2019-01-012024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/683919摘要：研究背景與目的：幽門螺旋桿菌已被證明是胃癌和消化性潰瘍的重要誘發因素。在改善公共衛生和根除幽門螺旋桿菌的國家政策後，台灣的幽門螺旋桿菌的盛行率減少。然而台灣缺乏最新的幽門螺旋桿菌感染的全國盛行率資料。世界各國幽門螺旋桿菌感染的除菌藥物抗藥性有增加的趨勢，研究台灣幽門桿菌抗藥性狀況可以提供給政府制定除菌政策和抗生素控管政策的資訊。我們的研究的目的是評估台灣幽門螺旋桿菌感染的最新全國盛行率和幽門螺旋桿菌感染的抗藥性變化。研究方法: 幽門桿菌盛行率將以社區民眾為收案對象:我們將招募1200名20歲以上成人未曾接受過幽門螺旋桿菌除菌的志願者，接受碳13尿素酶呼氣試驗、收集糞便做幽門螺旋桿菌糞便抗原快速檢測測試，此外，將招募300位20歲以下之未曾接受過幽門螺旋桿菌除菌的青少年及兒童，收集糞便進行幽門螺旋桿菌糞便抗原快速檢測，以調查台灣幽門螺旋桿菌盛行率的情況。抗藥性調查將將以到醫院接受上內視鏡檢查之患者為收案對象:將納入1000名到醫院並同意接受胃幽門螺旋桿菌檢查的20歲以上成年患者加入抗藥性研究，符合收案條件的患者將接受胃粘膜切片以進行組織學檢查，快速尿素酶試驗和幽門螺旋桿菌培養，預期將有400名有幽門螺旋桿菌感染並可培養出幽門螺旋桿菌菌株，將用瓊脂稀釋法進行藥敏試驗，用於鑑定抗生素的最小抑菌濃度，並萃取DNA以檢測23S rRNA和gyrase A的點突變。所有研究族群將抽血以測試胃蛋白酶原I和II以找出胃黏膜萎縮的患者，未來將連結癌症登記及健保資料庫，以分析透過幽門桿菌篩檢及除菌治療是否能降低胃癌發生率。預期成果: 在本計畫中，我們可以了解台灣幽門螺旋桿菌的感染及抗藥性盛行率，並找出幽門螺旋桿菌感染的危險因子，以協助政府制定胃癌防治策略。幽門螺旋桿菌抗藥性之調查除了提供臨床醫師選擇除菌處方之依據之外，也有助於政府制定抗生素管理之政策。<br> Abstract: Backgroud and Aims: Helicobacter pylori (H. pylori) has been proved to be an important predisposing factor for gastric cancer and peptic ulcer. After improved public sanitation and national policy of H. pylori eradication, some relevant studies showed the prevalence of H. pylori in Taiwan seemed decreasing. However, the updated nationwide prevalence of H. pylori infection in Taiwan is lacking. The prevalence of antimicrobial resistance for H. pylori infection increased by time in the world. Further research for pattern of antimicrobial resistance for H. pylori in Taiwan is worthy performed for eradication policy and antimicrobial control. We aimed to assess the updated prevalence of H. pylori infection and change of antimicrobial resistance for H. pylori infection in Taiwan. Methods: We will recruit 1200 volunteers aged 20 or greater who never receive H. pylori eradication. They will receive C13 urease breath test, H. pylori stool Antigen ELISA and the Rapid Test for screening of H. pylori infection to find the prevalence of H. pylori infection in Taiwan. We will also recruit 300 children and adolescent to receive H. pylori stool Antigen ELISA and the Rapid Test for screening of H. pylori. On the other hand, 1000 adult patients with ≧ 20 years-old who visit hospitals for upper endoscopy will be invited for antimicrobial resistance surveillance program (expect 400 H. pylori strains will be isolated). Eligible patients will received gastric mucosal biopsy for histological examination, rapid urease test and cultures of H. pylori. Agar dilution test will be used to determine the minimum inhibitory concentration of antibiotics and DNA will be extracted to detect the point mutation of 23S rRNA and gyrase A in H. pylori infected patients. All of study population will receive blood sampling to test pepsinogen I and II for identification of gastric atrophy.Expected results: We will be able to estimate the disease burden of H. pylori and its associated disease in Taiwan through this program. The surveillance of antibiotic resistance of H. pylori may help the clinicians to choose the optimal regimens for patients and may also help the government to make the policy for controlling antimicrobial resistance in Taiwan.幽門螺旋桿菌抗藥性碳13尿素酶呼氣試驗胃黏膜萎縮性別Helicobacter pyloriantibiotic resistanceC13 urea breath testgastric atrophygender