Tu T C, Lee C L, Wu C H, Chen T K, Chan C C, Huang S H, Lee MS S C
Division of Gastroenterology, Department of Internal Medicine, and the Department of Pathology, Cathay General Hospital, Taipei, Taiwan.
Gastrointest Endosc. 1999 Mar;49(3 Pt 1):302-6. doi: 10.1016/s0016-5107(99)70005-2.
Eradication of Helicobacter pylori infection has been shown to prevent recurrent bleeding from peptic ulcers. However, the detection rate for H pylori infection seems to be underestimated in this group of patients and has been scarcely investigated.
Eighty patients with bleeding peptic ulcer were studied for evidence of H pylori infection. Seventy-seven of these patients were enrolled as having H pylori infection after any one of the following 3 tests were positive: culture, histologic study, or any 2 of rapid urease test (CLO test), carbon 13-labeled urea breath test (UBT), and serologic examination. Fresh blood or blood-containing material in the gastric antrum was noted by panendoscopy in 22 patients (group A). In the remaining 55 cases there was no blood in the antrum (group B).
The sensitivities of the CLO test, bacterial culture, histologic study, 13C-labeled UBT, and immunoglobulin G serologic test were 45.5%, 36.4%, 77.2%, 95.4%, and 100% in group A, respectively, and 70.9%, 40.0%, 70.9%, 92.7%, and 96.4%, respectively, in group B. There was a statistically significant difference between the sensitivities found for CLO test and 13C-labeled UBT (p < 0.05). Of these 5 tests, only the sensitivity of the CLO test showed a statistically significant difference between groups A and B (p < 0.05). A delayed positive CLO test result was recorded in 13 patients (3 in group A, 10 in group B).
Noninvasive tests seemed to be more sensitive than invasive tests in detecting H pylori infection in patients with bleeding peptic ulcers. Blood in the antrum might reduce the sensitivity of the CLO test but have no effect on the other tests. The CLO test should be observed for more than 24 hours because of the possibility of a delayed positive result in some patients with bleeding peptic ulcers.
幽门螺杆菌感染的根除已被证明可预防消化性溃疡复发出血。然而，在这类患者中，幽门螺杆菌感染的检出率似乎被低估，且鲜有研究。
对80例消化性溃疡出血患者进行幽门螺杆菌感染证据的研究。以下3项检查中任何一项呈阳性后，这77例患者被登记为幽门螺杆菌感染：培养、组织学研究，或快速尿素酶试验（CLO试验）、碳13标记尿素呼气试验（UBT）和血清学检查中的任意2项。22例患者（A组）经全内镜检查发现胃窦有新鲜血液或含血物质。其余55例患者胃窦无血液（B组）。
A组中，CLO试验、细菌培养、组织学研究、13C标记UBT和免疫球蛋白G血清学试验的敏感性分别为45.5%、36.4%、77.2%、95.4%和100%，B组分别为70.9%、40.0%、70.9%、92.7%和96.4%。CLO试验和13C标记UBT的敏感性之间存在统计学显著差异（p<0.05）。在这5项检查中，只有CLO试验的敏感性在A组和B组之间存在统计学显著差异（p<0.05）。13例患者（A组3例，B组10例）记录到CLO试验延迟阳性结果。
在检测消化性溃疡出血患者的幽门螺杆菌感染时，非侵入性检查似乎比侵入性检查更敏感。胃窦内的血液可能会降低CLO试验的敏感性，但对其他检查无影响。由于一些消化性溃疡出血患者可能出现延迟阳性结果，CLO试验应观察超过24小时。
