{"id":24370,"date":"2022-03-28T09:00:37","date_gmt":"2022-03-28T06:00:37","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=24370"},"modified":"2022-03-28T10:34:01","modified_gmt":"2022-03-28T07:34:01","slug":"h-pylori-tanisinda-kullanilan-testlerin-performansi","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2022\/03\/28\/h-pylori-tanisinda-kullanilan-testlerin-performansi\/","title":{"rendered":"Helicobacter pylori<\/i> \u0130nfeksiyonu Tan\u0131s\u0131nda K\u00fclt\u00fcr, H\u0131zl\u0131 \u00dcreaz Testi ve Histopatolojinin Tan\u0131 De\u011ferlerinin ve \u00c7e\u015fitli Antimikrobiyallerin Helicobacter pylori<\/i>\u2019ye Kar\u015f\u0131 In Vitro<\/i> Etkilerinin \u0130ncelenmesi"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/h2>\n

Helicobacter pylori (H. pylori)<\/i>, ilk kez 1983 y\u0131l\u0131nda Warren ve Marshall taraf\u0131ndan insan midesinde g\u00f6sterilmi\u015f, \u00f6zellikle peptik \u00fclser hastal\u0131\u011f\u0131 ile birlikteli\u011fi bildirilmi\u015ftir (1). H. pylori <\/i>infeksiyonu d\u00fcnyada olduk\u00e7a yayg\u0131n olup geli\u015fmi\u015f \u00fclkelerde %20-50; geli\u015fmekte olan \u00fclkelerde ise %50-90 oran\u0131nda g\u00f6r\u00fclmektedir (2). H. pylori<\/i> \u00e7e\u015fitli mide hastal\u0131klar\u0131na neden olan bir bakteri olup infeksiyon sonucunda gastrit, peptik \u00fclser, mide mukozas\u0131 ile ili\u015fkili lenfoid doku lenfomas\u0131 ve mide kanseri geli\u015fmesi g\u00fcn\u00fcm\u00fczde \u00f6nemini art\u0131rmaktad\u0131r (3, 4).<\/p>\n

H. pylori <\/i>infeksiyonunun tan\u0131s\u0131nda, invazif ve invazif olmayan \u00e7e\u015fitli testler kullan\u0131lmaktad\u0131r. Seroloji, \u00fcre nefes testi ve d\u0131\u015fk\u0131da antijen testleri invazif olmayan tan\u0131 y\u00f6ntemleridir. \u0130nvazif testler ise; h\u0131zl\u0131 \u00fcreaz testi (H\u00dcT), histoloji, k\u00fclt\u00fcr ve molek\u00fcler y\u00f6ntemlerdir. Bu testler i\u00e7in endoskopi ile al\u0131nan mide biyopsi \u00f6rne\u011fine gereksinim duyulur. Tan\u0131da endoskopi ile al\u0131nan \u00f6rneklerde, en az iki testin birlikte kullan\u0131lmas\u0131, y\u00fcksek duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fc\u011f\u00fcnden dolay\u0131 \u00f6nerilmektedir (5).<\/p>\n

H. pylori <\/i>infeksiyonu tedavisinde lansoprazol ile birlikte kombine antibiyotik kullan\u0131m\u0131 gerekmektedir. Amoksisilin, klaritromisin, levofloksasin ve metronidazol, infeksiyonun tedavisinde se\u00e7ilen antibakteriyel ajanlard\u0131r. Tedavi ba\u015far\u0131s\u0131zl\u0131klar\u0131; hastan\u0131n ya\u015f\u0131, tedavi \u00f6ncesi midedeki bakteri y\u00fck\u00fc, sigara kullan\u0131m\u0131, hastan\u0131n ila\u00e7 uyumu ve ila\u00e7 direnci gibi nedenlere ba\u011flanmaktad\u0131r.<\/p>\n

