Value of Helicobacter pylori resistance gene detection in clinical precision therapy

doi:10.20199/j.issn.1672-2302.2024.04.011

Abstract

Abstract:

Objective To investigate the infection status of Helicobacter pylori (Hp) in patients with stomach discomfort in Xuancheng Central Hospital, and evaluate the accuracy of fecal sample detection for Hp infection and the precision treatment effect after drug resistance gene testing combined with fecal Hp nucleic acid and drug resistance gene tests. Methods Patients with stomach discomfort admitted to the Gastroenterology Department in a hospital were included from January to December 2023. All patients underwent screening with carbon-13 urea breath test (¹³C-UBT) and rapid urea test (RUT). Then the patients with double positive or double negative findings were included as study subjects, and undergone fecal Hp DNA detection. The consistency between the findings of fecal Hp detection and ¹³C-UBT+RUT detection was analyzed. Patients with positive fecal Hp and with voluntary intention to receive resistance gene testing (experimental group) were given precision treatment based on the test results, and Hp infected victims who did not undergo resistance gene testing (control group) were treated with conventional quadruple therapy regimen. Finally, the clinical prognosis was compared between the experimental group and the control group. Results Among the 446 patients included in the study, 170 were detected as Hp double positive by ¹³C-UBT+RUT, and 162 were detected as Hp positive by ¹³C-UBT+RUT and fecal Hp DNA detection. The consistency between fecal Hp DNA detection and ¹³C-UBT+RUT detection was good in general (Kappa value=0.962, P<0.05). Seventy-three patients were finally included in the experimental group, and 89 in the control group. The detection rate of mutant strains in the experimental group was 73.97%. The clinical curative rate was 90.41% (66/73) in the experimental group, which was higher than that in the control group 67.42% (60/89). The difference was significant (χ²=12.270, P<0.05). Conclusion The results of fecal Hp DNA detection are accurate and reliable, and can be used for bacterial resistance detection. This test protocol can be guiding value for precision medication in clinic, and conducive to improving the clinical curative rate for the patients.

Key words: Helicobacter pylori, Fecal specimens, Drug resistance genes, Precision therapy

CLC Number:

R378

XU Bei, LI Ping, ZHU Chuanwei, ZHANG Qingsong. Value of Helicobacter pylori resistance gene detection in clinical precision therapy[J]. Journal of Tropical Diseases and Parasitology, 2024, 22(4): 244-247.

Figures/Tables 3

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HP DNA粪便检测	¹³C-UBT+RUT		合计
HP DNA粪便检测	阳性	阴性	合计
阳性	162	0	162
阴性	8	276	284
合计	170	276	446

抗生素	DNA 测序		突变率 [n（%）]
抗生素	耐药基因型	突变位点	突变率 [n（%）]
喹诺酮类	gyrA	D91G	9（12.33）
	gyrA	D91N	12（16.44）
	gyrA	D91Y	6（8.22）
	gyrA	N87K	17（23.29）
	gyrA	N97I	5（6.85）
克拉霉素	23S	A2143G	44（60.27）
呋喃唑酮	pord	G357T	6（8.22）
	pord	G353A	5（6.85）
阿莫西林	PBP1A	—	0（0）
四环素	16S	—	0（0）

基因突变类型	患者数（例）	青霉素过敏情况	抗生素用法
喹诺酮+克拉霉素	2	是	呋喃唑酮（100 mg，bid）+四环素（0.5 g，bid）
喹诺酮+克拉霉素+呋喃唑酮	1	是	四环素（0.5 g，bid）+甲硝唑（0.4 g，bid）
喹诺酮+克拉霉素	32	否	阿莫西林（1 000 mg，bid）+呋喃唑酮（100 mg，bid）
喹诺酮+克拉霉素+呋喃唑酮	3	否	阿莫西林（1 000 mg，bid）+四环素（0.5 g，bid）
喹诺酮+呋喃唑酮	2	否	阿莫西林（1 000 mg，bid）+四环素（0.5 g，bid）
克拉霉素+呋喃唑酮	3	否	阿莫西林（1 000 mg，bid）+四环素（0.5 g，bid）
喹诺酮	7	否	阿莫西林（1 000 mg，bid）+呋喃唑酮（100 mg，bid）
克拉霉素	3	否	阿莫西林（1 000 mg，bid）+呋喃唑酮（100 mg，bid）
呋喃唑酮	1	否	阿莫西林（1 000 mg，bid）+四环素（0.5 g，bid）