Park Gihong, Kim Bokyung, Chung Hyunsoo, Kim Sang Gyun, Cho Soo-Jeong
Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Korean J Helicobacter Up Gastrointest Res. 2023 Dec;23(4):268-276. doi: 10.7704/kjhugr.2023.0037. Epub 2023 Dec 8.
The A2142G and A2143G mutations in the 23S ribosomal ribonucleic acid (rRNA) of are the most common mutations associated with clarithromycin resistance. This study aimed to determine the differences in eradication rates in patients infected with bacteria carrying the A2142G and A2143G mutations who were treated with clarithromycin-based triple therapy.
Data from a previous randomized controlled trial were analyzed retrospectively. Eradication rates were compared based on the presence of carrying the A2142G and A2143G mutations. A meta-analysis was also conducted of relevant studies containing data regarding patients who received clarithromycin-based therapy due to infections with harboring 23S rRNA mutations.
No significant difference was observed in eradication rates between patients infected with wild-type bacteria (95.7% [44/46]) compared with those infected with bacteria carrying the A2142G mutation (100.0% [3/3]; >0.9). However, the eradication rate was significantly lower for patients infected with bacteria carrying the A2143G mutation (16.7% [1/6]; <0.001) than for those infected with wild-type bacteria or bacteria with the A2142G mutation (100.0% [3/3]; =0.048). In the meta-analysis, the between-group comparisons yielded similar results. Although patients infected with bacteria having the A2142G mutation exhibited no significant risk difference (RD) for eradication compared with those infected with wild-type bacteria (RD=-0.05 [-0.18 to 0.08]; I=0%; =0.42), those infected with bacteria having the A2143G mutation demonstrated a lower eradication rate compared with patients infected with either wild-type (RD=0.72 [0.64-0.80]; I=0%; <0.001) or A2143G mutant bacteria (RD=0.76 [0.61-0.91]; I=0%; < 0.001).
The A2143G mutation may play a more significant role in clarithromycin triple therapy eradication failure than does the A2142G mutation. Additionally, strains with the A2142G mutation can be treated effectively with clarithromycin-based triple therapy.
23S核糖体核糖核酸（rRNA）中的A2142G和A2143G突变是与克拉霉素耐药相关的最常见突变。本研究旨在确定接受基于克拉霉素的三联疗法治疗的携带A2142G和A2143G突变细菌感染患者的根除率差异。
对先前一项随机对照试验的数据进行回顾性分析。根据是否携带A2142G和A2143G突变比较根除率。还对包含因携带23S rRNA突变的幽门螺杆菌感染而接受基于克拉霉素治疗的患者数据的相关研究进行了荟萃分析。
与感染携带A2142G突变细菌的患者（100.0%[3/3]；P>0.9）相比，感染野生型细菌的患者（95.7%[44/46]）的幽门螺杆菌根除率未观察到显著差异。然而，感染携带A2143G突变细菌的患者（16.7%[1/6]；P<0.001）的根除率显著低于感染野生型细菌或携带A2142G突变细菌的患者（100.0%[3/3]；P=0.048）。在荟萃分析中，组间比较得出了类似结果。虽然与感染野生型细菌的患者相比，感染携带A2142G突变细菌的患者在根除方面未表现出显著风险差异（RD=-0.05[-0.18至0.08]；I²=0%；P=0.42），但与感染野生型（RD=0.72[0.64-0.80]；I²=0%；P<0.001）或A2143G突变细菌（RD=0.76[0.61-0.91]；I²=0%；P<0.001）的患者相比，感染携带A2143G突变细菌的患者幽门螺杆菌根除率较低。
与A2142G突变相比，A2143G突变在克拉霉素三联疗法幽门螺杆菌根除失败中可能起更重要作用。此外，携带A2142G突变的幽门螺杆菌菌株可以通过基于克拉霉素的三联疗法有效治疗。
