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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 112 -120. doi: 10.3877/cma.j.issn.1674-0793.2026.02.007

论著

基于定量聚合酶链反应的幽门螺杆菌感染率及其对克拉霉素和氟喹诺酮类抗生素耐药性的监测:一项单中心横断面研究
温业楷1,2,3, 刘德华1,2,3, 林香伶4, 田琼5, 王春飞5, 钟理6, 严乐平6, 何裕隆1,2,3, 杨峥4, 杨东杰1,2,3,†()   
  1. 1　518107　深圳，中山大学附属第七医院消化医学中心胃肠外科
    2　518107　深圳，广东省消化系统恶性肿瘤防治研究重点实验室
    3　510000　广州，中山大学胃癌诊治研究中心
    4　518107　深圳，中山大学附属第七医院病理科
    5　518107　深圳，中山大学附属第七医院内镜中心
    6　518107　深圳，中山大学附属第七医院科研中心
  • 收稿日期:2026-03-15 出版日期:2026-04-01
  • 通信作者: 杨东杰
  • 基金资助:
    国家自然科学基金项目(82172637，82220108013，U20A2037932371472); 中山大学附属第七医院科研启动基金项目(ZSQYJZPI202010); 广东省消化系统恶性肿瘤防治研究重点实验室项目(2021B1212040006); 深圳市消化系统疾病（胃肠外科）临床医学研究中心项目(LCYSSQ20220823091203008); 广东省医学科学技术研究基金项目(A2016295); 广东省国际科技合作项目(2023A0505050120); 深圳市国际科技合作项目(GJHZ20220913142401003); 广东省自然科学基金项目(2023A1515011962)

Research on Helicobacter pylori prevalence and antibiotic resistance to clarithromycin based on fluoroquinolones using quantitative polymerase chain reaction: A single-center, cross-sectional surveillance

Yekai Wen1,2,3, Dehua Liu1,2,3, Xiangling Lin4, Qiong Tian5, Chunfei Wang5, Li Zhong6, Leping Yan6, Yulong He1,2,3, Zheng Yang4, Dongjie Yang1,2,3,†()   

  1. 1 Department of Gastrointestinal Surgery, Digestive Medicine Center, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
    2 Guangdong Provincial Key Laboratory of Digestive Cancer Research, Shenzhen 518107, China
    3 Research Center for Diagnosis and Treatment of Gastric Cancer, Sun Yat-sen University, Guangzhou 510000, China
    4 Department of Pathology, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
    5 Endoscopy Center, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
    6 Scientific Research Center, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
  • Received:2026-03-15 Published:2026-04-01
  • Corresponding author: Dongjie Yang
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温业楷, 刘德华, 林香伶, 田琼, 王春飞, 钟理, 严乐平, 何裕隆, 杨峥, 杨东杰. 基于定量聚合酶链反应的幽门螺杆菌感染率及其对克拉霉素和氟喹诺酮类抗生素耐药性的监测:一项单中心横断面研究[J/OL]. 中华普通外科学文献(电子版), 2026, 20(02): 112-120.

Yekai Wen, Dehua Liu, Xiangling Lin, Qiong Tian, Chunfei Wang, Li Zhong, Leping Yan, Yulong He, Zheng Yang, Dongjie Yang. Research on Helicobacter pylori prevalence and antibiotic resistance to clarithromycin based on fluoroquinolones using quantitative polymerase chain reaction: A single-center, cross-sectional surveillance[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(02): 112-120.