Bu \u00e7al\u0131\u015fmada, dispeptik \u015fikayetlerle ba\u015fvuran hastalardan al\u0131nan mide biyopsi \u00f6rneklerinde k\u00fclt\u00fcr, histoloji ve H\u00dcT y\u00f6ntemleriyle H. pylori<\/i> infeksiyonu varl\u0131\u011f\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131 ve izolatlar\u0131n amoksisilin, klaritromisin, levofloksasin ve metronidazole kar\u015f\u0131 diren\u00e7lerinin antibiyotik gradyan y\u00f6ntemi (Etest\u00ae bioM\u00e9rieux, Marcy-l\u2019\u00c8toile, Fransa) ile belirlenmesi ama\u00e7land\u0131.<\/p>\n

Y\u00d6NTEMLER<\/h2>\n

\u00c7al\u0131\u015fmaya, alarm semptomlar\u0131 (kilo kayb\u0131, bulant\u0131, kusma, disfaji, hematemez, melena, vb.) olmayan ancak dispeptik \u015fikayetleri olan ve gastroenteroloji bilim dal\u0131na ba\u015fvurarak, endoskopik incelemeleri yap\u0131lan 278 hasta dahil edildi. Antrum ve korpus b\u00f6lgelerinden al\u0131nan biyopsi \u00f6rneklerinin mikrobiyolojik ve histopatolojik incelemesi yap\u0131ld\u0131. Her hastadan histopatolojik inceleme i\u00e7in 2 antrum, 1 korpus; h\u0131zl\u0131 \u00fcreaz testi i\u00e7in 1 antrum, 1 korpus; k\u00fclt\u00fcr i\u00e7in 1 antrum, 1 korpus olmak \u00fczere toplam 4 antrum ve 3 korpus biyopsi \u00f6rne\u011fi al\u0131nd\u0131.<\/p>\n

Eradikasyon tedavisi alm\u0131\u015f, son iki hafta i\u00e7inde proton pompa inhibit\u00f6r\u00fc kullanm\u0131\u015f, son iki ay i\u00e7inde antibiyotik veya bismut i\u00e7eren bile\u015fikler alm\u0131\u015f ve endoskopi i\u00e7in kontrendikasyon kriterlerinden birisi pozitif olan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131ld\u0131.<\/p>\n

Sel\u00e7uk \u00dcniversitesi Meram T\u0131p Fak\u00fcltesi Etik Kurulu\u2019ndan 27.02.2009 tarih ve 2009\/065 karar numaras\u0131yla onay al\u0131nd\u0131. Ayr\u0131ca, hastalar\u0131n hepsine \u00e7al\u0131\u015fma hakk\u0131nda ayr\u0131nt\u0131l\u0131 bilgi verildi ve ayd\u0131nlat\u0131lm\u0131\u015f onam formu al\u0131nd\u0131.<\/p>\n

H\u0131zl\u0131 \u00dcreaz Testi<\/h3>\n

Gastrik biyopsi dokusu, \u00fcre i\u00e7eren bir ortamda tutulacak olursa H. pylori<\/i> taraf\u0131ndan \u00fcretilen \u00fcreaz \u00fcreyi k\u0131sa zamanda amonyak ve bikarbonata par\u00e7alar. Amonyak \u00fcretiminin sonucu pH y\u00fckselir ve ortamdaki renk pembeye d\u00f6n\u00fc\u015f\u00fcr. Bu sonu\u00e7 biyopsi materyalinde bakterinin bulundu\u011funu g\u00f6sterir (6). \u00c7al\u0131\u015fmam\u0131zda, biyopsi \u00f6rneklerinde \u00fcreaz aktivitesini ara\u015ft\u0131rmak amac\u0131yla CLO test (Kimberly-Clark Ballard Medical Products, Roswell, GA, ABD) kullan\u0131ld\u0131. Bir antrum \u00f6rne\u011fi ve bir korpus biyopsi \u00f6rne\u011fi CLO testine al\u0131nd\u0131; oda s\u0131cakl\u0131\u011f\u0131nda bekletilen test 1 saat ve 24 saat sonra de\u011ferlendirilerek sonu\u00e7lar not edildi.<\/p>\n

