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  • 學位論文

探討幽門螺旋桿菌根除治療後再感染率及腸道菌落抗藥性之影響因子

Analysis of re-infection rate and factor in the antimicrobial resistance of gut flora after eradication of Helicobacter pylori infection.

指導教授 : 方啟泰

摘要


摘要: 根據過去研究發現,根除幽門螺旋桿菌感染可以解決胃潰瘍、十二指腸潰瘍以及非潰瘍性消化不良,更重要的是,可以防止胃癌的發生。但是也有研究顯示根除感染只能減緩腸胃道症狀,而原本逆流性的相關疾病卻沒有被解決。(7)大多數發達國家研究復發率的報告約<1%,而在大多數的發展中國家,卻呈現較高的復發率。再感染率因各個國家幽門螺旋桿菌的盛行率以及衛生環境不同而有差異,因此需要有本土的流行病學調查以了解本國的再感染率。在發達國家,復發的幽門螺旋桿菌通常被認定是『復發』,而發展中國家的研究卻表示,幽門螺旋桿菌復發的原因主要是『再度感染』,過去研究顯示,長期使用抗菌治療可能與幽門螺旋桿菌根除率有關係,主要是因為抗生素的耐藥性。因此我們可以探討腸胃道菌欉的抗藥性影響因子,來協助了解幽門螺旋桿菌的復發/再度感染,是否與長期使用抗生素有相關。 研究目的與方法: 目前三合一或四合一藥物的組合療法雖然可以達到80-90%的根除率,但成功根除幽門螺旋桿菌後仍有1%~20%不等的患者可能會再感染。再感染率因各個國家幽門螺旋桿菌的盛行率以及衛生環境不同而有差異,因此需要有本土的流行病學調查以了解本國的再感染率以及再感染的危險因子。因此除了了解上述目的之外,也想了解 (1)腸胃道細菌抗藥性之影響因子 (2)評估不同的殺菌治療處方及多次殺菌成功個案幽門螺旋桿菌根除治療後的復發率。 在過去5年期間,北台灣地區共進行了3個幽門桿菌根除治療的臨床試驗 (一線三合一殺菌治療成功309人、二線殺菌治療成功72人、三線殺菌治療成功75人),共收案456人。我們將邀請成功根除幽門桿菌一年的患者回診參與吹氣檢驗,確認有無再次感染幽門桿菌、並協助個案填寫生活問卷了解殺菌之後的生活型態以及收集糞便檢體來檢查腸道菌落抗藥性。 結果與結論: 從幽門螺旋桿菌復發/再感染率來看,使用一線RCT治療復發/再感染率約2.9%;三線治療復發/再感染率約4.9%,符合了原先文獻佐證的復發率約為1~5%。各組幽門螺旋桿菌復發/再感染率P-value0.49>0.05;表示不論是殺菌幾次的復發/再感染率是沒有差異的,且各組表示不論使用幾次的殺菌藥物殺菌治療完成後其復發/再感染也沒有不同。另外在一線RCT與三線復發/再感染率的男女之間復發情形也沒有顯著的差異性。RCT一線治療使用A或B組藥物的復發率各為3.6%、2.8%,P-value1>0.05,顯示不論使用哪一種藥物殺菌其復發/再感染率無差異性。腸胃道細菌抗藥性顯示不論哪一組殺菌過後的腸胃道細菌其抗藥性在多次殺菌或者使用不同的藥物殺菌時都不影響菌株的抗藥性。

並列摘要


According to past research found that eradication of H. pylori infection can solve ulcer, duodenal ulcer and non-ulcer dyspepsia, more importantly, can prevent the occurrence of gastric cancer. However, studies have shown that eradication of infection can only slow gastrointestinal symptoms originally reflux related diseases has not been resolved.Most of the developed countries, the report of the study the recurrence rate of about <1% in most of the developing countries, but showed a higher recurrence rate. Reinfection rates differ due to the prevalence of H. pylori in various countries as well as the health environment, local epidemiological survey in order to understand their own re-infection rates. Recurrence of H. pylori in developed countries, is usually identified as "relapse" research in developing countries Helicobacter pylori recurrence of the main reasons is the "re-infection", past studies have shown that long-term use of antimicrobial therapy may be associated with pyloric pylori eradication rate, mainly because of antibiotic resistance. So we can investigate the resistance of gastrointestinal bacteria Tsung impact factor, to assist in the understanding of H. pylori recurrence / reinfection, whether associated with long-term use of antibiotics.

參考文獻


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