[14C]尿素呼气试验以确认幽门螺杆菌的根除情况。

Sharma B C, Bhasin D K, Pathak C M, Sinha S K, Ray P, Vaiphei K, Singh K

Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

J Gastroenterol Hepatol. 1999 Apr;14(4):309-12. doi: 10.1046/j.1440-1746.1999.01869.x.

BACKGROUND

Treatment for Helicobacter pylori reduces ulcer recurrence. Eradication rates of the organism vary with different drug regimens from 30% to 90%. There is a need to identify patients who have failed treatment. [14C]-Urea breath test (UBT) is non-invasive, sensitive, safe and highly reliable test for diagnosis of H. pylori infection. As there is a paucity of reports on the utility of [14C]-UBT in confirming H. pylori eradication, this study was undertaken.

METHODS

Thirty-eight patients (age 34 +/- 17 years, range 16-84 years, 27 men) with upper gastrointestinal symptoms underwent upper gastrointestinal endoscopy. Baseline H. pylori infection was diagnosed by identification of the organism on antral biopsies and positive rapid urease test (RUT). After 1 month of completion of treatment, repeat RUT and histological examination of antral endoscopic biopsies were performed. Eradication of H. pylori was defined as absence of the organism on histology, and negative RUT. The [14C]-UBT was performed using 185 kBq [14C]-urea dissolved in 300 mL water. Breath samples were collected once before ingestion of [14C]-urea, and subsequently at 5 and 15 min. Results were expressed as 14CO2/mmol CO2 exhaled as per cent of administered urea.

RESULTS

Endoscopy revealed antral gastritis (n = 14), duodenal ulcer (n = 8), duodenitis (n = 2), oesophagitis (n = 1), antral gastritis and duodenal ulcer (n = 3), antral gastritis and duodenitis (n = 7) and normal upper gastrointestinal endoscopy (n = 3). All the 20 patients who were negative for H. pylori on RUT and histology, tested negative for H. pylori on [14C]-UBT. However, of 18 patients shown to have H. pylori infection on RUT and histology, 16 were positive for H. pylori on [14C]-UBT. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of [14C]-UBT were 100, 89, 91, 100 and 95% respectively.

CONCLUSIONS

The [14C]-UBT is a reliable indicator of H. pylori eradication after treatment. It can obviate the need for antral biopsies to confirm eradication of H. pylori after completion of treatment.

背景

幽门螺杆菌治疗可降低溃疡复发率。该病菌的根除率因不同药物治疗方案而异，在30%至90%之间。有必要识别治疗失败的患者。[14C] - 尿素呼气试验（UBT）是一种用于诊断幽门螺杆菌感染的非侵入性、灵敏、安全且高度可靠的检测方法。由于关于[14C] - UBT在确认幽门螺杆菌根除效用方面的报道较少，因此开展了本研究。

方法

38例有上消化道症状的患者（年龄34±17岁，范围16 - 84岁，男性27例）接受了上消化道内镜检查。通过对胃窦活检组织中病菌的鉴定及快速尿素酶试验（RUT）阳性诊断基线幽门螺杆菌感染。治疗结束1个月后，进行重复RUT及胃窦内镜活检组织学检查。幽门螺杆菌根除定义为组织学检查未发现该病菌且RUT阴性。[14C] - UBT使用溶解于300 mL水中的185 kBq [14C] - 尿素进行。在摄入[14C] - 尿素前、摄入后5分钟和15分钟各采集一次呼气样本。结果以呼出的14CO2/mmol CO2占给予尿素的百分比表示。

结果

内镜检查显示胃窦炎（n = 14）、十二指肠溃疡（n = 8）、十二指肠炎（n = 2）、食管炎（n = 1）、胃窦炎和十二指肠溃疡（n = 3）、胃窦炎和十二指肠炎（n = 7）以及上消化道内镜检查正常（n = 3）。所有RUT和组织学检查幽门螺杆菌阴性的20例患者，[14C] - UBT检测幽门螺杆菌也为阴性。然而，在18例RUT和组织学检查显示有幽门螺杆菌感染的患者中，16例[14C] - UBT检测幽门螺杆菌为阳性。[14C] - UBT的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为100%、89%、91%、100%和95%。