Histopatolojik \u0130nceleme<\/h3>\n

Hastalar\u0131n antrum ve korpus biyopsi preparatlar\u0131, histopatolojik tan\u0131 ve organizman\u0131n direkt taranmas\u0131 i\u00e7in s\u0131ras\u0131yla; formalinde fiksasyon, rutin hematoksilen-eosin (HE) boyamas\u0131 ve \u00f6zel boyama (Giemsa boyamas\u0131) i\u015flemlerine tabi tutularak \u0131\u015f\u0131k mikroskobunda birbirinden habersiz (k\u00f6r) iki farkl\u0131 patolog taraf\u0131ndan incelendi. Sonu\u00e7lar preparatlardaki bakteri yo\u011funlu\u011funa g\u00f6re; hafif (+), orta (++), \u015fiddetli (+++) poziti\ufb02ik olarak raporland\u0131.<\/p>\n

Bakteri K\u00fclt\u00fcr\u00fc<\/h3>\n

Endoskopi \u00fcnitesinden al\u0131nan mide biyopsi \u00f6rnekleri, Portagerm pylori (PORT-PYL, bioM\u00e9rieux, Marcy-l\u2019\u00c9toile, Fransa) transport medyumu i\u00e7erisinde h\u0131zl\u0131ca laboratuvara ula\u015ft\u0131r\u0131ld\u0131ktan sonra, at serumu ilave edilmi\u015f pylori besiyerine (PYL, bioM\u00e9rieux, Marcy-l\u2019\u00c9toile, Fransa) ekim yap\u0131ld\u0131. Ekimleri yap\u0131lan \u00f6rnekler hemen jara (bioM\u00e9rieux, Marcy-l\u2019\u00c9toile, Fransa) yerle\u015ftirilip H. pylori<\/i>\u2019nin \u00fcreyebilece\u011fi mikroaerofilik atmosfer (1 saat sonraki ortalama O2<\/sub> konsantrasyonu %7.5 ve 24 saat sonraki ortalama CO2<\/sub> konsantrasyonu %8) \u201cGENbox microaer\u201d (bioM\u00e9rieux, Marcy-l\u2019\u00c9toile, Fransa) ile sa\u011flanarak 37\u00b0C\u2019de 72 saat ink\u00fcbe edildi. Besiyerinde \u00fcreyen koloniler Gram boyama yap\u0131larak incelendi. Mikroskopta, Gram negatif boyanm\u0131\u015f, k\u0131vr\u0131k g\u00f6r\u00fcn\u00fcmde, bazen de tipik g\u00f6r\u00fcn\u00fcmlerinin yan\u0131 s\u0131ra d\u00fcz basiller g\u00f6r\u00fclmesi, \u00fcreaz (Urea-indole medium, bioM\u00e9rieux, Marcy-l\u2019\u00c9toile, Fransa), katalaz (ID color Catalase, bio-M\u00e9rieux, Marcy-l\u2019\u00c9toile, Fransa) ve oksidaz (Oxidase Reagent, bioM\u00e9rieux, Fransa) pozitifli\u011fi saptanan kolonilerin varl\u0131\u011f\u0131nda H. pylori<\/i> y\u00f6n\u00fcnden anlaml\u0131 olarak de\u011ferlendirildi.<\/p>\n

