梁翠萍?耿岚岚?叶丽萍?李慧雯?任路?陈佩瑜?龚四堂

【摘要】目的 總结广州市某医院幽门螺杆菌（Hp）感染患儿的诊断与治疗现状。方法 回顾在该院接受Hp根除治疗患儿的临床资料，分析其Hp感染、诊断及治疗情况。结果 接受Hp根除治疗的560例患儿中男288例、女272例，年龄（7.94±2.63）岁。45.4%（254/560）患儿行胃镜检查，54.6%（306/560）患儿13C-尿素呼气试验阳性。所有患儿1次根除成功率为60.0%（336/560），3联14 d方案（PPI+阿莫西林+克拉霉素）根除成功率（70.0%）最高，3联序贯方案（PPI+阿莫西林5 d，PPI+克拉霉素+甲硝唑5 d）次之（53.6%），3联10 d方案根除率最低（49.4%）。102例患儿在首次根除失败后放弃再次根除治疗，112例患儿接受再次根除治疗。2次根除成功率为69.2%，3次根除成功率为75.0%。86例患儿行Hp耐药检测，Hp分离培养及药敏试验显示培养阳性率为77.9%（67/86），克拉霉素耐药率为17.9%（12/67）。寡核苷酸微阵列技术方法检测克拉霉素耐药基因检出率为19.8%（17/86）。结论 目前该医院未严格采用基于胃镜检查的侵入性方法进行Hp感染诊断，Hp根除成功率较低，应该进行规范化治疗，提高根除成功率，避免扩大根除治疗范围。

【关键词】幽门螺杆菌;诊断;治疗;儿童;广州

Analysis of current status of diagnosis and treatment of pediatric Helicobacter pylori infection in Guangzhou： a single-center study Liang cuiping， Geng lanlan， Ye liping， Li huiwen， Ren Lu， Chen peiyu， Gong sitang.Department of Gastroenterology， Guangzhou Women and Children Medical Center， Guangzhou 510250， China

Corresponding author， Geng lanlan， E-mail： Genglan_2001@hotmail.com

【Abstract】Objective To evaluate current status of diagnosis and treatment of pediatric Helicobacter pylori （Hp） infection in a hospital in Guangzhou. Methods Clinical data of Hp children receiving Hp eradication therapy in our hospital were retrospectively analyzed. The current status of incidence， diagnosis and treatment of Hp infection was investigated. Results A total of 560 children were treated with Hp eradication therapy， including 288 boys and 272 girls， aged （7.94±2.63） years. Gastroscopy was performed in 45.4% （254/560） and 54.6% （306/560） were positive for 13C-urea breath test. The first eradication success rate of all children was 60.0% （336/560）. The success eradication rate of 14-d triple regimen （PPI+ amoxicillin+clarithromycin） was the highest （70.0%）， followed by 14-d triple sequential regimen （53.6%） and 10-d triple regimen （49.4%）. 102 cases abandoned reeradication treatment after the failure of the first eradication therapy， and 112 children were given with reeradication management. The success rate of twice eradication therapies was 69.2%， and 75.0% for triple eradication interventions. 86 children were tested for Hp resistance. Hp culture and drug sensitivity tests of clarithromycin showed that the positive rate of Hp culture was 77.9% （67/86）， and the clarithromycin resistance rate was 17.4% （12/67）. The positive rate of clarithromycin resistant genes was 19.8% （17/86） by oligonucleotide microarray. Conclusions The invasive method based on gastroscopy has not been strictly implemented in our hospital for the diagnosis of Hp infection， and the success eradication rate of Hp is relatively low. Therefore， standardized treatment should be conducted to improve the success eradication rate and avoid expanding the scope of eradication treatment.

【Key words】Helicobacter pylori; Diagnosis; Treatment; Children; Guangzhou

幽门螺杆菌（Hp）是一种革兰阴性、螺旋状、微需氧菌，其与慢性胃炎、消化性溃疡、胃癌、胃黏膜相关淋巴组织淋巴瘤的发生密切相关，于1994年被WHO列为Ⅰ级致癌因子。儿童是Hp感染的高危人群，一旦感染很少自然根除，感染导致的胃黏膜慢性炎症将持续存在[1]。儿童Hp感染虽然很少引起胃部恶性病变，但可导致儿童慢性胃炎、消化性溃疡发病率上升，而且与诸如生长发育迟缓等疾病相关[2]。……