上海市某三甲医院幽门螺杆菌耐药性和毒力与其生物膜形成能力的相关性研究

为探讨复旦大学附属华东医院(以下简称本院)分离培养的幽门螺杆菌(Helicobacter pylori，H. pylori)的耐药性、毒力和感染特征与其生物膜形成能力的相关性，收集2014年12月-2015年6月于本院消化内镜中心的胃活检组织标本及相应临床病例资料，分离培养获得幽门螺杆菌，分析菌株的耐药性、毒力基因型、临床病例特征。结果显示，从胃活检组织样本中共分离培养28株幽门螺杆菌，对左氧氟沙星(levofloxacin，LEV)、甲硝唑(metronidazole，MTZ)和克拉霉素(clarithromycin，CLA)的耐药率分别为32%、75%和11%，未发现阿莫西林(amoxicillin，AMX)耐药。单一药物耐药17株(17/28，61%)，双重耐药10株(10/28，36%)。毒力基因cagA、oipA和vacAs1检出率为100%，未检出vacAs2。基因型vacAs1m1占39%(11/28)，vacAs1m2占61%(17/28)；iceA1占54%(15/28)，iceA2占21%(6/28)，iceA1A2占25%(7/28)；dupA^＋占36%(10/28)。28株菌株均能形成生物膜，但能力不尽相同。单因素及独立样本t检验分析显示，45～59岁、iceA1^＋dupA^－基因型和甲硝唑敏感菌株形成生物膜的能力较强。结果提示，本院分离的幽门螺杆菌对甲硝唑耐药率最高，双重耐药不容忽视。菌株主要毒力基因型为cagA、oipA、vacAs1m2。幽门螺杆菌的生物膜形成能力与患者年龄有关，45～59岁组较强；携带毒力基因iceA1的菌株生物膜形成能力强；dupA基因型及甲硝唑耐药与菌株生物膜形成呈负相关。

Relationship between drug resistance and virulence of Helicobacter pylori and its biofilm formation ability

To investigate the drug resistance and virulence of Helicobacter pylori (H. pylori) strains, and explore their relationship with the infection characteristics and biofilm formation ability, gastric mucosa biopsy samples and related clinical data were collected from Huadong Hospital Affiliated to Fudan University between December 2014 and June 2015. H. pylori strains isolated from these clinical samples were subjected to drug resistance assay, virulence gene assay and biofilm-forming assay. Twenty-eight H. pylori strains were acquired. The resistance rates to levofloxacin (LEV), metronidazole (MTZ), clarithromycin (CLA) and amoxicillin (AMX) were 32%, 75%, 11% and 0, respectively. The single and double resistance rates were 61% (17/28) and 36% (10/28), respectively. The detection rates of virulence genes cagA, oipA and vacAs1 were 100%, and no vacAs2 was detected. vacAs1m2 genotype accounted for 61% (17/28), followed by vacAs1m1(11/28, 39%). The prevalence rates of iceA1, iceA2 and iceA1 iceA2 were 54% (15/28), 21% (6/28), 25% (7/28), respectively. The detection rate of dupA was 36% (10/28). The biofilm-forming ability of 28 strains varied. Single factor and independent sample t test analysis showed that strains isolated from 45-59 years old patients, iceA1^＋ dupA^－ genotype, metronidazole-sensitive strains could form stronger biofilm. In conclusion, the resistance rate of H. pylori to metronidazole was highest in single resistance, and the double resistance should not be neglected. The main genotypes of H. pylori isolates were cagA, oipA, vacAs1m2. The H. pylori biofilm-forming ability is related to the age of patients. Specifically, strains isolated from the age 45-59 group have stronger biofilm-forming ability than those obtained from other age groups. In addition, isolates carrying the virulence gene iceA1 have strong biofilm-forming ability. And there is a negative correlation between dupA genotype or metronidazole resistance and the biofilm-forming ability of the H. pylori isolates.