Antibiyotik Duyarl\u0131l\u0131k Testleri<\/h3>\n

\u0130zolatlar\u0131n; amoksisilin, klaritromisin, levofloksasin ve metronidazol duyarl\u0131l\u0131\u011f\u0131 antibiyotik gradyan y\u00f6ntemiyle (Etest\u00ae, bioM\u00e9rieux, Marcy-l\u2019\u00c8toile, Fransa) ara\u015ft\u0131r\u0131ld\u0131. Saf olarak elde edilen H. pylori<\/i> k\u00fclt\u00fcrlerinden al\u0131nan kolonilerle, s\u0131v\u0131 besiyeri i\u00e7inde McFarland 3 bulan\u0131kl\u0131\u011f\u0131na g\u00f6re haz\u0131rlanan bakteri s\u00fcspansiyonundan, %5 koyun kanl\u0131 Mueller-Hinton besiyeri (bioM\u00e9rieux, Marcy-l\u2019\u00c9toile, Fransa) y\u00fczeyine ekim yap\u0131ld\u0131. Plaklar mikroaerofilik ortamda 37 \u00b0C\u2019de 3 ile 5 g\u00fcn aras\u0131nda ink\u00fcbe edildi. \u0130nk\u00fcbasyon sonunda, elips \u015feklindeki inhibisyon zonunun Etest\u00ae<\/span> \u015feridi ile kesi\u015fti\u011fi noktaya kar\u015f\u0131l\u0131k gelen antibiyotik konsantrasyonu minimum inhibit\u00f6r konsantrasyon (M\u0130K) de\u011feri olarak kabul edildi. Kontrol su\u015fu olarak besiyerlerinin denetimi i\u00e7in H. pylori<\/i> NCTC 11637 ve antibiyotik duyarl\u0131l\u0131k testleri i\u00e7in H. pylori<\/i> ATCC 43504 kullan\u0131ld\u0131. Sonu\u00e7lar Klinik ve Laboratuvar Standardlar\u0131 Enstit\u00fcs\u00fc (\u201cClinical and Laboratory Standards Institute\u201d, CLSI) standardlar\u0131na g\u00f6re de\u011ferlendirildi (7). Bu \u00e7al\u0131\u015fmada kullan\u0131lan antibiyotiklere ait M\u0130K de\u011ferleri Tablo 2\u2019de g\u00f6sterilmi\u015ftir.<\/p>\n

Hastalarda alt\u0131n standard olarak; tek ba\u015f\u0131na k\u00fclt\u00fcr y\u00f6ntemi ya da histoloji ve H\u00dcT ikilisinin birlikte pozitif olmas\u0131 kabul edildi. K\u00fclt\u00fcr, alt\u0131n standard kriteri al\u0131narak histoloji ve H\u00dcT i\u00e7in duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fck hesapland\u0131. Ayr\u0131ca histoloji ve H\u00dcT\u2019\u00fcn ikisinin birlikte pozitifli\u011fi alt\u0131n standard kriteri al\u0131narak k\u00fclt\u00fcr i\u00e7in duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fck hesapland\u0131.<\/p>\n

\u0130statistiksel Analiz<\/h3>\n

Verilerin istatistiksel analizi \u201cIBM SPSS Statistics for Windows. Version 22.0\u201d (IBM Corp., Armonk, NY, ABD)\u201d program\u0131 kullan\u0131larak yap\u0131ld\u0131. p<\/i> de\u011ferinin \u2264 0.05 olmas\u0131 istatistiksel olarak anlaml\u0131 kabul edildi.<\/p>\n

BULGULAR<\/h2>\n

\u00c7al\u0131\u015fmaya; 16-83 ya\u015flar\u0131 aras\u0131nda, ya\u015f ortalamas\u0131 40.8 olan 156 (%56.1)\u2019s\u0131 kad\u0131n, 122 (%43.9)\u2019si erkek 278 hasta al\u0131nd\u0131. Endoskopi i\u015flemi sonras\u0131nda; 174 hastada gastrit ve\/veya duodenit, 37 hastada duodenal \u00fclser, 14 hastada \u00f6zofajit, 35 hastada gastrik \u00fclser, 9 hastada gastrik kanser ve 9 hastada normal endoskopik bulgular saptand\u0131.<\/p>\n

