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

doi:10.3877/cma.j.issn.1674-0793.2026.02.007

Abstract

Abstract:

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

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]. Chinese Archives of General Surgery(Electronic Edition), 2026, 20(02): 112-120.

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References 25

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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)

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)

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
变量及分组	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	-	-

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
变量及分组	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	-	-

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