传染病信息

目的 探讨四川成都地区与藏区幽门螺杆菌(Helicobacter pylori, Hp)感染患者的高危因素及耐药性差异。方法 将2022年1月至2023年12月期间，在四川省中西医结合医院和三六三医院就诊且行上消化道内镜检查/治疗的200例患者(成都、藏区各100例)作为观察对象，通过¹³C/¹⁴C呼气试验检测Hp感染状态，对阳性样本进行细菌培养及药敏试验。采用单因素χ²检验与多因素Logistic回归分析感染危险因素。结果 中年患者Hp的感染占比(67.62%)高于青年组(32.38%)(χ²=7.572,P=0.006)；藏区Hp感染率(63.00%)明显高于成都地区(42.00%)(χ²=8.842,P<0.001)。单因素分析显示，共用餐具、饭前便后洗手、规律运动、动物接触、熬夜、进食瓜果蔬菜、食物来源是Hp感染的影响因素(均P<0.05)；多因素分析显示，共用餐具(OR=2.31,95%CI:1.24～4.30)、动物接触(OR=1.86,95%CI:1.02～3.41)、不洁食物来源(OR=1.67,95%CI:1.05～2.65)是Hp感染的独立危险因素；熬夜与Hp感染具有相关性；饭前便后洗手、规律运动(OR=0.53,95%CI:0.31～0.90)、进食瓜果蔬菜(OR=0.48,95%CI:0.27～0.85)是Hp感染的保护因素(均P<0.05)。与成都地区患者相比，藏区患者对阿莫西林(18.1%vs. 6.3%,P=0.021)和莫西沙星(15.9%vs. 4.8%,P=0.047)耐药率显著降低。结论 中年人群、藏区居民Hp感染风险更高。共用餐具、动物接触、不洁食物来源显著增加感染风险；良好卫生习惯、规律运动及健康饮食具有保护作用。藏区Hp感染者对阿莫西林、莫西沙星耐药率更低，临床应结合地域耐药特点优化根除方案。

Objective To investigate the high risk factors and drug resistance of Helicobacter pylori(Hp) infection in patients in Chengdu and Tibetan areas of Sichuan. Methods From January 2022 to December 2023, 200 patients(100 cases in Chengdu area and 100 cases in Tibetan area) who received upper gastrointestinal endoscopy/treatment in Sichuan Provincial Hospital of Integrated Traditional Chinese and Western Medicine and 363 rd Hospital were selected as observation subjects. Hp infection status was detected by ¹³C/¹⁴C breath test, and bacterial culture and drug sensitivity test were performed on positive samples. Univariate chi-square test and multivariate Logistic regression analysis were conducted to analyze the risk factors of infection. Results The proportion of infection with 67.62%(71/105) in middle-aged patients was higher than 32.38%(34/105) in young patients(χ²=7.572, P=0.006), and the infection rate of Hp in Tibetan area [63.00%(63/100)] was significantly higher than that in Chengdu area [42.00%(42/100)](χ²=8.842, P<0.001). Univariate analysis showed that sharing tableware, washing hands before meals and after using the toilet, regular exercise, animal contact, staying up late, eating fruits and vegetables, and food source were the influencing factors of Hp infection(P<0.05). Multivariate analysis revealed that sharing tableware(OR=2.31, 95%CI: 1.24-4.30), animal contact(OR=1.86, 95%CI: 1.02-3.41) and unclean food source(OR=1.67, 95%CI: 1.05-2.65) were independent risk factors of Hp infection, and staying up late was associated with Hp infection. Washing hands before meals and after using the toilet, regular exercise(OR=0.53, 95%CI: 0.31-0.90) and eating fruits and vegetables(OR=0.48, 95%CI: 0.27-0.85) were protective factors for Hp infection(P<0.05). The drug resistance rates of patients in Tibetan area to amoxicillin(18.1% vs. 6.3%, P=0.021) and moxifloxacin(15.9% vs. 4.8%, P=0.047) were significantly lower than those in Chengdu area. Conclusion The risk of Hp infection is high in middle-aged patients and Tibetan population. It is necessary to strengthen clinical prevention and control for such high-risk population. Sharing tableware, animal contact, unclean food source and other behaviors significantly increase the risk of Hp infection, while washing hands before meals and after using the toilet, regular exercise, healthy diet and other habits have a protective effect. The drug resistance rates of patients in Tibetan area to amoxicillin and moxifloxacin are significantly lower than those in Chengdu area. Clinical medication needs to be combined with regional characteristics to optimize the treatment regimen.