\"\"<\/a>

Tablo 1.<\/strong> \u00c7al\u0131\u015fmada H. pylori<\/i> Tan\u0131s\u0131nda Kullan\u0131lan Y\u00f6ntemlerin Duyarl\u0131l\u0131k ve \u00d6zg\u00fcll\u00fck De\u011ferleri<\/p><\/div>\n

\u00c7al\u0131\u015fmaya al\u0131nan 278 hastan\u0131n 140\u2019\u0131n\u0131n k\u00fclt\u00fcr\u00fcnde \u00fcreme saptand\u0131; 174\u2019\u00fcnde histoloji ile pozitiflik tespit edildi. Ayr\u0131ca H\u00dcT ile 191 hastada H. pylori<\/i> pozitifli\u011fi g\u00f6r\u00fcld\u00fc. Alt\u0131n standard kriterine g\u00f6re k\u00fclt\u00fcr y\u00f6ntemiyle 39, histoloji ile 17 ve H\u00dcT ile 8 olguda yalanc\u0131 negatif sonu\u00e7 saptand\u0131. Hastalar\u0131n k\u00fclt\u00fcr, histoloji ve H\u00dcT y\u00f6ntemleri i\u00e7in duyarl\u0131l\u0131k oranlar\u0131 s\u0131ras\u0131yla %76.5 ve %88.3, %87.8 ve \u00f6zg\u00fcll\u00fckleri %63, %94.2 ve %57.2 olarak tespit edildi (Tablo 1).<\/p>\n

\"\"<\/a>

Tablo 2.<\/strong> \u0130zole edilen H. pylori Su\u015flar\u0131 (N=140) i\u00e7in M\u0130K50, M\u0130K90 De\u011ferleri, M\u0130K Aral\u0131klar\u0131 ve S\u0131n\u0131r De\u011ferleri<\/p><\/div>\n

K\u00fclt\u00fcrden izole edilen 140 H. pylori <\/i>su\u015funda, antibiyotik gradyan y\u00f6ntemiyle (Etest\u00ae) antibiyotik direnci ara\u015ft\u0131r\u0131ld\u0131. H. pylori <\/i>su\u015flar\u0131n\u0131n 9 (%6.4)\u2019unda amoksisiline, 22 (%15.7)\u2019sinde klaritromisine, 17 (%12.1)\u2019sinde levofloksasine ve 57 (%40.7)\u2019sinde metronidazole kar\u015f\u0131 diren\u00e7 saptand\u0131. \u0130zole edilen 140 H. pylori <\/i>su\u015fu i\u00e7in antibiyotik gradyan y\u00f6ntemiyle (Etest\u00ae) elde edilen M\u0130K50 ve M\u0130K90 de\u011ferleri Tablo 2\u2019de g\u00f6sterilmi\u015ftir.<\/p>\n

TARTI\u015eMA<\/h2>\n

H. pylori<\/i>, insan ve di\u011fer primatlar\u0131n midesine yerle\u015fen spiral \u015feklinde, mikroaerofilik, Gram negatif bir bakteridir. V\u00fccuda bir defa girdi\u011finde, tedavi edilmedi\u011fi takdirde ya\u015fam boyu varl\u0131\u011f\u0131n\u0131 devam ettirmektedir. \u00dclkemiz gibi geli\u015fmekte olan \u00fclkelerde, H. pylori <\/i>infeksiyonu, geli\u015fmi\u015f \u00fclkelere g\u00f6re daha s\u0131k ve daha erken ya\u015flarda saptanmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131zda dispeptik \u015fikayetleri olan hastalarda k\u00fclt\u00fcr ile H. pylori<\/i> pozitifli\u011fi %50.3 (140\/278) oran\u0131nda saptand\u0131.<\/p>\n

