Huang A H, Sheu B S, Yang H B, Huang C C, Wu J J, Lin X Z
Department of Pathology, National Cheng Kung University, Tainan, Taiwan.
J Formos Med Assoc. 2000 Sep;99(9):704-9.
To determine the effect of Helicobacter pylori antimicrobial resistance on the efficacy of different proton pump inhibitor (PPI)-based triple therapies.
One-hundred and twelve dyspeptic patients with H. pylori infection, as demonstrated by positive histology and culture, were randomized to receive one of the three PPI-based triple therapies. The regimens included lansoprazole (L) plus any two of the following three antibiotics: amoxicillin (A), metronidazole (M), and clarithromycin (C); patients were allocated to ALC, MLC, and ALM subgroups. Six weeks after the start of triple therapy, the 13C-urea breath test (UBT) was performed to evaluate the success of H. pylori eradication. Patients with positive UBT results underwent endoscopy for H. pylori culture. The pre- and post-treatment H. pylori isolates were analyzed for initial and acquired resistance using the E-test.
One hundred patients completed the study. The H. pylori eradication rates were 70% (21/30) in the ALM subgroups, 79% (26/33) in the MLC subgroup, and 89% (33/37) in the ALC subgroup. The frequencies of pretreatment H. pylori antimicrobial resistance were 0% for amoxicillin resistance (AR), 32% for metronidazole resistance (MR), and 6% for clarithromycin resistance (CR). For H. pylori isolates with initial MR, the eradication rates in the ALM (40%) and MLC (67%) subgroups were apparently lower than that in the ALC (92%) subgroup. In the ALM and MLC subgroups (i.e., patients who received metronidazole), the eradication failure rate was significantly higher for patients with MR isolates than for patients with metronidazole-susceptible isolates (47% vs 16%, p < 0.05). In the ALC and MLC subgroups (i.e., patients who received clarithromycin), the eradication failure rate was significantly higher for patients with CR isolates than for those with clarithromycin-susceptible isolates (100% vs 11%, p < 0.05).
The results indicate that H. pylori antimicrobial resistance is relevant to the success of eradication. The high MR but low CR and AR prevalence among H. pylori isolates in this study suggests that PPI-based triple therapy including amoxicillin and clarithromycin may achieve the most favorable eradication rate.
确定幽门螺杆菌抗菌药物耐药性对不同质子泵抑制剂（PPI）三联疗法疗效的影响。
112例经组织学和培养证实为幽门螺杆菌感染的消化不良患者被随机分配接受三种基于PPI的三联疗法中的一种。治疗方案包括兰索拉唑（L）加以下三种抗生素中的任意两种：阿莫西林（A）、甲硝唑（M）和克拉霉素（C）；患者被分配到ALC、MLC和ALM亚组。三联疗法开始6周后，进行13C尿素呼气试验（UBT）以评估幽门螺杆菌根除是否成功。UBT结果呈阳性的患者接受内镜检查以进行幽门螺杆菌培养。使用E-test分析治疗前后幽门螺杆菌分离株的初始耐药性和获得性耐药性。
100例患者完成了研究。ALM亚组的幽门螺杆菌根除率为70%（21/30），MLC亚组为79%（26/33），ALC亚组为89%（33/37）。治疗前幽门螺杆菌对阿莫西林耐药（AR）的频率为0%，对甲硝唑耐药（MR）的频率为32%，对克拉霉素耐药（CR）的频率为6%。对于初始对甲硝唑耐药的幽门螺杆菌分离株，ALM亚组（40%）和MLC亚组（67%）的根除率明显低于ALC亚组（92%）。在ALM和MLC亚组（即接受甲硝唑治疗的患者）中，对甲硝唑耐药的分离株患者的根除失败率显著高于对甲硝唑敏感的分离株患者（47%对16%，p<0.05）。在ALC和MLC亚组（即接受克拉霉素治疗的患者）中，对克拉霉素耐药的分离株患者的根除失败率显著高于对克拉霉素敏感的分离株患者（100%对11%，p<0.05）。
结果表明幽门螺杆菌抗菌药物耐药性与根除成功率相关。本研究中幽门螺杆菌分离株对甲硝唑耐药率高但对克拉霉素和阿莫西林耐药率低，提示含阿莫西林和克拉霉素的基于PPI的三联疗法可能获得最理想的根除率。
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