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目的研究幽门螺杆菌(Hp)特异性蛋白抗体表达差异在海南地区Hp抗生素耐药中的意义。方法选择2014年9月~2015年4月在我院经胃黏膜活组织培养阳性的消化性溃疡和慢性胃炎患者107例,随机分为ECM组(兰索拉唑+克拉霉素+甲硝唑)和ECA组(兰索拉唑+克拉霉素+阿莫西林),三联10 d疗法根除Hp,~(13)C呼气试验复查Hp,Hp特异性蛋白抗体检测芯片检测患者外周血抗Hp特异性蛋白Cag A,Vac A,Ure,Rdx A及HSP60抗体水平。结果 1ECM组Hp根除率明显低于ECA组(71.4%vs 88.5%,P<0.05),ECM组Hp耐药率明显高于ECA组(58.4%vs 11.7%,P<0.05)。2抗Ure+率最高(96.2%),抗HSP60+率最低(5.8%)。3抗Vac A+和抗Ure+患者中,ECA组根除率均明显高于ECM组(100%vs 40%,P<0.05;88.5%vs 71.4%,P<0.05)。4抗Rdx A-和抗HSP60-患者中,ECA组Hp根除率均明显高于ECM组(86.7%vs 68.1%,P<0.05;91.7%vs 72%,P<0.05)。5抗Vac A+,抗Ure+,抗Rdx A-和抗HSP60-患者ECM组Hp耐药率明显高于ECA组(P<0.05)。结论海南地区甲硝唑耐药率远高于阿莫西林;Hp对甲硝唑的耐药主要与抗Vac A+,抗Ure+及抗Rdx A-及抗HSP60-有关;Hp特异性蛋白的表达差异可能是Hp耐药的重要机制。
Objective To study the significance of Hp antibody expression in Hp antibiotic resistance in Hainan. Methods A total of 107 patients with peptic ulcer and chronic gastritis who were positive for gastric mucosa culture in our hospital from September 2014 to April 2015 were randomly divided into ECM group (lansoprazole + clarithromycin + metronidazole ) And ECA group (lansoprazole + clarithromycin + amoxicillin), triple therapy for 10 days to eradicate Hp, ~ (13) C breath test review Hp, Hp specific protein antibody detection chip detection of peripheral blood anti-Hp Specific proteins Cag A, Vac A, Ure, Rdx A and HSP60 antibody levels. Results The eradication rate of Hp in 1ECM group was significantly lower than that in ECA group (71.4% vs 88.5%, P <0.05). The Hp resistance rate in ECM group was significantly higher than that in ECA group (58.4% vs 11.7%, P <0.05). 2 The highest anti-Ure + rate (96.2%) and the lowest anti-HSP60 + rate (5.8%). 3 EAC and anti-Ure + patients, the eradication rates in ECA group were significantly higher than those in ECM group (100% vs 40%, P <0.05; 88.5% vs 71.4%, P <0.05). 4 anti-Rdx A- and anti-HSP60- patients, the eradication rate of Hp in ECA group was significantly higher than that in ECM group (86.7% vs 68.1%, P <0.05; 91.7% vs 72%, P <0.05). Hp resistance in 5 ECV-resistant, anti-Ure +, anti-Rdx A- and anti-HSP60-treated patients was significantly higher than that in ECM (P <0.05). Conclusions The metronidazole resistance rate in Hainan is much higher than that of amoxicillin. The resistance of Hp to metronidazole is mainly related to anti-Vac A +, anti-Ure + and anti-Rdx A- and anti-HSP60-. The difference of Hp-specific protein expression It may be an important mechanism of Hp resistance.