Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Helicobacter. 2013 Apr;18(2):89-101. doi: 10.1111/hel.12016. Epub 2012 Oct 12.
Helicobacter pylori infection is acquired mainly during childhood. To eradicate H. pylori, clarithromycin-based triple therapy has been recommended in children and adults by the latest Maastricht Consensus. However, the prevalence of clarithromycin-resistant H. pylori was higher in children than that in adults. Therefore, rapid, reliable and noninvasive methods for detecting clarithromycin-resistant H. pylori strains should be developed for children.
Studies on evaluating stool PCR in detecting clarithromycin-resistant H. pylori and epidemiological surveys of the prevalence of clarithromycin-resistant H. pylori in children were searched in PubMed (from 1966 to December, 2011) for reviewing.
The average rates of primary clarithromycin-resistant H. pylori ranged from less than 10% to more than 40% in different regions. The rates of secondary resistance to clarithromycin were higher than primary resistance in the same population. In H. pylori isolated from children, the frequent point mutations that are responsible for the clarithromycin resistance included A2143G, A2142G, A2142C and A2144G, and they varied geographically. Comparing with culture-based susceptibility tests, stool PCR performed excellently for their rapidity, independence of bacterial growth, reproducibility and easy standardization. However, stool PCR showed lower sensitivity but perfect specificity in detection of clarithromycin-resistant H. pylori in children. Methodology and mixed infections of resistant H. pylori strains might contribute to the considerable discrepancies of stool PCR results.
Detection of clarithromycin-resistant H. pylori by stool PCR for children are reliable, rapid, noninvasive methods that are worthy of further clinical promotion. However, more evaluations of stool PCR in detection of clarithromycin-resistant H. pylori in children need to be conducted.
幽门螺杆菌感染主要发生在儿童时期。为了根除幽门螺杆菌，最新的马斯特里赫特共识推荐在儿童和成人中使用以克拉霉素为基础的三联疗法。然而，儿童中克拉霉素耐药的幽门螺杆菌的流行率高于成人。因此，需要为儿童开发快速、可靠和非侵入性的方法来检测克拉霉素耐药的幽门螺杆菌菌株。
在 PubMed（从 1966 年到 2011 年 12 月）中搜索了评估粪便 PCR 检测克拉霉素耐药的幽门螺杆菌的研究和儿童中克拉霉素耐药的幽门螺杆菌流行率的流行病学调查，以进行综述。
不同地区的初治克拉霉素耐药幽门螺杆菌的平均耐药率从不足 10%到超过 40%不等。同一人群中克拉霉素的继发耐药率高于初治耐药率。在儿童分离的幽门螺杆菌中，导致克拉霉素耐药的常见点突变包括 A2143G、A2142G、A2142C 和 A2144G，且其分布具有地域性。与基于培养的药敏试验相比，粪便 PCR 在快速性、细菌生长独立性、可重复性和易于标准化方面表现出色。然而，粪便 PCR 在检测儿童克拉霉素耐药的幽门螺杆菌时，其敏感性较低但特异性完美。方法学和耐药幽门螺杆菌菌株的混合感染可能导致粪便 PCR 结果存在较大差异。
粪便 PCR 检测儿童克拉霉素耐药的幽门螺杆菌是可靠、快速、非侵入性的方法，值得进一步临床推广。然而，还需要进一步评估粪便 PCR 在检测儿童克拉霉素耐药的幽门螺杆菌中的应用。
