Priadko Kateryna, Gibaud Sophie-Anne, Druet Amaury, Galmiche Louise, Megraud Francis, Corvec Stéphane, Matysiak-Budnik Tamara
Nantes Université, CHU Nantes, IMAD, Hepato-Gastroenterology & Digestive Oncology, Nantes, France.
Department of Bacteriology and Microbiological Control, University Hospital of Nantes, Nantes, France.
Helicobacter. 2025 Mar-Apr;30(2):e70031. doi: 10.1111/hel.70031.
In our center, RT-PCR was integrated as a routine method to diagnose Helicobacter pylori due to its higher availability after COVID-19 pandemics. The objective of this study was to assess the feasibility and performance of systematically performed RT-PCR for H. pylori detection and clarithromycin (CLA) resistance in a real-life clinical practice.
One hundred consecutive patients underwent an upper digestive endoscopy during which at least four biopsies (two from the antrum and two from the corpus) were obtained for RT-PCR and culture with antibiogram and four additional biopsies for histology. The results of H. pylori detection were compared among RT-PCR, histology, and bacterial culture, and the results of CLA susceptibility were compared between culture-based antibiogram and RT-PCR.
Out of 100 patients, 64 were positive for H. pylori by RT-PCR, 66 by histology, and 53 by culture, with no statistically significant difference among the three methods (p > 0.05). CLA resistance was found in 8 out of 45 patients (17.7%) by culture and in 12 out of 64 patients (18.7%) by PCR. In 8 H. pylori-positive patients by culture, the antibiogram could not be realized due to lack of viability of the strains. In one patient, after a double checking, discrepant results were observed, requiring a complementary molecular analysis by the French National Reference Center for Helicobacters, which confirmed the existence of a double population of H. pylori strains within biopsies, with and without CLA resistance.
Our study demonstrates that in real-life clinical practice, RT-PCR is feasible and comparable in the ability to detect H. pylori and its resistance to CLA to bacterial culture with antibiogram and histology. Given its rapidity and limited dependence on the operator's interpretation, it appears preferable to the other methods.
在我们中心，由于新冠疫情后实时荧光定量聚合酶链反应（RT-PCR）的可及性更高，它已被整合为诊断幽门螺杆菌的常规方法。本研究的目的是评估在实际临床实践中系统进行的RT-PCR检测幽门螺杆菌及克拉霉素（CLA）耐药性的可行性和性能。
连续100例患者接受了上消化道内镜检查，在此过程中至少获取了4份活检样本（2份来自胃窦，2份来自胃体）用于RT-PCR和药敏试验培养，另外还获取了4份活检样本用于组织学检查。比较了RT-PCR、组织学和细菌培养检测幽门螺杆菌的结果，以及基于培养的药敏试验和RT-PCR检测CLA敏感性的结果。
100例患者中，RT-PCR检测幽门螺杆菌阳性64例，组织学检测阳性66例，培养检测阳性53例，三种方法之间无统计学显著差异（p>0.05）。培养法检测的45例患者中有8例（17.7%）对CLA耐药，PCR检测的64例患者中有12例（18.7%）对CLA耐药。在8例培养法检测为幽门螺杆菌阳性的患者中，由于菌株无活力，无法进行药敏试验。在1例患者中，经过复查后观察到结果不一致，需要法国国家幽门螺杆菌参考中心进行补充分子分析，该分析证实活检样本中存在两种幽门螺杆菌菌株群体，一种对CLA耐药，另一种不耐药。
我们的研究表明，在实际临床实践中，RT-PCR检测幽门螺杆菌及其对CLA耐药性的能力与药敏试验培养法和组织学检查相当，且具有可行性。鉴于其速度快且对操作人员解读的依赖性有限，它似乎比其他方法更具优势。