目的

评估深圳市人口的幽门螺杆菌（Hp）感染率及其抗生素耐药情况。

方法

纳入7 000名参与者，在胃镜检查过程中获取胃活检标本，并进行胃镜检查和组织病理学评估。通过对提取的基因组DNA进行定量聚合酶链反应分析，确定Hp感染状态和抗生素耐药模式。

结果

2023—2025年，参与者Hp的总体感染率为55.36%。感染率峰值出现在25~34岁。在接受抗生素耐药性筛查的3 875例感染者中，克拉霉素耐药率为40.75%，氟喹诺酮类抗生素耐药率为22.63%；儿童和青少年中克拉霉素耐药率更高。经组织病理学确诊的胃萎缩患者的Hp感染率最高，而在伴有肠上皮化生的感染病例中抗生素耐药最常发生。与初次感染相比，持续性感染表现出更高的抗生素耐药率。

结论

本研究提供了中国南方地区人口Hp感染情况的最新全面数据，描述了其当前的流行模式、新出现的抗生素耐药特征及临床关联。

关键词: 幽门螺杆菌, 抗生素耐药性, 定量聚合酶链反应
Objective

To evaluate the prevalence of Helicobacter pylori (Hp) infection and its antibiotic resistance profile in the population of Shenzhen.

Methods

A total of 7 000 participants were enrolled. Gastric biopsy specimens were obtained during gastroscopy, followed by endoscopic and histopathological evaluation. Hp infection status and antibiotic resistance patterns were determined by quantitative polymerase chain reaction analysis of extracted genomic DNA.

Results

The overall Hp infection rate among participants was 55.36% from 2023 to 2025. The peak infection rate occurred in participants aged 25-34 years. Among the 3 875 infected individuals screened for antibiotic resistance, the clarithromycin resistance rate was 40.75%, and the fluoroquinolone resistance rate was 22.63%. Higher clarithromycin resistance rates were observed in children and adolescents. Patients with histologically confirmed gastric atrophy exhibited the highest infection rate, while antibiotic resistance was most frequently observed in infected cases with concomitant intestinal metaplasia. Persistent infections demonstrated higher antibiotic resistance rates compared to initial infections.

Conclusion

This study presents a comprehensive update on Hp infection in southern China, characterizing its current prevalence patterns, emerging antibiotic resistance profiles, and clinical associations.

