摘要
幽门螺杆菌（H. pylori）耐药性增加导致传统经验性根除治疗失败率升高，亟需精准干预策略。本文系统阐述耐药基因检测对个体化治疗的指导价值，重点解析23S rRNA、gyrA、PBP1等基因突变与克拉霉素、左氧氟沙星、阿莫西林耐药表型的关联机制。研究表明，基于基因型检测的个体化方案可显著提升根除率，较传统经验疗法更具优势，同时降低抗生素不合理使用及相关不良反应发生率。多重耐药菌株的精准识别依赖于实时荧光PCR、基因测序等技术的临床应用，其快速性和特异性为优化治疗方案提供技术保障。研究进一步指出，整合区域性耐药流行病学数据、建立标准化检测体系是提高治疗成功率的关键，标志着幽门螺杆菌感染治疗向精准医学模式转变。
关键词： 幽门螺杆菌；耐药基因检测；个体化治疗；抗生素耐药性；精准医学
Abstract
The increased resistance of Helicobacter pylori (H. pylori) has led to an increase in the failure rate of traditional empirical eradication therapy, and precise intervention strategies are urgently needed. This article systematically expounds the guiding value of resistance gene detection for personalized treatment, focusing on the association mechanism between 23S rRNA, gyrA, PBP1 and other gene mutations and clarithromycin, levofloxacin, and amoxicillin resistance phenotypes. Studies have shown that individualized programs based on genotype detection can significantly improve the eradication rate, which is more advantageous than traditional empirical therapy, while reducing the incidence of irrational use of antibiotics and related adverse reactions. The accurate identification of multidrug-resistant strains depends on the clinical application of technologies such as real-time fluorescence PCR and gene sequencing, and its rapidity and specificity provide technical guarantees for optimizing treatment plans. The study further pointed out that integrating regional resistance epidemiological data and establishing a standardized detection system are the key to improving the success rate of treatment, marking the transformation of Helicobacter pylori infection treatment to a precision medicine model.
Key words： Helicobacter pylori; Drug resistance gene detection; Personalized treatment; Antibiotic resistance; Precision medicine
参考文献 References
[1] Ren, Xinlu, et al. "Individualized diagnosis and eradication therapy for Helicobacter pylori infection based on gene detection of clarithromycin resistance in stool specimens: a systematic review and meta‐analysis." Helicobacter 28.3 (2023): e12958.
[2] Lin, Yifan, et al. "Antibiotic resistance in Helicobacter pylori: From potential biomolecular mechanisms to clinical practice." Journal of Clinical Laboratory Analysis 37.7 (2023): e24885.
[3] Alfaray, Ricky Indra, et al. "Global antimicrobial resistance gene study of Helicobacter pylori: comparison of detection tools, ARG and efflux pump gene analysis, worldwide epidemiological distribution, and information related to the antimicrobial-resistant phenotype." Antibiotics 12.7 (2023): 1118.
[4] Jearth, Vaneet, et al. "Drug-resistant Helicobacter pylori: Diagnosis and evidence-based approach." Diagnostics 13.18 (2023): 2944.
[5] 徐贝,李萍,朱传卫,等.幽门螺杆菌耐药基因检测在临床精准治疗中的价值[J].热带病与寄生虫学, 2024, 22(4): 244-247.
[6] 赵岩.基于TaqMan-MGB探针的幽门螺杆菌多重耐药基因检测研究[D].青岛大学,2022.
[7] 翁梅婷,杨莉丽,邹傲,等.基于一次性胃部细胞无创采样器的幽门螺杆菌耐药基因检测及其临床应用研究[J].新发传染病电子杂志, 2023, 8(5):36-40.
[8] 王萍,李时光,陈群,等.淄博市难治性幽门螺杆菌耐药性及耐药基因分析[J].中国抗生素杂志, 2024, 49(9):1038-1044.
[9] 牛占岳,周丽雅.全球耐药趋势下中国幽门螺杆菌根除治疗进展[J].中华消化杂志, 2021, 41(10):4.
[10] 马欣,胡崇晖,赵秀英.幽门螺杆菌耐药性的分子检测方法及进展[J].中华检验医学杂志, 2025, 48(03):419-424.
[11] 梅浩,赵喆,赵靖涛,等.幽门螺杆菌感染患者耐药的危险因素分析[J].胃肠病学, 2022, 27(2):87-91.
[12] Liping L , Wendi Z .101例胃黏膜幽门螺杆菌感染耐药基因突变分析[J].临床与病理杂志, 2022, 42(9):8.
[13] 张啸天,柯重伟.耐药幽门螺杆菌感染治疗的研究进展[J].上海医药, 2022, 43(1):22-24.
[14] 牟姗姗,韩霞,王娜,et al.幽门螺杆菌对5种抗生素的耐药率及与相关耐药基因的关系研究[J].河北医学, 2025, 31(1):106-111.
[15] 瞿燚,张振玉.基于粪便样本检测幽门螺杆菌感染及耐药情况的研究进展[J].胃肠病学和肝病学杂志, 2024, 33(11): 1552-1556.
[16] 温华,张明鑫,路宁,等.多重qPCR技术检测幽门螺杆菌及其耐药基因用于精准治疗的初步探讨[J].胃肠病学和肝病学杂志, 2023, 32(12):1343-1347.
[17] 张志镒,吴正奇,郜恒骏,等.454例幽门螺杆菌耐药性及药敏试验个性化诊疗效果分析[J].重庆医学, 2022(017): 051.
[18] 何琪云娜,潘美伶,田海英,等.根除治疗失败患者幽门螺杆菌的耐药特性及毒力基因研究[J].现代预防医学, 2024(7).
[19] 邵慧娟,李初谊,于晓辉,等.幽门螺杆菌的耐药机制及应对策略[J].实用临床医药杂志, 2023, 27(2):139-144.
[20] 彭若琳,张振玉.幽门螺杆菌耐药分子生物学检测的研究进展[J].胃肠病学和肝病学杂志, 2023, 32(12):1394-1398.