Wongkusoltham P, Vilaichone R K, Kullavanijaya P, Phaosawadi K, Mahachai V
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2001 Jun;84 Suppl 1:S474-80.
The results of the in vitro metronidazole resistance on Helicobacter pylori (H. pylori) eradication have been inconclusive. Metronidazole resistance varies among different geographical locations and a previous study from Thailand reported an in vitro metronidazole resistance of H. pylori of 51 per cent. This study was designed to investigate further the effect of the in vitro metronidazole resistance on the outcome of eradication of H. pylori in the Thai population. Fifty two patients with active gastric ulcer (GU) and duodenal ulcer (DU) who had positive culture for H. pylori were studied. All of these patients had positive rapid urease test (CLO test, Delta West, Australia) using gastric biopsy specimens from the antrum and body taken at the time of initial upper endoscopy. In vitro antimicrobial susceptibility test was performed using Epsilometer test (AB Biodisk, Solna, Sweden). All patients received a one-week triple regimen consisting of omeprazole 20 mg twice daily, clarithromycin 500 mg twice daily, metronidazole 500 mg twice daily. Patients with GU continued with another five weeks of omeprazole 20 mg twice daily and patients with DU received another three weeks of omeprazole 20 mg twice daily. Upper endoscopy was repeated at four weeks after the end of the treatment. Three antral and two body biopsy specimens were obtained for identification of H. pylori using CLO test, histology (modified Giemsa stain) and culture. All of these tests had to be negative to confirm a successful eradication. Metronidazole-resistant (MR) strains with MIC > or = 32 mg/l were identified in 27 of the 52 patients (51.92%), whereas, metronidazole-susceptible (MS) strains were isolated from 25 patients (48.08%). Five patients were lost to follow-up and one patient had drug allergy. Successful eradication as defined by negative CLO test, histology and culture was attained in 17/23 (73.91%) patients (GU = 6, DU = 16, GU and DU = 1) with MR strains. 20 out of 23 (86.96%) patients (GU = 9, DU = 12 GU and DU = 2) who had MS strains. The difference was not statistically significant in both groups (P > 0.05). The ulcer healing was, however, highly achieved in both groups (MS = 95.65%, MR = 91.30%, P > 0.05). In vitro metronidazole resistance was high in this population group although this does not predict the outcome of eradication in patients with GU and DU.
体外甲硝唑耐药性对幽门螺杆菌（H. pylori）根除效果的研究结果尚无定论。甲硝唑耐药性在不同地理位置存在差异，此前一项来自泰国的研究报告称，幽门螺杆菌的体外甲硝唑耐药率为51%。本研究旨在进一步探讨体外甲硝唑耐药性对泰国人群幽门螺杆菌根除结果的影响。对52例幽门螺杆菌培养阳性的活动性胃溃疡（GU）和十二指肠溃疡（DU）患者进行了研究。所有这些患者在初次上消化道内镜检查时，取自胃窦和胃体的胃活检标本快速尿素酶试验（CLO试验，澳大利亚Delta West公司）均呈阳性。采用Epsilometer试验（瑞典索尔纳AB Biodisk公司）进行体外抗菌药敏试验。所有患者接受为期一周的三联疗法，即奥美拉唑20 mg，每日2次；克拉霉素500 mg，每日2次；甲硝唑500 mg，每日2次。GU患者继续服用奥美拉唑20 mg，每日2次，持续5周；DU患者服用奥美拉唑20 mg，每日2次，持续3周。治疗结束后4周重复上消化道内镜检查。获取3份胃窦和2份胃体活检标本，采用CLO试验、组织学检查（改良吉姆萨染色）和培养法鉴定幽门螺杆菌。所有这些检测结果均为阴性才能确认根除成功。52例患者中，27例（51.92%）鉴定出甲硝唑耐药（MR）菌株，MIC≥32 mg/l，而25例（48.08%）患者分离出甲硝唑敏感（MS）菌株。5例患者失访，1例患者出现药物过敏。MR菌株组23例患者中17例（73.91%）（GU = 6例，DU = 16例，GU合并DU = 1例）根除成功，定义为CLO试验、组织学检查和培养均为阴性。MS菌株组23例患者中20例（86.96%）（GU = 9例，DU = 12例，GU合并DU = 2例）根除成功。两组差异无统计学意义（P>0.05）。然而，两组溃疡愈合率均很高（MS = 95.65%，MR = 91.30%，P>0.05）。该人群组体外甲硝唑耐药率较高，尽管这并不能预测GU和DU患者的根除结果。
