幽門桿菌感染是全世界最盛行的細菌感染疾病之一。幽門桿菌會造成慢性胃炎、潰瘍性疾病、甚至胃癌的發生，因此根除幽門桿菌感染就顯得相當重要。目前，以氫離子幫浦阻斷劑、clarithromycin、amoxicillin治療7至14天的三合治療，仍是常用的第一線處方。在台灣，三合治療的成功除菌率大約是82-94%。然而，研究顯示糖尿病病患與非糖尿病病患相比，有較高的幽門桿菌除菌失敗風險。其中，又以clarithromycin為基底的處方更為明顯。在糖尿病病患，以clarithromycin為基底的三合治療及序列治療成功除菌率只有約50%。糖尿病病患幽門桿菌除菌率較差的原因仍不明確。本研究發現之前曾經除菌失敗過的糖尿病病患比非糖尿病病患，有較高的clarithromycin抗藥性。而且糖尿病病患胃液中的葡萄糖濃度也較非糖尿病病患的稍高。過去研究顯示葡萄糖對於細菌及黴菌的抗藥性有所影響，也會對抗生素的穩定性有所影響。因此，我設計了實驗要探討葡萄糖在體外是否會引發幽門桿菌對clarithromycin的抗藥性及是否會影響clarithromycin的降解。
第一個體外實驗，我選取了具有clarithromycin敏感性的幽門桿菌標準菌株J99，以及從成大醫院糖尿病病患胃中分離出來的臨床菌株。我將這些菌株置於布魯氏菌培養肉湯中，並額外添加葡萄糖及低於致死劑量的clarithromycin (葡萄糖濃度分別為：100、200及300 mg/dl；clarithromycin濃度分別為：0.015及0.031 μg/ml)，用振盪器於37℃微需氧環境中培養。初代培養三天後，更換一次培養液，進行繼代培養，直到第27天。接著於第三、六、九代利用瓊脂稀釋法測試幽門桿菌的最小抑菌濃度。最小抑菌濃度大於等於1 μg/ml即是對clarithromycin有抗藥性。並以L-form葡萄糖當作osmolality control。
第二個體外實驗，我抽取來成大醫院做胃鏡的病人的胃液，離心去除黏液後，利用pH meter測定胃液的pH值，利用glucose assay kit測定胃液中的葡萄糖濃度。接著我將clarithromycin配製在不同葡萄糖濃度的胃液和水溶液中 (葡萄糖濃度分別為：0、100、200及300 mg/dl)，放入37℃的培養箱。每24小時收集一次溶液樣本，立即冷凍於-20℃的冰箱中，連續收集七天。最後利用高效液相層析法分析溶液樣本中clarithromycin的剩餘濃度，來計算其降解的情況。
本研究發現在沒有clarithromycin的培養肉湯中，幽門桿菌菌株在不同葡萄糖濃度下，生長狀況良好。然而，不論是標準菌株J99或從糖尿病病人胃中分離出來的臨床菌株 (包含三株clarithromycin-sensitive菌株、兩株clarithromycin-intermediate菌株、及一株clarithromycin-resistant菌株)，葡萄糖均不會使其最小抑菌濃度上升，意即在本研究的設計下，葡萄糖不會促使幽門桿菌產生抗藥性菌株。另一部分，配製在不同葡萄糖濃度的胃液和水溶液中的clarithromycin，直到第七天，這些溶液樣本中clarithromycin的剩餘濃度並無顯著減低，意即葡萄糖不會加速clarithromycin的降解。
因此，本研究推論造成糖尿病病患幽門桿菌除菌率低的原因，可能不是因為高葡萄糖濃度引發幽門桿菌對clarithromycin的抗藥性，也不是高葡萄糖濃度加快clarithromycin的降解。

The eradication rate of Helicobacter pylori (H. pylori) in the patients with diabetes mellitus (DM) was poor. The mechanism remained unclear. I found that higher glucose levels neither induced the clarithromycin-resistant H. pylori nor enhanced clarithromycin degradation, which may correspond to eradication failure of H. pylori in diabetic patients.

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