探讨分子生物学方法及细菌培养法检测西藏地区H.pylori对常用抗生素的耐药情况，并观察两种方法对诊断H.pylori耐药情况的临床价值。

选取2023年9月至2025年6月就诊于西藏自治区人民医院消化内科门诊的100名确诊为现症感染H.pylori的患者为研究对象。所有入组患者均详细记录病史（特别是H.pylori治疗史、既往抗生素使用史，药物过敏史等），签署知情同意并完成胃镜检查，并于胃窦（大弯）、胃体（小弯侧）各取活检，并均分成2份。其中一份采用耐克拉霉素、耐喹诺酮类药物幽门螺杆菌核酸检测试剂盒（PCR法）检测是否存在抗生素耐药相关基因突变。另一份标本用于H.pylori的分离培养及纸片法检测耐药情况。统计分析两种不同方法H.pylori耐药情况，并以培养法为金标准探讨PCR法对H.pylori克拉霉素、左氧氟沙星耐药检测的诊断价值。

共入组100例患者（其中无H.pylori治疗史患者92例，有H.pylori治疗史患者8例），采用培养法和PCR法检出H.pylori阳性率比较，差异具有统计学意义（81.0% vs 99.0%，P＜0.001）。培养法提示H.pylori对甲硝唑的耐药率为66.7%（54/81），对盐酸左氧氟沙星耐药率为39.5%（32/81），克拉霉素耐药率22.2%（18/81），阿莫西林耐药率4.9%（4/81），庆大霉素耐药率3.7%（3/81）对呋喃唑酮、四环素、利福平耐药均为1.2%（1/81）。81例H.pylori培养阳性患者中，单一耐药33株，以甲硝唑耐药为主，单一耐药率40.7%（33/81）；双重耐药20株，以左氧氟沙星和甲硝唑耐药为主，双重耐药率24.7%（20/81）；三重耐药10株，以左氧氟沙星、克拉霉素和甲硝唑耐药为主，三重耐药率12.4%（10/81）。耐药率由高到低依次是甲硝唑、左氧氟沙星、克拉霉素、阿莫西林、庆大霉素、呋喃唑酮、四环素、利福平。PCR法检测H.pylori耐药基因提示在99例H.pylori阳性患者中，克拉霉素耐药率38.4% （38/99），左氧氟沙星耐药率41.4%（41/99），克拉霉素、左氧氟沙星双重耐药率28.3%（28/99）。一致性分析显示PCR法与培养法检测克拉霉素耐药的Kappa值为0.62（95%CI：0.43~0.80，P＜0.001），检测左氧氟沙星耐药的Kappa值为0.72（95%CI：0.57~0.86，P＜0.001）。

本研究首次揭示了西藏地区幽门螺杆菌耐药率排列前三的抗生素为甲硝唑、左氧氟沙星和克拉霉素，阿莫西林、庆大霉素耐药率介于中间，呋喃唑酮、四环素、利福平耐药率较低。PCR法检测H.pylori阳性率显著高于培养法，两种方法对克拉霉素和左氧氟沙星耐药结果检测一致性较好。

To characterize antimicrobial resistance patterns of Helicobacter pylori (H.pylori) in the Xizang region through parallel molecular and conventional culture-based susceptibility testing, and to assess the clinical concordance between these methods.

A cohort of 100 consecutive patients with active H.pylori infection confirmed by gastroscopy was prospectively enrolled between September 2023 and June 2025. Detailed data on prior H.pylori treatment histories, antibiotic exposure, and allergies were documented. Gastric mucosal biopsies from the antrum and body were split for: (1) PCR detection of clarithromycin (23S rRNA) and fluoroquinolone (gyrA) resistance mutations; and (2) culture and Kirby-Bauer disk diffusion susceptibility testing against eight antibiotics. Resistance rates of H. pylori to different antibiotics were analyzed. Using the culture method as the gold standard, the diagnostic value of the PCR method for detecting clarithromycin and levofloxacin resistance was explored.

A total of 100 patients were enrolled (92 with no prior H.pylori treatment history and 8 with prior H.pylori treatment). The positivity rates for H.pylori detected by culture and PCR methods showed a statistically significant difference (81.0% vs 99.0%, P<0.01). Phenotypic resistance rates were as follows: metronidazole 66.7% (54/81), levofloxacin 39.5%(32/81), clarithromycin 22.2% (18/81), amoxicillin 4.9% (4/81), gentamicin 3.7% (3/81), and furazolidone/tetracycline/rifampicin each at 1.2%(1/81). Multidrug resistance patterns were observed: 40.7% (33/81) single-drug resistance (mainly metronidazole), 24.7% (20/81) double-drug resistance (mainly levofloxacin+metronidazole), and 12.4% (10/81) triple-drug resistance (levofloxacin+clarithromycin+metronidazole). PCR identified clarithromycin and levofloxacin resistance in 38.4% (38/99) and 41.4% (41/99) of cases, respectively, with 28.3% (28/99) exhibiting dual resistance. The Kappa value for detecting clarithromycin resistance between PCR and culture methods was 0.62 (95% confidence interval [CI]: 0.43~0.80, P＜0.001), and for levofloxacin resistance, it was 0.72 (95%CI: 0.57~0.86, P＜0.001).

This study reveal that the three antibiotics with the highest resistance rates to H. pylori in Xizang are metronidazole, levofloxacin, and clarithromycin, while amoxicillin and gentamicin show intermediate resistance rates, and furazolidone, tetracycline, and rifampin exhibit lower resistance rates. The PCR method demonstrated a significantly higher positive rate for H. pylori compared to the culture method, and both methods showed good consistency in detecting resistance to clarithromycin and levofloxacin.