Key words: Helicobacter pylori infection, Antibiotic resistance, Quantitative polymerase chain reaction
表1 Hp阳性参与者的基线特征[例（%）]
变量 Hp阳性(3 875例) 克拉霉素耐药(1 579例) 氟喹诺酮类抗生素耐药 (877例) 双重抗生素耐药(545例)
年龄（岁）
总计 3 875 (55.36) 1 579 (40.75) 877 (22.63) 545 (14.06)
0~19 43 (60.56) 21 (48.84) 4 (9.30) 3 (6.98)
>19~24 129 (66.15) 62 (48.06) 11 (8.53) 6 (4.65)
>24~29 316 (73.15) 119 (37.66) 33 (10.44) 24 (7.59)
>29~34 487 (69.97) 204 (41.89) 72 (14.78) 47 (9.65)
>34~39 598 (65.43) 222 (37.12) 127 (21.21) 80 (13.38)
>39~44 556 (61.10) 235 (42.27) 129 (23.20) 82 (14.75)
>44~49 453 (56.00) 188 (41.50) 110 (24.28) 76 (16.78)
>49~54 426 (49.77) 177 (41.55) 131 (30.75) 76 (17.84)
>54~59 354 (43.38) 144 (40.68) 111 (31.36) 69 (19.49)
≥60 513 (39.43) 207 (40.35) 149 (29.04) 82 (15.98)
感染强度
A (+) 825 297 (36.00) 131 (15.88) 79 (9.58)
B (++) 2 185 899 (41.14) 515 (23.57) 331 (15.15)
C (+++) 865 383 (44.28) 231 (26.71) 135 (15.64)
感染亚型
Ⅰ型 2 759 1 164 (42.19) 679 (24.61) 430 (15.59)
非Ⅰ型 1 116 415 (37.19) 198 (17.74) 115 (10.30)
炎症严重程度分级
1 670 (20.63) 265 (39.55) 142 (21.19) 85 (12.69)
2 3 115 (85.65) 1 284 (41.22) 720 (23.11) 448 (14.38)
3 80 (97.56) 25 (31.25) 12 (15.00) 9 (11.25)
炎症活动度分级
0 646 (20.14) 247 (38.24) 131 (20.28) 79 (12.23)
1 1 520 (76.92) 674 (44.34) 336 (22.11) 222 (14.61)
2 1 684 (95.41) 647 (38.42) 404 (23.99) 238 (14.13)
3 15 (78.95) 6 (40.00) 3 (20.00) 3 (20.00)
胃萎缩程度分级
0 3 198 (54.51) 1 300 (40.65) 709 (22.17) 442 (13.82)
1 553 (60.97) 219 (39.60) 140 (25.32) 83 (15.01)
2 102 (62.20) 49 (48.04) 23 (22.55) 15 (14.71)
3 5 (55.56) 2 (40.00) 0 (0) 0 (0)
肠上皮化生程度分级
0 3 126 (56.83) 1 270 (40.63) 668 (21.37) 417 (13.34)
1 538 (50.28) 209 (38.85) 149 (27.70) 86 (15.99)
2 176 (50.00) 82 (46.59) 51 (28.98) 34 (19.32)
3 25 (55.56) 13 (52.00) 6 (24.00) 5 (20.00)
胃镜诊断
浅表性胃炎 1 379 (48.56) 572 (41.48) 261 (18.93) 162 (11.75)
萎缩性胃炎(C1) 695 (53.38) 265 (38.13) 137 (19.71) 80 (11.51)
萎缩性胃炎(C2) 1 339 (63.49) 530 (39.58) 337 (25.17) 198 (14.79)
萎缩性胃炎(C3) 311 (64.52) 149 (47.91) 97 (31.19) 74 (23.79)
萎缩性胃炎(O1) 94 (68.12) 38 (40.43) 26 (27.66) 17 (18.09)
萎缩性胃炎(O2) 13 (61.90) 5 (38.46) 4 (30.77) 4 (30.77)
萎缩性胃炎(O3) 20 (47.62) 13 (65.00) 8 (40.00) 7 (35.00)
病理诊断
胃炎 2 847 (55.58) 1 160 (40.74) 617 (21.67) 386 (13.56)
胃萎缩 266 (77.55) 106 (39.85) 50 (18.80) 30 (11.28)
肠上皮化生 725 (50.42) 298 (41.10) 205 (28.28) 125 (17.24)
胃不典型增生 0 (0) 0 (0) 0 (0) 0 (0)