H. pylori <\/i>infeksiyonunun s\u0131k g\u00f6r\u00fclmesi ve \u00f6nemli mide hastal\u0131klar\u0131na yol a\u00e7mas\u0131, tan\u0131 testlerinin h\u0131zla geli\u015fmesine neden olmu\u015ftur. K\u00fclt\u00fcr, histoloji, H\u00dcT ve molek\u00fcler testler gibi invazif; seroloji, \u00fcre nefes testi ve d\u0131\u015fk\u0131da antijen testleri gibi noninvazif testler tan\u0131 amac\u0131yla kullan\u0131lmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131zda; k\u00fclt\u00fcr, histoloji ve H\u00dcT y\u00f6ntemleri kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131. Bakterinin oksijene olan duyarl\u0131l\u0131\u011f\u0131, \u00f6rne\u011fin al\u0131nd\u0131\u011f\u0131 yer, ta\u015f\u0131nma ko\u015fullar\u0131 ve \u00e7al\u0131\u015fan\u0131n tecr\u00fcbesi gibi nedenlerden dolay\u0131, k\u00fclt\u00fcr\u00fcn duyarl\u0131l\u0131\u011f\u0131 olduk\u00e7a d\u00fc\u015f\u00fckt\u00fcr. Bakterinin mide mukozas\u0131nda yamal\u0131 boh\u00e7a bi\u00e7iminde da\u011f\u0131l\u0131m g\u00f6stermesi, histoloji ve H\u00dcT ile yalanc\u0131 negatif sonu\u00e7lara yol a\u00e7maktad\u0131r. Bununla beraber oral kavitede bulunabilen ve \u00fcreaz pozitif \u00f6zellik g\u00f6steren di\u011fer bakterilerden veya H\u00dcT\u2019\u00fcn 24 saatten sonra de\u011ferlendirilmesinden dolay\u0131 yalanc\u0131 pozitif sonu\u00e7lar g\u00f6r\u00fclebilmektedir (8, 9).\u00a0 <\/span><\/sup>H. pylori<\/i>\u2019nin saptanmas\u0131n\u0131n yan\u0131 s\u0131ra antibiyotik direncini de g\u00f6sterebilen molek\u00fcler y\u00f6ntemler duyarl\u0131l\u0131\u011f\u0131 ve \u00f6zg\u00fcll\u00fc\u011f\u00fc y\u00fcksek di\u011fer invazif testlerdir. Bu testler, \u00f6zel transport \u015fartlar\u0131 gerektirmeyen, d\u00fc\u015f\u00fck say\u0131daki bakteriyi tespit edebilen ve h\u0131zl\u0131 sonu\u00e7 al\u0131nan tan\u0131 y\u00f6ntemleridir.<\/p>\n

Yap\u0131lan ara\u015ft\u0131rmalarda, endoskopi ve biyopsi gerektiren invazif testlerde, mide antrum ve korpus \u00f6rneklerinin birlikte incelenmesinin tan\u0131n\u0131n do\u011frulu\u011funu art\u0131rd\u0131\u011f\u0131 bildirilmektedir (10).\u00a0 <\/span>\u00c7al\u0131\u015fmam\u0131zda endoskopi s\u0131ras\u0131nda t\u00fcm hastalardan hem antrumdan hem de korpustan biyopsi \u00f6rne\u011fi al\u0131nd\u0131.<\/p>\n

