基于一次性胃部细胞无创采样器的幽门螺杆菌耐药基因检测及其临床应用研究

doi:10.19871/j.cnki.xfcrbzz.2023.05.007

新发传染病电子杂志 ›› 2023, Vol. 8 ›› Issue (5): 36-40.doi: 10.19871/j.cnki.xfcrbzz.2023.05.007

基于一次性胃部细胞无创采样器的幽门螺杆菌耐药基因检测及其临床应用研究

翁梅婷, 杨莉丽, 邹傲, 吴慧华, 郭海, 张燕燕, 李曦, 王俊萍

北京大学深圳医院消化内科,广东深圳 518036

收稿日期:2023-04-17 出版日期:2023-10-31 发布日期:2023-12-05
通讯作者: 王俊萍,Email：wjp2006sz@aliyun.com
基金资助:
北京大学深圳医院临床研究面上项目基金资助（LCYJ2021014)

Disposable non-invasive gastric specimen collection string-based genetic testing for Helicobacter pylori drug resistance and its clinical application

Weng Meiting, Yang Lili, Zou Ao, Wu Huihua, Guo Hai, Zhang Yanyan, Li Xi, Wang Junping

Department of Gastroenterology, Peking University Shenzhen Hospital, Guangdong Shenzhen 518036, China

Received:2023-04-17 Online:2023-10-31 Published:2023-12-05

摘要/Abstract

摘要： 目的基于一次性胃部细胞无创采样器采集胃液标本进行幽门螺杆菌耐药基因检测,指导幽门螺杆菌个体化治疗,探讨此技术的临床应用价值。方法选取2021年5月至2022年5月北京大学深圳医院收治的根治失败2次或以上的难治性幽门螺杆菌感染患者50例,使用一次性胃部细胞无创采样器采集胃液,通过荧光定量PCR法检测抗生素耐药基因,根据耐药结果给予患者制订基于铋剂四联根除治疗方案,疗程14d,治疗结束至少4周后复查尿素呼气试验,确定幽门螺杆菌是否被成功根除。结果在50例送检样本中,检测幽门螺杆菌阳性者为43例。43例个体化治疗患者根除成功41例,幽门螺杆菌感染根除率意向性分析为95.35%（95%CI为84.19%~99.43%）,遵循方案分析为97.62%（95%CI为87.43%~99.94%）,均显著优于标准铋剂四联疗法（P<0.001）。结论基于一次性胃部细胞无创采样器采集胃液标本进行幽门螺杆菌耐药基因检测技术指导的个体化治疗在顽固性幽门螺杆菌感染患者中取得比较理想的临床效果,具有较好的应用价值。

关键词: 幽门螺杆菌, 一次性胃部细胞无创采样器, 基因检测, 耐药检测, 个体化治疗

Abstract: Objective We explored the clinical application value of using disposable non-invasive gastric specimen collection string to collect patient gastric material followed by antibiotic resistance detection to facilitate susceptibility-guided Helicobacter pylori (H. pylori) eradication therapy. Method Fifty patients with refractory H. pylori infection who previously failed twice or more H. pylori eradication to Peking University Shenzhen Hospital from May 2021 to May 2022, therapies performed a disposable non-invasive gastric specimen collection string that involves swallowing and retrieval of a disposable string to obtain their gastric specimen for drug resistance detection via quantitative PCR. Based on the test results, patients were prescribed with susceptibility-guided bismuth-based quadruple eradication therapy for 14 days. A follow-up urea breath test was performed at least 4 weeks after the completion of treatment to confirm eradication. Result Of 50 recruited patients, 43 were tested positive for H. pylori infection by the qPCR test and received individualized treatment. Successful H. pylori eradication was confirmed in 41 patients, with an eradication rate of 95.35% (95%CI 84.19% to 99.43%) in the intention-to-treat analysis and 97.62% (95%CI 87.43% to 99.94%) based on per-protocol analysis, which were significantly better than that of the conventional bismuth-based eradication therapy (P<0.001). Conclusion Based on disposable non-invasive gastric specimen collection string,the qPCR test has been shown to be clinically effective in guiding our use of personalized H. pylori eradication therapy for treating patients with antibiotic-resistant H. pylori infection.

Key words: Helicobacter pylori, Disposable non-invasive gastric specimen collection string, Quantitative polymerase chain reaction, Resistance detection, Personalized eradication therapy

中图分类号:

R573

翁梅婷, 杨莉丽, 邹傲, 吴慧华, 郭海, 张燕燕, 李曦, 王俊萍. 基于一次性胃部细胞无创采样器的幽门螺杆菌耐药基因检测及其临床应用研究[J]. 新发传染病电子杂志, 2023, 8(5): 36-40.

Weng Meiting, Yang Lili, Zou Ao, Wu Huihua, Guo Hai, Zhang Yanyan, Li Xi, Wang Junping. Disposable non-invasive gastric specimen collection string-based genetic testing for Helicobacter pylori drug resistance and its clinical application[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(5): 36-40.

