Clinical Precision Treatment Application Of Helicobacter Pylori Infection Diagnosis And Drug Resistance Gene Detection

Objective:To explore the diagnostic value of different methods for Helicobacter pylori（Hp）infection and the application value of Hp resistance gene detection in guiding clinical accurate treatment of Hp infection.Methods:The patients who visited the Affiliated Hospital of Yunnan University from October to December 2022 were selected in this study.Gastroscopy,histological examination,¹⁴C urea breath test(¹⁴C-UBT)and rapid urease test（RUT）were performed at the same time in 113 patients,using histology as the gold standard,compared the diagnostic results and analyzed the diagnostic efficacy of the above methods,including the coincidence rate,consistency,negative predictive value（NPV）,specificity,positive predictive value（PPV）,sensitivity,area under the curve（AUC）and other related indicators,and white light endoscopic imaging is based on the"Kyoto Gastritis Classification"standard,judged by the endoscopist directly observing the endoscopic gastric mucosal manifestations of the subject.Patients with Hp infection who require Hp resistance gene and drug susceptibility testing are performed to complete molecular biology examination.Results:1.Basic clinical characteristics of the research subjects:This study eventually included 113 patients who met the study criteria,including 51 males and62 females.Compared with patients without smoking and drinking history,patients with smoking and drinking history had a higher Hp infection rate,Compared with negative Hp histological diagnosis,the incidence of belching,bad breath and diarrhea was higher,the incidence of duodenal ulcer was higher,and the incidence of fundic gland polyps was lower in the patients with positive Hp histological diagnosis,and the differences were statistically significant（P<0.05）.In endoscopic gastric mucosal manifestations considered to support Hp infection,diffuse redness,mucosal swelling,sticky mucus,enlarged and tortuous fold were different under gastroscopy between Hp positive and negative patients,it is statistically significant（P<0.05）.In endoscopic gastric mucosal manifestations considered to nonsupport Hp infection,red streak,regular arrangement collecting venules（RAC）,fundic gland polyps,raised erosion,hematin were different under gastroscopy between Hp positive and negative patients,it is statistically significant（P<0.05）.2.The positive rates of Hp diagnosed by pathological histology,¹⁴C-UBT,RUT were 29.20%and white light gastroscopy were30.97%,and the positive rates of Hp infection diagnosed by the above methods were not statistically significant（P>0.05）.Taking the histological results as the gold standard,the sensitivities of ¹⁴C-UBT,RUT and white gastroscopy in the diagnosis of Hp infection were 93.90%,97.00%and 90.90%,the specificities were 97.50%,98.80%,and 93.75%;PPV were 93.90%,97.00%and 85.71%;NPV were 97.50%,98.80%,and 96.15%;The coincidence rate were 96.5%,98.2%and 92.92%;The Kappa values were 0.914,0.957,and 0.832.Comparison of sensitivity、specificity、PPV、NPV and coincidence rate,the difference was not statistically significant（P>0.05）.The AUCs of ¹⁴C-UBT,RUT,and white-light endoscopy for independent diagnosis of Hp infection were 0.957,0.979,0.989 in turn（P<0.05）,and the differences in AUC between groups were not statistically significant（P>0.05）.Among them,the AUCs of RAC,diffuse redness,mucosal swelling,enlarged and tortuous fold,sticky mucus under white-light endoscopy were 0.804,0.873,0.873,0.654,0.620（P<0.05）,and the coincidence rates were 82.30%,92.00%,85.84%,78.80%and 75.20%.3.The resistance rates of Hp in 17 patients were as follows:the resistance rates of furazoldone,metronidazole,clarithromycin,tetracycline,quinolones and amoxicillin were 100.00%,100.00%,52.94%,29.41%,17.65%,11.76%,respectively.Hp resistance gene:furazolidone:C156T,C165T,A335G,C349A-G mutation of oor D and C347G mutation of por D,metronidazole:A19G,C92A,G392A,T262C mutation,clarithromycin:A2143G mutation,tetracycline:mutations at 16s 926 and 928,quinolones:87SNP2 mutation,amoxicillin:V374L,T593A,G595S,N562Y mutations.Conclusions:1.¹⁴C-UBT is a quick and convenient method for non-invasive diagnosis of Hp infection;2.In patients requiring both gastroscopy and Hp testing,RUT can be a quick and inexpensive way to diagnose Hp infection;3.Direct observation of gastric mucosal changes under white-light gastroscopy has certain diagnostic value for the diagnosis of Hp infection;4.The completion of Hp resistance genes and drug susceptibility detection is of great significance to guide clinical precision and radical treatment of Hp and avoid the abuse of antibiotics.