胃癌 33 (42.86) 13 (39.39) 5 (15.15) 4 (12.12)
持续性感染
是 328 172 (52.44) 92 (28.05) 67 (20.43)
否 3 547 1 407 (39.67) 785 (22.13) 478 (13.48)
地区经济发展情况
发达 2 078 (55.74) 847 (40.76) 451 (21.70) 283 (13.62)
欠发达 1 396 (52.66) 580 (41.55) 343 (24.57) 218 (15.62)
表2 分组比较及统计检验结果
变量及分组 Hp感染 克拉霉素耐药 氟喹诺酮类抗生素耐药 双重抗生素耐药
χ2值 P值 χ2值 P值 χ2值 P值 χ2值 P值
Hp感染亚型
Ⅰ型 vs 非Ⅰ型 - - 8.237 <0.01 21.408 <0.001 - -
Hp感染强度
A (+) vs B (++) - - 6.618 <0.05 21.016 <0.001 - -
A (+) vs C (+++) - - 12.032 <0.001 29.405 <0.001 - -
年龄（岁）
≥44 vs <44 - - - - - - 28.450 <0.001
≥49 vs <49 - - - - 64.137 <0.001 - -
胃镜诊断
SG vs AG_C1 8.307 <0.01 - - - - - -
SG vs AG_C2 109.015 <0.001 - - - - - -
SG vs AG_C3 42.032 <0.001 4.290 <0.05 22.857 <0.001 - -
SG vs AG_O1 20.142 <0.001 - - - - - -
SG vs AG_O3 - - 4.483 <0.05 5.637 <0.05 - -
病理诊断
胃炎 vs 胃萎缩 63.458 <0.001 - - - - - -
胃炎 vs 肠上皮化生 11.933 <0.001 - - 14.224 <0.001 - -
胃炎 vs 胃癌 5.453 <0.05 - - - - - -
胃萎缩 vs 肠上皮化生 - - - - 9.149 <0.005 - -
炎症严重程度分级
1 vs 2 2 934.186 <0.001 - - - - - -
1 vs 3 57.868 <0.001 - - - - - -
炎症活动度分级
0 vs 1 1 620.387 <0.001 - - - - - -
0 vs 2 2 589.996 <0.001 - - - - - -
0 vs 3 40.090 <0.001 - - - - - -
胃萎缩程度分级
0 vs 1~3 16.103 <0.001 - - - - - -
肠上皮化生程度分级
0 vs 1~3 19.513 <0.001 - - - - - -
地区经济发展情况
发达 vs 欠发达 5.930 <0.05 - - 3.892 <0.05 - -
图1 研究参与者的人口学特征、幽门螺杆菌感染率及两种诊断方法的一致性　A. 研究对象的地区分布；B.不同年龄段人群的幽门螺杆菌感染率分布；C.基于Ct值绘制的反映定量PCR与碳13尿素呼气试验诊断结果一致性的ROC曲线；曲线下面积（AUC）；在该值时可达到最大尤登指数的值（Cut-off）；敏感度（SEN）；特异度（SPE）
图2 克拉霉素耐药性在不同年龄段、幽门螺杆菌亚型及感染强度中的分布　A.不同年龄段耐药性的分布；B.幽门螺杆菌菌株亚型的分布；C.幽门螺杆菌感染强度的分布
图3 氟喹诺酮类抗生素耐药性在不同年龄段、幽门螺杆菌亚型及感染强度中的分布　A.不同年龄段氟喹诺酮类抗生素耐药性的分布；B.幽门螺杆菌亚型的分布；C.幽门螺杆菌感染强度的分布
图4 不同年龄段人群中对克拉霉素和氟喹诺酮类抗生素双重耐药性分布
图5 经胃镜及病理诊断的不同胃部疾病类别中幽门螺杆菌感染率分布　A.基于木村-竹本分类法的胃炎及胃萎缩中幽门螺杆菌感染率；B.不同胃部疾病组间幽门螺杆菌感染率的比较；C.按炎症严重程度分级的幽门螺杆菌感染分布；D.按炎症活动度分级的幽门螺杆菌感染分布；E.不同胃萎缩程度下的幽门螺杆菌感染模式；F.按肠上皮化生分级统计的幽门螺杆菌感染频率；浅表性胃炎（SG）；萎缩性胃炎(C1)（AG_C1）；萎缩性胃炎(C2)（AG_C2）；萎缩性胃炎(C3)（AG_C3）；萎缩性胃炎(O1)（AG_O1）；萎缩性胃炎(O2)（AG_O2）；萎缩性胃炎(O3)（AG_O3）
图6 不同疾病组的抗生素耐药性分布　根据胃镜诊断，胃炎和胃萎缩患者对克拉霉素（A）和氟喹诺酮类抗生素（B）的耐药率；根据病理诊断，胃炎和胃萎缩患者对克拉霉素（C）和氟喹诺酮类抗生素（D）的耐药率；E.持续性幽门螺杆菌感染患者的克拉霉素和氟喹诺酮类抗生素耐药性分布；F.持续性幽门螺杆菌感染病例中出现炎症活动性的比例；G.持续性幽门螺杆菌感染病例按疾病分类的分布；浅表性胃炎（SG）；萎缩性胃炎(C1)（AG_C1）；萎缩性胃炎(C2)（AG_C2）；萎缩性胃炎(C3)（AG_C3）；萎缩性胃炎(O1)（AG_O1）；萎缩性胃炎(O2)（AG_O2）；萎缩性胃炎(O3)（AG_O3）
图7 不同经济地区的幽门螺杆菌感染率及抗生素耐药性的分布　A.发达和欠发达地区幽门螺杆菌感染率的分布；B、C.发达和欠发达地区克拉霉素和氟喹诺酮类抗生素耐药性的分布
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