Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea.
J Clin Gastroenterol. 2010 Sep;44(8):536-43. doi: 10.1097/MCG.0b013e3181d04592.
The current prevalence of primary antibiotic resistance of H. pylori is not known in Korea. This study was done to evaluate the prevalence of primary antibiotic resistance of H. pylori, and to evaluate the effect of point mutations of 23S rRNA on the rate of eradication of H. pylori.
H. pylori were isolated from gastric mucosal biopsy specimens obtained from 222 Koreans. The susceptibilities of the H. pylori isolates to amoxicillin, clarithromycin, metronidazole, tetracycline, ciprofloxacin, and levofloxacin were examined using the agar dilution method. DNA sequencing was carried out to detect H. pylori 23S rRNA mutations.
The resistance to clarithromycin, tetracycline, ciprofloxacin, and levofloxacin increased during the period of 2007 to 2009 compared with 2003 to 2005 (P<0.05). However, amoxicillin and metronidazole resistance slightly decreased. The rates of eradication were 95.5% for the clarithromycin-sensitive strains, which was higher than the 67.9% for the clarithromycin-resistant strains (P=0.001). By contrast, the eradication rate was 100% in patients with amoxicillin-resistant H. pylori. Among 26 clarithromyin-resistant strains, 6 (23%) had A2143G mutations, and all of the cases in which these mutations were present were not eradicated by proton pump inhibitor-based triple therapy (P=0.0004). By contrast, none of the 26 clarithromyin-sensitive strains had A2143G mutations. The T2183C and A2223G mutations were frequently found in the sensitive strains and in the resistant strains.
Clarithromycin resistance of H. pylori, which determined the efficacy of H. pylori eradication of proton pump inhibitor triple regimen, was found to be increased in a single center study. A2143G was an important 23S rRNA mutation associated with clarithromycin resistance and affected the H. pylori eradication efficacy.
目前尚不清楚韩国幽门螺杆菌的主要抗生素耐药率。本研究旨在评估幽门螺杆菌的主要抗生素耐药率，并评估 23S rRNA 点突变对幽门螺杆菌根除率的影响。
从 222 名韩国人胃黏膜活检标本中分离出幽门螺杆菌。采用琼脂稀释法检测幽门螺杆菌对阿莫西林、克拉霉素、甲硝唑、四环素、环丙沙星和左氧氟沙星的敏感性。进行 DNA 测序以检测幽门螺杆菌 23S rRNA 突变。
与 2003 年至 2005 年相比，2007 年至 2009 年期间，克拉霉素、四环素、环丙沙星和左氧氟沙星的耐药率增加（P<0.05）。然而，阿莫西林和甲硝唑的耐药性略有下降。克拉霉素敏感株的根除率为 95.5%，高于克拉霉素耐药株的 67.9%（P=0.001）。相比之下，阿莫西林耐药的幽门螺杆菌患者的根除率为 100%。在 26 株克拉霉素耐药株中，有 6 株（23%）发生 A2143G 突变，所有存在这些突变的病例均未通过质子泵抑制剂三联疗法根除（P=0.0004）。相比之下，26 株克拉霉素敏感株均未发生 A2143G 突变。T2183C 和 A2223G 突变在敏感株和耐药株中均较常见。
在单中心研究中发现，幽门螺杆菌对克拉霉素的耐药性决定了质子泵抑制剂三联疗法根除幽门螺杆菌的疗效，并且有所增加。A2143G 是与克拉霉素耐药相关的重要 23S rRNA 突变，影响幽门螺杆菌的根除效果。
