基于抗生素耐药基因检测的精准治疗在根除幽门螺杆菌中的临床效果评价

Evaluation of the Clinical Efficacy of Precision Therapy Based on Antibiotic Resistance Gene Testing in the Eradication of Helicobacter pylori

摘要: 目的：探讨基于抗生素耐药基因检测的精准治疗方案在初次根除幽门螺杆菌(Hp)中的疗效及安全性。方法：选择2022年10月至2023年8月在我院确诊Hp感染的患者共90名，随机分配至经验性铋剂四联组(对照组)和药敏指导的精准治疗组(试验组)。对照组给予标准铋剂四联方案(艾司奥美拉唑20 mg + 枸橼酸铋钾220 mg + 阿莫西林1000 mg + 克拉霉素500 mg，2次/天)；试验组的患者行克拉霉素和左氧氟沙星耐药基因突变位点检测，给予精准治疗[艾司奥美拉唑20 mg + 枸橼酸铋钾220 mg + 阿莫西林1000 mg (2次/天)，第四种药物依据药敏结果选择克拉霉素(500 mg，2次/天)或左氧氟沙星(500 mg，1次/天)或四环素(500 mg，3次/天)]，两组疗程均为14天。结果：试验组的根除率为93.3%，对照组根除率为75.6%，P = 0.02，χ² = 5.414，差异有统计学意义，两组间不良事件发生率无显著差异(P = 0.561)。结论：在一线根除Hp中，基于克拉霉素及左氧氟沙星耐药突变位点检测的精准治疗可显著提高根除率。

Abstract: Objective: To investigate the efficiency and safety of a precision treatment regimen based on antibiotic resistance gene testing in the initial eradication of Helicobacter pylori (Hp). Methods: A total of 90 patients diagnosed as Hp-positive from October 2022 to August 2023 were randomly assigned to the empirical bismuth quadruple combination group (control group) and precision treatment group (experimental group). The control group was given the standard bismuth quadruple regimen (esomeprazole 20 mg + bismuth potassium citrate 220 mg + amoxicillin 1000 mg + clarithromycin 500 mg twice/day); patients in the experimental group underwent clarithromycin and levofloxacin resistance gene mutation site detection and were given precision therapy [esomeprazole 20 mg + bismuth potassium citrate 220 mg + amoxicillin 1000 mg (2 times/day), and the fourth drug was selected as clarithromycin (500 mg, 2 times/day) or levofloxacin (500 mg, 1 time/day) or tetracycline (500 mg, 3 times/day) based on the drug sensitivity results]. The course of treatment was 14 days in both groups. Results: The eradication rate was 93.3% in the experimental group and 75.6% in the control group, P = 0.02, χ² = 5.414, and the difference was statistically significant, with no significant difference in the incidence of adverse events between the two groups (P = 0.561). Conclusion: In first-line eradication of Hp, precision therapy based on clarithromycin and levofloxacin resistance mutation sites can improve eradication rates significantly.