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Objective To investigate the antibiotic resistance trend of commonly used antibiotics of Helicobacter pylori (H.pylori) in Huzhou district,and to summarize the efficacy of eradication in related digestive diseases.Methods In year 2009,2013,2014 and 2015,8 139 gastric mucosa samples of patients undergoing gastroendoscopy examination were collected and H.pylori strains were isolated and cultured.The situation of resistance to levofloxacin,clarithromycin,metronidazole,amoxicillin,tetracycline and furazolidone was analyzed.The infection and antibiotics resistance of H.pylori were analyzed in 11 digestive diseases including functional dyspepsia,chronic gastritis,acute gastritis,duodenitis,gastric ulcer,duodenal ulcer,gastrointestinal dysfunction,gastric cancer,residual gastritis,reflux esophagitis and gastric lymphoma.The eradication schemes and eradication rate of H.pylori was reviewed in six digestive diseases including functional dyspepsia,chronic gastritis,duodenitis,gastric ulcer,duodenal ulcer and reflux esophagitis.Fisher's exact test was performed to compare the differences among the groups.Results A total of 3 263 H.pylori strains were obtained and the infection rate of H.pylori was 40.09％ (3 263/8 139).The H.pylori infection rates of 11 digestive diseases were from 0 to 57.89％,and which was high in duodenal ulcer,gastric ulcer,duodenitis,chronic gastritis and functional dyspepsia (57.89％,726/1 254;49.83％,301/604;42.91％,118/275;37.45％,1 518/4 053 and 36.78％,146/397;respectively).The results of single antibiotic resistance analysis in six digestive diseases needed or planed for H.pylori eradication indicated that resistance rate of H.pylori to levofloxacin and clarithromycin reached 23.09％ (663/2 871) and 17.87％ (513/2 871),respectively.The resistance rate tolevofloxacin dramatically increased from 5.03％ (8/159) in 2009 to 28.24％ (586/2 075) in 2015;the resistance rate to clarithromycin increased from 12.58％ (20/159) in 2009 to 21.78％ (452/2 075) in 2015;meanwhile,the resistance rate of H.pylori to metronidazole was nearly 100.00％.However,the resistance rates to amoxicillin,tetracycline and tetracycline were all zero.The results of double antibiotic resistance analysis in six digestive diseases needed or planed for H.pylori eradication indicated that the rate of both levofloxacin and clarithromycin resistance was 7.73 ％ (222/2 871).The double antibiotic resistance rate of levofloxacin and clarithromycin in different diseases fluctuated between 4.82 ％ and 10.96 ％.Totally 1 479patients of six digestive diseases were treated with quadruple therapy,and 1 363 patients were followed up after eradication therapy,with the eradication rate of 85.99％ (1 172/1 363).Conclusions In Huzhou district,for six common digestive diseases needed or planed for H.pylori eradication,any combination of two drugs in all three drugs including amoxicillin,tetracycline and furazolidone is the first choice for treatment.Only when patients are allergic to penicillin or furazolidone and tetracycline can not be obtained,will levofloxacin and clarithromycin be chosen.A high eradication rate can be achieved by choosing eradication schemes according to the results of H.pylori drug sensitivity test in local region.
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Objective To investigate the effects of estrogen receptor alpha (Erα) gene polymorphism on the efficacy of ursodeoxycholic acid (UDCA) in female primary biliary cirrhosis (PBC) treatment. Methods The polymorphism of Xba Ⅰ and Pvu Ⅱ sites in No. 1 Intron of Erαgene was detected by polymerase chain reaction-restriction fragment length polymorphism in 65 female patients with PBC. The patients were treated with UDCA tablets daily (13-15 mg·kg-1 · d- 1,divided for 3 times oral taking). The variations of patients' serum total bilirubin (Tbil), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyle transpeptidase (GGT) were followed up totally for 24 months. Results Totally the complete follow-up data had been obtained in 60 patients. Four indicators of XX or PP type patients slowly declined till the end of follow-up point still had not reached the effective treatment standard. Four indicators of Xx type patients were also slowly declined, while the effective treatment standard was achieved till the end of follow-up. Four indicators of Pp/pp or xx type patients were rapid declined to the effective treatment standard. The effective rate of UDCA in PBC treatment was 75.0％ (45/60). The distribution difference of Pvu Ⅱ between the UDCA treating effective group and the ineffective group in PP, Pp, pp types patients and XX、Xx、xx types patients was statistic significant (x2 = 12.13、 P = 0.003 and x2 = 9.95 、 P = 0.007 respectively). The distribution difference of Xba Ⅰ between the effective group and the ineffective group with UDCA treatment in XX, Xx and xx types patients was also significant (P ＜0.05). The effective rate of Pp, pp, Xx, xx types patients [82.61％ (19/23)、80.65％ (25/31) 、9/14、83. 33％ (35/42) respectively] was higher than PP and XX types patients (1/6 and 1/4 respectively).Conclusion Erα gene polymorphism influenced the efficacy of ursodeoxycholic acid in treating primary biliary cirrhosis.
ABSTRACT
Objective To investigate the antibiotic resistance rate of Helicobacter pylori,and to provide reliable evidence of choosing optimal drugs for clinical therapy.Methods Overall 3304 patients were enrolled from February 2006 to March 2007 who accepted gastroscopy followed by Helicobacter pylori culture of the gastric mucosa from biopsy.The antimicrobial susceptibilities of Helicobacter pylori strains for six antibiotics including metronidazole,amoxicilin,gentamycin,levofloxacin,furazolidone,clarithromycin were observed by Kirby-Bauer disk diffusion test.Results 1171(35.4%)biopsy clinical specimens were proved to be Helicobacter pylori positive when cultured in vitro and identified by conventional assays.The metronidazole resistance rate(99.32%)of Helicobacter pylori was significantly higher than that of any of the other 5 antibiotics,and the levofloxacin resistance rate(0.51%)was the lowest.Furthermore there were no significantly change in the tendency of resistance rate for the two above antibiotics from February 2006 to March 2007.However,Helicobacter pylori was resistant to amoxicilin,gentamycin,furazolidone,clarithromycin,and the resistance rate was 61.06%、4.78%、21.35% and 39.45% respectively.Meanwhile,the resistance rates corresponding to four antibiotics were different obviously.Conclusions With the application of antibiotics for Helicobacter pylori eradication,the antibiotic resistance rate increased perceptibly.The rate of resistance to metronidazole appeared to be the highest among six antibiotics applied to clinical treatment.Drug susceptibility testing was valuable to eradicate Helicobacter pylori in clinical therapy.