Weiss ve arkada\u015flar\u0131 (11) \u00e7al\u0131\u015fmalar\u0131nda, k\u00fclt\u00fcr ve H\u00dcT duyarl\u0131l\u0131\u011f\u0131 sonu\u00e7lar\u0131n\u0131 s\u0131ras\u0131yla %70 ve %88 olarak tespit etmi\u015ftir. Khalifehgholi ve arkada\u015flar\u0131 (12), 91 hasta \u00fczerinde yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckleri; histolojide %9.6, %77.8 ve H\u00dcT\u2019te %95.6, %100 olarak tespit etmi\u015ftir. Ankara\u2019da 2016 y\u0131l\u0131nda 126 hasta \u00fczerinde yap\u0131lan bir \u00e7al\u0131\u015fmada, duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckler; k\u00fclt\u00fcrde %68.1 ve %100; histolojide %94.8 ve %100; H\u00dcT\u2019te %87.9 ve %70 saptanm\u0131\u015ft\u0131r (13). \u00dclkemizde 102 \u00e7ocuk hasta \u00fczerinde yap\u0131lan ba\u015fka bir ara\u015ft\u0131rmada k\u00fclt\u00fcr\u00fcn duyarl\u0131l\u0131\u011f\u0131 %54.9, H\u00dcT\u2019\u00fcn duyarl\u0131l\u0131\u011f\u0131 %89.2 olarak bildirilmi\u015ftir (14). Kakl\u0131kkaya ve arkada\u015flar\u0131n\u0131n (15), 200 antral mide biyopsi \u00f6rne\u011finde yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckler; k\u00fclt\u00fcrde %87.1, %99 ve H\u00dcT\u2019te %77.2, %92 olarak saptanm\u0131\u015ft\u0131r. \u00c7al\u0131\u015fmam\u0131zda alt\u0131n standard kriterine g\u00f6re 278 mide biyopsi \u00f6rne\u011fi de\u011ferlendirildi\u011finde duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckler; k\u00fclt\u00fcrde %76.5 ve %88; histolojide %87,8 ve %63; H\u00dcT\u2019te %94.2 ve %57.2 olarak tespit edilmi\u015ftir.<\/p>\n

Tedavi ba\u015far\u0131s\u0131zl\u0131\u011f\u0131n\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131, kullan\u0131lan antibiyotiklere kar\u015f\u0131 diren\u00e7 nedeniyle ortaya \u00e7\u0131kmaktad\u0131r (16, 17). Dil\u00fcsyon y\u00f6ntemlerine g\u00f6re daha k\u0131sa zamanda ve kolay uygulanabilir bir y\u00f6ntem olan antibiyotik gradyan y\u00f6ntemi (Etest\u00ae) antibiyotik duyarl\u0131l\u0131k ara\u015ft\u0131rmalar\u0131nda s\u0131kl\u0131kla kullan\u0131lmaktad\u0131r. 2007 y\u0131l\u0131nda Tayvan\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada amoksisilin direnci %36.1 oran\u0131nda g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (18). \u00dclkemizde son y\u0131llarda yap\u0131lan bir \u00e7al\u0131\u015fmada amoksisilin direnci %3.2 olarak saptanm\u0131\u015ft\u0131r (19). \u00c7al\u0131\u015fmam\u0131zda antibiyotik gradyan y\u00f6ntemiyle (Etest\u00ae) %6.4 oran\u0131nda amoksisilin direnci saptand\u0131. Kanada, \u0130ran, Peru ve T\u00fcrkiye\u2019de yap\u0131lan ara\u015ft\u0131rmalarda, klaritromisin diren\u00e7 oranlar\u0131, s\u0131ras\u0131yla %40, %21.7, %35.5 ve %28 olarak g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (20-23). \u00c7al\u0131\u015fmam\u0131zda ise %15.7 oran\u0131nda klaritromisin direnci tespit edildi.<\/p>\n

