我國幽門螺桿菌感染患者原發(fā)耐藥情況以及不同根除方案對其療效的前瞻性多中心研究

1、目錄目錄我國幽門螺桿菌感染患者原發(fā)耐藥情況以及我國幽門螺桿菌感染患者原發(fā)耐藥情況以及不同根除方案對其影響的不同根除方案對其影響的前瞻性多中心研究前瞻性多中心研究目錄目錄A Comparative Study of Sequential A Comparative Study of Sequential Therapy andTherapy andStandard Triple Therapy for Standard Triple Therapy for Helicobacter pyloriHelicobacter pyloriInfection: A Randomized Infectio

2、n: A Randomized Multicenter TrialMulticenter Trial目錄目錄IntroductionIntroductionn2014年4月Am J Gastroenterol發(fā)表了北京大學第三醫(yī)院消化科周麗雅教授牽頭的一項國內5家中心共同完成的臨床試驗“序貫方案和標準三聯(lián)方案在我國幽門螺桿菌感染初治患者中的多中心、隨機對照研究”(Zhou L，Zhang J，Chen M，et a1A comparative study of sequential therapy and standard triple therapy for Helicobacter pyl

3、ori infection：a randomized multicenter trialAm J Gastroenterol，2014，109：535-541)，系統(tǒng)嚴格地比較了序貫方案和標準三聯(lián)方案根除幽門螺桿菌(Hp)感染的療效、安全性、依從性等問題，并深人探討了抗菌藥物耐藥對序貫方案療效的影響。目錄目錄Background Background nHelicobacter pylori ( H. pylori ) infection is an important causal factor in a wide range of upper gastrointestinal diseas

4、es, including chronic gastritis, peptic ulcer disease, and gastric cancer. As such, it is a major contributor that affects public health on a worldwide basis, especially in developing countries.目錄目錄Background Background nTraditionally, standard triple therapy (STT) comprising a proton pump inhibitor

5、 (PPI) combined with two antibiotics (clarithromycin and amoxicillin or metronidazole) is the firstline option for empiric H. pylori eradication. However, the effectiveness of STT has declined to unacceptable levels in many regions of the world, mainly owing to antibiotic resistance. Consequently, i

6、t is no longer a suitable first-line treatment approach, and there is a clear need for new regimens with good efficacy and safety in order to effectively manage this widespread form of infection.目錄目錄ObjectivesObjectivesnStudies conducted in large populations of patients and providing full informatio

7、n on Helicobacter pylori ( H. pylori ) antibiotic resistance are needed to determine the efficacy of sequential therapy (SQT) against this pathogen. This study compared eradication rates with SQT and standard triple therapy (STT), and evaluated the impact of antibiotic resistance on outcomes.目錄目錄Met

8、hods Methods nThe study population included adults with positive H. pylori culture presenting at four centers in China between March 2008 and December 2010. Patients were randomly assigned to 10 days of treatment with esomeprazole, amoxicillin, and clarithromycin (STT; n = 140) or to 5 days of treat

9、ment with esomeprazole and amoxicillin, followed by 5 days of esomeprazole, clarithromycin, and tinidazole (SQT; n = 140). Eradication was assessed 8 12 weeks after treatment.目錄目錄ResultsResults1.There was no significant difference between the eradication rates achieved with STT (66.4 % (95 % confide

10、nce interval (CI) 59.3 74.3) and SQT (72.1 % (65.0 79.3); P = 0.300) in either the intention-to-treat analysis or the per-protocol analysis (72.7 % (65.6 79.7) and 76.5 % (69.7 83.3), respectively; P = 0.475).目錄目錄ResultsResults2.Clarithromycin resistance (CLA-R, odds ratio (OR) = 8.34 (3.13 22.26),

11、P 0.001) and metronidazole resistance (MET-R, OR = 7.14 (1.52 33.53), P = 0.013) both independently predicted treatment failure in the SQT group. 3.Patients in the SQT group with dual CLA-R and MET-R had a lower eradication rate (43.9 % ) than those with isolated CLA-R (88.9 % , P = 0.024) or isolat

