Eradication of Helicobacter pylori According to 23S Ribosomal RNA Point Mutations Associated With Clarithromycin Resistance
Eradication of Helicobacter pylori According to 23S Ribosomal RNA Point Mutations Associated With Clarithromycin Resistance
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DOI：
10.1093/infdis/jit287
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发表时间：
2013-10-01
影响因子：
6.4
通讯作者：
Kim, Kwang
中科院分区：
文献类型：
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作者：
Lee, Hyun Jeong;Kim, Jin Il;Kim, Kwang
背景克拉霉素耐药幽门螺杆菌与23 S核糖体RNA（rRNA）基因点突变相关。共1232例患者参与研究，并分为2个对照组和1个病例组。APC对照组患者包括308名随机分配的参与者，接受标准三联疗法治疗，包括阿莫西林、雷贝拉唑和克拉霉素; APM对照组308名参与者接受阿莫西林、雷贝拉唑和甲硝唑治疗。对病例组的616名参与者进行了H. pylori进行。病例组中共有218例患者接受了新的定制治疗方案，在没有突变的情况下给予阿莫西林、雷贝拉唑和克拉霉素，而如果检测到突变，则用甲硝唑代替克拉霉素。H. pylori的检出率为91.2%（176/193），显著高于APC组（75.9% [214/282]; P <0.001）和APM组（79.1% [219/277]; P <0.001）。H.在通过聚合酶链反应检测克拉霉素耐药突变的基础上接受定制治疗的患者中，幽门螺杆菌根除率远高于接受标准三联治疗方案的患者。
Background. Clarithromycin-resistant Helicobacter pylori is associated with point mutations in the 23S ribosomal RNA (rRNA) gene.Methods. A total of 1232 patients participated and were divided into 2 control groups and 1 case group. Patients in the APC control group, which consisted of 308 randomly assigned participants, were treated with standard triple therapy, consisting of amoxicillin, rabeprazole, and clarithromycin; 308 participants in the APM control group were treated with amoxicillin, rabeprazole, and metronidazole. For the 616 participants in the case group, a test for point mutations in the 23S rRNA gene of H. pylori was conducted. A total of 218 individuals in the case group received a new tailored therapy regimen, in which amoxicillin, rabeprazole, and clarithromycin were given in the absence of a mutation, whereas clarithromycin was replaced by metronidazole if the mutation was detected.Results. The rate of eradication of H. pylori in the tailored group was 91.2% (176/193), which was significantly higher than that in the APC (75.9% [214/282]; P < .001) and APM (79.1% [219/277]; P < .001) control groups.Conclusion. The rate of H. pylori eradication among patients who received tailored therapy on the basis of detection of a clarithromycin resistance mutation by polymerase chain reaction was much higher than the rate among patients who received a standard triple therapy regimen.