Amerika\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada levofloksasin direnci %31.3 olarak g\u00f6r\u00fclm\u00fc\u015ft\u00fcr (24). Kanada\u2019da 2015 y\u0131l\u0131nda 20 H. pylori <\/i>izolat\u0131nda yap\u0131lan bir \u00e7al\u0131\u015fmada levofloksasin direnci %30 olarak saptanm\u0131\u015ft\u0131r (20). \u00dclkemizde 2015 y\u0131l\u0131nda yap\u0131lan bir \u00e7al\u0131\u015fmada levofloksasin direnci %29.5 olarak saptanm\u0131\u015ft\u0131r (25). \u00c7al\u0131\u015fmam\u0131zda antibiyotik gradyan y\u00f6ntemiyle (Etest\u00ae) %12.1 oran\u0131nda levofloksasin direnci saptand\u0131. \u00dclkemizde b\u00f6lgeler aras\u0131nda farkl\u0131l\u0131klar olmakla birlikte H. pylori\u2019de<\/i> metronidazol direnci %41.9-53 aras\u0131nda de\u011fi\u015fmektedir (19, 26). \u00c7al\u0131\u015fmam\u0131zda antibiyotik gradyan y\u00f6ntemiyle (Etest\u00ae) metronidazol direnci %40.7 oran\u0131nda saptand\u0131.<\/p>\n

Sonu\u00e7 olarak, \u00e7al\u0131\u015fmam\u0131zda k\u00fclt\u00fcr, H\u00dcT ve histoloji y\u00f6ntemleri aras\u0131nda en duyarl\u0131 testin H\u00dcT oldu\u011fu tespit edildi. Ancak \u00f6zg\u00fcll\u00fc\u011f\u00fc d\u00fc\u015f\u00fck bulundu\u011fu i\u00e7in sonu\u00e7lar\u0131n en az bir farkl\u0131 y\u00f6ntemle desteklenmesi gerekmektedir. K\u00fclt\u00fcr y\u00f6nteminin \u00f6zg\u00fcll\u00fc\u011f\u00fcn\u00fc y\u00fcksek olarak tespit etmemize ra\u011fmen, duyarl\u0131l\u0131\u011f\u0131 di\u011fer y\u00f6ntemlere g\u00f6re olduk\u00e7a d\u00fc\u015f\u00fck olarak g\u00f6r\u00fcld\u00fc. H. pylori<\/i> k\u00fclt\u00fcr\u00fcn\u00fcn duyarl\u0131l\u0131\u011f\u0131n\u0131n d\u00fc\u015f\u00fck olmas\u0131; bakterinin nazl\u0131, g\u00fc\u00e7 \u00fcreyen bir mikroorganizma olmas\u0131, klinik \u00f6rne\u011fin al\u0131nmas\u0131 ve transport ko\u015fullar\u0131n\u0131n izolasyon \u015fans\u0131n\u0131 do\u011frudan etkilemesi gibi fakt\u00f6rlerden kaynaklanabilir. Geli\u015fen teknolojilerle birlikte; k\u00fclt\u00fcr, histoloji ve H\u00dcT y\u00f6ntemlerini, bir di\u011fer alt\u0131n standard olabilecek molek\u00fcler y\u00f6ntemlerle birlikte inceleyen ara\u015ft\u0131rmalara ihtiya\u00e7 bulunmaktad\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Helicobacter pylori (H. pylori), ilk kez 1983 y\u0131l\u0131nda Warren ve Marshall taraf\u0131ndan insan midesinde g\u00f6sterilmi\u015f, \u00f6zellikle peptik \u00fclser hastal\u0131\u011f\u0131 ile birlikteli\u011fi bildirilmi\u015ftir (1). H. pylori infeksiyonu d\u00fcnyada olduk\u00e7a yayg\u0131n olup geli\u015fmi\u015f \u00fclkelerde %20-50; geli\u015fmekte olan \u00fclkelerde ise %50-90 oran\u0131nda g\u00f6r\u00fclmektedir (2). H. pylori \u00e7e\u015fitli mide hastal\u0131klar\u0131na neden olan bir bakteri olup infeksiyon sonucunda gastrit, […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5402,5399,5400,5401,3253],"class_list":["post-24370","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-antimikrobiyal-direnc","tag-h-pylori","tag-histopatoloji","tag-hizli-ureaz-testi","tag-kultur"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24370","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=24370"}],"version-history":[{"count":4,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24370\/revisions"}],"predecessor-version":[{"id":24688,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/24370\/revisions\/24688"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=24370"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=24370"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=24370"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}