treatment is indicated in patients with peptic ulcer disease, MALToma,atrophic gastritis,post-gastric cancer resection,or patients who are first-degree relatives of patients with gastric cancer.
幽门螺杆菌根除治疗的适应症包括：消化性溃疡胃MALT淋巴瘤,萎缩性胃炎,胃癌切除术后,或胃癌患者的一级亲属。

Among numerous eradication regimens,a proton pump inhibitor and combination of two antibiotics(amoxicillin,clarithromycin,and metronidazole)
are considered to be the most effective and first-line therapy regimens recommended by Maastricht III Consensus and in China.
在多种根除方案中,质子泵抑制剂联合两种抗生素(阿莫西林、克拉霉素和甲硝唑)被认为是最有效的治疗方法，同时也是Maastricht III和中国共识中所推荐的一线治疗方案。

However,antibiotic resistance of H.pylori,especially to clarithromycin and metronidazole,strongly undermined the efficacy of eradication treatment.
然而,幽门螺旋杆菌的抗生素耐药性,尤其是对克拉霉素和甲硝唑的耐药性,强烈的影响了根除治疗的疗效。

The reported frequencies of resistance to antibiotics varied widely between geographic regions.
文献中报道的抗生素耐药率在世界范围内不同的地区之间有很大的差异。

As culture-based antimicrobial susceptibility data are not always available and the H.Pylori eradication regimen especially antibiotics involved should be chosen based on local resistant epidemiologic data and an empirical basis,it is important to understand the regional antibiotics resistance status and trend of this bacterium.
因为以细菌培养为基础的抗生素敏感性数据并不总是可获得的，根除幽门螺杆菌方案中选用何种抗生素，应根据当地抗生素耐药率的流行病学
数据和临床经验。

了解本地区幽门螺杆菌对这些种抗生素的耐药现状和趋势是十分重要的。

Conclusion
结论
The high prevalence of clarithromycin,metronidazole,and fluoroquinolone resistance of H.pylori strains particularly in cases of secondary resistance highlighted that the management of the treatment of H.pylori infection is becoming a problem.
幽门螺杆菌对克拉霉素、甲硝唑和氟喹诺酮类抗生素耐药率很高，尤其是存在继发耐药的情况下，强烈表明幽门螺旋杆菌感染的治疗正在成为一个棘手的问题。

Even knowing the susceptibility of H.pylori,eradication rates do not achieve 100%,as the results observed in vivo by following in vitro susceptibility to
anti-H.pylori antibiotics are often disappointing.
即使了解了幽门螺旋杆菌对各种抗生素的敏感性,根除率也不可能达到100%,因为将根据体外实验得到的幽门螺杆菌抗生素敏感性的结果选用的抗生素，应用于患者体内观察到的结果往往是令人失望的。

More than20%of patients will fail to eradicate H.pylori infection even with the current most effective treatment regimens.
有超过20%的患者即使应用当前最有效的治疗方案，也无法根除其幽门螺杆菌感染。

Antibiotic resistance to clarithromycin has been identified as one of the major factors affecting the eradication rate of H.pylori infection,as
PPI-amoxicillin-clarithromycin regimen is recommended as first-line treatment in most countries.
克拉霉素的抗生素耐药性已被确定为影响幽门螺旋杆菌感染根除率的一个主要因素,因为大多数国家建议将质子泵抑制剂-阿莫西林-克拉霉素标准三联疗法作为一线治疗方案。

The resistance rate to clarithromycin seemed to be relatively high and increasing in China annually.
在中国克拉霉素的耐药率似乎是相对较高,而且呈逐年增加趋势。

Alternative antibiotics should be considered as a choice of first-line or rescue therapy.
应该考虑选择其他替代的抗生素作为一线或挽救治疗方案中应用的抗生素。

Amoxicillin and tetracycline might be a good option as their resistance rates were very low.
阿莫西林和四环素可能是不错的选择,因为他们的耐药率都很低。

However,levofloxacin or moxifloxacin-based first-line or rescue therapy may constitute an encouraging strategy,as in vitro antimicrobial susceptibility does not necessarily lead to eradication in vivo.
然而,将以左氧氟沙星或莫西沙星为基础的疗法作为一线或挽援治疗方案可能是一个令人鼓舞的策略,因为体外抗菌药的敏感性并不一定适用于体内。