幽门螺杆菌耐药性的现状、机制及应对策略

doi:10.19871/j.cnki.xfcrbzz.2025.03.013

摘要/Abstract

摘要： 幽门螺杆菌（helicobacter pylori,H. pylori）感染是全球性公共卫生问题,与多种胃部疾病密切相关,包括慢性胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织淋巴瘤等。随着抗生素的广泛使用,H. pylori的耐药性逐渐成为治疗失败的关键因素。近年来,H. pylori的耐药率在全球范围内显著上升,尤其是对克拉霉素、甲硝唑和左氧氟沙星等常用抗生素的耐药较为突出。耐药机制复杂多样,包括抗生素作用靶点的改变、药物外排泵系统的上调、生物膜的形成以及其他机制。为了有效应对耐药性问题,除了传统的药物敏感试验指导治疗外,还应探索新的治疗方法,如噬菌体治疗、纳米技术输送抗生素、疫苗开发等。此外,优化现有治疗方案、延长治疗疗程、联合益生菌或中药治疗等策略也显示出一定的疗效。本文通过对多篇相关文献的综合分析,从耐药性现状、耐药机制以及应对策略等方面进行综述,旨在为临床治疗和进一步研究提供参考依据。

关键词: 幽门螺杆菌, 耐药性, 耐药机制, 治疗

Abstract: Helicobacter pylori (H. pylori) infection is a global public health issue and is closely associated with a variety of gastric diseases, including chronic gastritis, peptic ulcers, gastric cancer, and gastric mucosa-associated lymphoid tissue lymphoma. With the extensive use of antibiotics, drug resistance in H. pylori has gradually become a key factor in treatment failure. In recent years, the drug resistance rate of H. pylori has significantly increased worldwide, particularly to commonly used antibiotics such as clarithromycin, metronidazole, and levofloxacin. The mechanisms of resistance are complex and diverse, including alterations in antibiotic targets, upregulation of drug efflux pump systems, biofilm formation, and other mechanisms. To effectively address the issue of drug resistance, in addition to traditional antibiotic susceptibility testing-guided treatment, new therapeutic approaches should be explored, such as phage therapy, nanoparticle delivery of antibiotics, and vaccine development. Moreover, strategies like optimizing existing treatment regimens, extending treatment duration, and combining probiotics or traditional Chinese medicine with antibiotics have also shown certain therapeutic effects. This review article provides a comprehensive analysis of multiple relevant studies, focusing on the current status of drug resistance, mechanisms of resistance, and coping strategies. The aim is to offer reference for clinical treatment and further research.

Key words: Helicobacter pylori, Drug resistance, Resistance mechanism, Treatment

中图分类号:

R446.5

樊冰, 聂勇波, 裴晓改, 李志鹏, 周明, 罗漪, 向琪. 幽门螺杆菌耐药性的现状、机制及应对策略[J]. 新发传染病电子杂志, 2025, 10(3): 72-77.

Fan Bing, Nie Yongbo, Pei Xiaogai, Li Zhipeng, Zhou Ming, Luo Yi, Xiang Qi. The current status, mechanisms, and coping strategies of helicobacter pylori drug resistance[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(3): 72-77.

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