幽门螺杆菌多重耐药性对胃肠疾病诊治的挑战与应对策略

Multidrug resistance of Helicobacter pylori and its impact on the diagnosis and treatment of gastrointestinal diseases and countermeasures

摘要:

幽门螺杆菌(Helicobacter pylori)可引起慢性胃炎、胃十二指肠溃疡等疾病，被世界卫生组织列为I类致癌物。临床上主要用抗生素对H.pylori进行杀菌清除治疗。抗生素清除H. pylori不彻底引起的持续感染成为胃癌高发的潜在风险。随着抗生素的广泛使用，H. pylori产生了多重耐药(multidrug resistance,MDR)，进而引起慢性胃病治疗失败及耐药菌株传播风险增加。幽门螺杆菌的多重耐药已成为胃肠疾病诊治的严峻挑战之一。本文结合相关文献和课题组的研究结果，综述了H. pylori多重耐药的全球发展趋势、发生机制、对临床诊断的挑战以及对药物研发的挑战，提出了依据H. pylori的cgt基因表达量测定活菌的新方法，胞内化是H. pylori耐药的新形式，O-聚糖抗H. pylori是应对多重耐药的防治新策略。本文为深入理解H. pylori多重耐药的机制及其防治策略提供了新的思路，有望为未来临床治疗和抗菌药物研发开辟新方向。

Abstract:

Helicobacter pylori is a bacterium that can cause chronic gastritis, peptic ulcers, and other gastrointestinal diseases. The World Health Organization has classified H. pylori as a group I carcinogen. Antibiotics are the primary clinical approach for eradicating H. pylori. However, incomplete eradication of H. pylori by antibiotics can lead to persistent infection, which is a major risk factor for the high incidence of gastric cancer. The widespread use of antibiotics has led to the emergence of multidrug resistance in H. pylori, contributing to treatment failures of chronic gastric diseases and increasing the risk of spreading resistant strains. Multidrug-resistant H. pylori has become a serious challenge in the diagnosis and treatment of gastrointestinal diseases. This paper reviews the global trends in the development of multidrug resistance in H. pylori, the underlying mechanisms, the challenges it poses to clinical diagnosis, and its impact on drug development, drawing on relevant literature and the research findings from our group. It proposes using cgt expression as a novel method for determining viable bacteria, identifying intracellularization as a new form of resistance in H. pylori, and exploring the potential of O-glycans as a therapeutic approach against H. pylori to address multidrug resistance. It provides new insights into understanding the mechanisms of H. pylori multidrug resistance and its prevention strategies, offering promising directions for future clinical treatments and antimicrobial drug development.