参考文献

[1] SIPPONEN P.Natural history of gastritis and its relationship to peptic ulcer disease[J]. Digestion, 1992, 51(1):70-75.
[2] SUGANO K, TACK J, KUIPERS EJ, et al.Kyoto global consensus report on Helicobacter pylori gastritis[J]. Gut, 2015, 64(9):1353-1367.
[3] GRAHAM DY.Helicobacter pylori update: gastric cancer, reliable therapy, and possible benefits[J]. Gastroenterology, 2015, 148(4):719-731.
[4] GONI E, FRANCESCHI F.Helicobacter pylori and extra gastric diseases[J]. Helicobacter, 2016, 21(1):45-48.
[5] IARC WORKING GROUP ON THE EVALUATION OF CARCINOGENIC RISKS TO HUMANS. Schistosomes, liver flukes and Helicobacter pylori[J]. IARC Monogr Eval Carcinog Risks Hum, 1994, 61(7):1-241.
[6] 中华医学会消化病学分会幽门螺杆菌学组. 第六次全国幽门螺杆菌感染处理共识报告(非根除治疗部分)[J].中华消化杂志, 2022, 42(5):289-303.
[7] BRAY F, FERLAY J, SOERJOMATARAM I, et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424.
[8] XIE C, LU NH.Review: clinical management of Helicobacter pylori infection in China[J]. Helicobacter, 2015, 20(1):1-10.
[9] HU Y, ZHU Y, LU NH.Primary Antibiotic Resistance of Helicobacter pylori in China[J]. Sci, 2017, 62(5):1146-1154.
[10] WINDSOR HM, ABIOYE-KUTEY EA, MARSHALL BJ.Methodology and transport medium for collection of Helicobacter pylori on a string test in remote location[J]. Helicobacter, 2005, 10(6):630-634.
[11] FLEISS JL, LEVIN B, PAIK MC.Statistical Methods for Rates and Proportions[M].3rd edition.New Jersey. John Wiley & Sons, Inc,2003:598-622.
[12] NEWCOMBE RG.Two-sided confidence intervals for the single proportion: comparison of seven methods[J].Statistics in Medicine, 1998, 17(8):857-872.
[13] 中华医学会消化病学分会幽门螺杆菌和消化性溃疡学组, 全国幽门螺杆菌研究协作组, 刘文忠, 等. 第五次全国幽门螺杆菌感染处理共识报告[J]. 胃肠病学, 2017, 22(6):346-360.
[14] GRAHAM DY, LU H, YAMAOKA Y.A report card to grade Helicobacter pylori therapy[J]. Helicobacter, 2007, 12(4): 275-278.
[15] NAGY P, JOHANSSON S, MOLLOY-BLAND M.Systematic review of time trends in the prevalence of Helicobacter pylori infection in China and the USA[J]. Gut Pathog, 2016, 8(1):8.
[16] ZHANG J, FANG C, SHI X, et al.Research Progress of Drug for Eradication of Helicobacter Pylori[J]. Medical Recapitulate, 2020, 26(2):316-320.
[17] GRAHAM DY, FISCHBACH L.Helicobacter pylori treatment in the era of increasing antibiotic resistance[J]. Gut, 2010, 59(8):1143-1153.
[18] 任小英,李雪宏,张淑贞,等. 根除幽门螺杆菌,从合理使用抗生素做起[J/CD].新发传染病电子杂志,2020,5(1):38-42.
[19] ZHANG YX, ZHOU LY, SONG ZQ, et al.Primary antibiotic resistance of Helicobacter pylori strains isolated from patients with dyspeptic symptoms in Beijing: a prospective serial study[J]. World J Gastroenterol, 2015, 21(9):2786-2792.
[20] PENG B, YA LZ, MEI XX, et al.Susceptibility of Helicobacter pylori to antibiotics in Chinese patients[J]. J Dig Dis, 2015, 16(8):464-470.
[21] MALFERTHEINER P, MEGRAUD F, O'MORAIN CA, et al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report[J]. Gut,2017, 66(1):6-30.
[22] 张淑贞,李雪宏,Marshall BJ, 等.深圳地区幽门螺杆菌临床分离菌株的耐药性分析[J/CD].新发传染病电子杂志,2021,6(2):79-83.
[23] 中华医学会消化病学分会幽门螺杆菌学组. 2022中国幽门螺杆菌感染治疗指南[J].胃肠病学, 2022, 27(3):150-162.
[24] HAN XY, YU XQ, GAO XJ, et al.Quantitative pcr of string-test collected gastric material: a feasible approach to detect helicobacter pylori and its resistance against clarithromycin and levofloxacin for susceptibility-guided therapy.[J]. Helicobacter, 2023, 28(4):e12985.
[25] WANG YK, KUO FC, LIU CJ, et al.Diagnosis of Helicobacter pylori infection: current options and developments[J]. World J Gastroenterol, 2015, 21(40):11221-11235.
[26] LI Y, LV T, HE C, et al.Evaluation of multiplex ARMS-PCR for detection of Helicobacter pylori mutations conferring resistance to clarithromycin and levofloxacin[J]. Gut Pathogens, 2020, 12(1):1-12.
[27] PICHON M, PICHARD B, BARRIOZ T, et al.Diagnostic Accuracy of a Noninvasive Test for Detection of Helicobacter pylori and Resistance to Clarithromycin in Stool by the Amplidiag H. pylori+ClariR Real-Time PCR Assay[J]. J Clin Microbiol, 2020, 58(4):1-30.
[28] ZHANG SZ, WANG XY, MICHAEL JW, et al.Mutations of Helicobacter pylori RdxA are mainly related to the phylogenetic origin of the strain and not to metronidazole resistance[J]. J Antimicrob Chemother, 2020, 75(11):3152-3155.

基于一次性胃部细胞无创采样器的幽门螺杆菌耐药基因检测及其临床应用研究

Disposable non-invasive gastric specimen collection string-based genetic testing for Helicobacter pylori drug resistance and its clinical application

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