12、ed MET-R (87.8 % , P 0.001).目錄目錄ConclusionsConclusions1.H. pylori eradication rates with STT and SQT were compromised by antibiotic resistance. 2.SQT may be suitable in regions with high prevalence of isolated CLA-R, but it is unsatisfactory when both CLA-R and MET-R are present.目錄目錄Study Highlights

13、Study Highlights目錄目錄Study HighlightsStudy Highlights目錄目錄Zhou L, Zhang J, Chen M, Hou X, Li Z, Song Z, He L, Lin S. A comparative study of sequential therapy and standard triple therapy for Helicobacter pylori infection: a randomized multicenter trial. Am J Gastroenterol 2014; 109: 535-541.目錄目錄周麗雅周麗雅

14、,宋志強宋志強.序貫方案和標準三聯(lián)方案在我國幽門螺桿菌感染初治患者中的多中心、隨機對序貫方案和標準三聯(lián)方案在我國幽門螺桿菌感染初治患者中的多中心、隨機對照研究照研究J.中華內科雜志中華內科雜志,2014,53(7):576.目錄目錄Prospective multi-region study on Prospective multi-region study on primary antibiotic resistance ofprimary antibiotic resistance ofHelicobacter pylori strains Helicobacter pylori stra

15、ins isolated from Chinese patientsisolated from Chinese patients目錄目錄IntroductionIntroductionn2014年9月Dig Liver Dis發(fā)表了北京大學第三醫(yī)院消化科周麗雅教授牽頭的一項國內5家中心共同完成的臨床試驗“中國幽門螺桿菌感染患者原發(fā)抗生素耐藥的一項前瞻性多中心研究”(Song Z, Zhang J, He L, Chen M, Hou X, Li Z, Zhou L. Prospective multi-region study on primary antibiotic resistance

16、of Helicobacter pylori strains isolated from Chinese patients. Dig Liver Dis 2014; 46: 1077-1081)，系統(tǒng)地介紹了我國各地區(qū)幽門螺桿菌(Hp)抗生素耐藥的情況，以及總體耐藥情況，并深人探討了在我國以及其他一些抗生素耐藥率很高的地區(qū)，獲取關于Hp耐藥的全面的、最新的信息對選擇最優(yōu)的根除方案的必要性。目錄目錄Background Background nLarge-scale multi-region studies are urgently needed to provide comprehensive

17、 and up-to-date information on the antibiotic resistance of Helicobacter pylori that is critical for selecting the most optimal eradication regimens.目錄目錄AimsAimsnTo determine the resistance patterns of Helicobacter pylori strains isolated from dyspeptic patients.目錄目錄Methods Methods nThis is a prospe

18、ctive, multicentre, cross-sectional, observational study. Helicobacter pylori cultures were successful in 600 patients (never receiving eradication therapy) from Northern, Eastern, Middle, and Southern regions between 2008 and 2012. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxa

19、cin, tetracycline, and rifampicin was determined by Epsilometer test. 目錄目錄ResultsResults1.The overall resistance rate was highest for metronidazole (403, 67.2%), followed by clarithromycin (225, 37.5%), levofloxacin (201, 33.5%), rifampicin (85, 14.2%), amoxicillin (41, 6.8%), and tetracycline (21,

20、3.5%). 2.There were 16.3% isolates susceptible to all tested antibiotics, followed by mono-resistance (34.2%), double resistance (27.0%), triple resistance (16.8%), quadruple resistance (4.7%), quintuple resistance (0.7%) and sextuple resistance (0.3%).目錄目錄ResultsResults3.Independent factors influen

21、cing antibiotic resistance were gender (to levofloxacin), age (to levofloxacin), and endoscopic finding (to clarithromycin, metronidazole, and levofloxacin). 4.Among the clarithromycin-resistant isolates, 75.6% and 48.0% were also resistant to metronidazole and levofloxacin, respectively. 目錄目錄ConclusionsConclusionsnHelicobacter pylori resistance to commonly used antibiotics in China is a