Bodger K, Wyatt J I, Heatley R V
Pathology Dept, St. James's University Hospital, Leeds, UK.
Scand J Gastroenterol. 1999 Sep;34(9):856-63. doi: 10.1080/003655299750025309.
We wanted to assess the diagnostic value of pre-endoscopy screening by Helicobacter pylori serology, serum recognition of the CagA and VacA proteins, and serum pepsinogen I levels (sPGI) in patients up to 55 years of age with uncomplicated simple dyspepsia.
Consecutive dyspeptic patients referred for open-access endoscopy, excluding patients with alarm symptoms, recent intake of acid suppressants, or ingestion of non-steroidal anti-inflammatory drugs. H. pylori status was determined by histology and urease testing. H. pylori serologic status was determined with the enzyme-linked immunosorbent assay (ELISA) and Western blotting, serum recognition of CagA and VacA with Western blot, and sPGI levels by radioimmunoassay.
One hundred and fifteen patients were studied (mean age, 40 years: range, 20-55 years), of whom 58 were H. pylori-positive in biopsy-based tests. Twenty-one patients (18%) had significant gastroduodenal lesions (erosions, ulcers, or cancer). The sensitivity (specificity) of the ELISA (optimized) and Western blot in determining H. pylori status was 94.8% (89.5%) and 100% (96.4%), respectively. Screening strategies based on the ELISA or Western blot for determining H. pylori serologic status would have detected 95% or 100% of significant lesions, respectively, and each 'saved' 47% of endoscopies for simple dyspepsia. Serum recognition of the CagA protein would have detected 95% of significant lesions and 'saved' 55% of endoscopies, whereas recognition of the VacA protein would have detected only 81% of the lesions. Screening by H. pylori serology plus a 'low' (<55 ng/ml) or 'high' sPGI (>125 ng/ml) would detect only 57% of significant lesions, although the only case of cancer was included in the hypopepsinogenaemic subgroup of just 11 patients.
In patients with uncomplicated, simple dyspepsia up to 55 years of age, screening by H. pylori serology identified 95%-100% of patients with significant gastroduodenal lesions while potentially saving 46.9% of endoscopies. Serum recognition of the CagA protein identified 95% of lesions and would have saved an additional number of endoscopies (7.9%) compared with basic serology. Measurement of sPGI was of limited diagnostic value.
我们想要评估幽门螺杆菌血清学、CagA和VacA蛋白的血清识别以及血清胃蛋白酶原I水平（sPGI）在55岁及以下无并发症的单纯消化不良患者中进行内镜检查前筛查的诊断价值。
连续纳入因开放式内镜检查就诊的消化不良患者，排除有警示症状、近期服用抑酸剂或摄入非甾体抗炎药的患者。通过组织学和尿素酶试验确定幽门螺杆菌感染状况。采用酶联免疫吸附测定（ELISA）和蛋白质印迹法测定幽门螺杆菌血清学状态，用蛋白质印迹法检测血清对CagA和VacA的识别情况，并用放射免疫测定法检测sPGI水平。
共研究了115例患者（平均年龄40岁，范围20 - 55岁），其中58例在基于活检的检测中幽门螺杆菌呈阳性。21例患者（18%）有明显的胃十二指肠病变（糜烂、溃疡或癌症）。ELISA（优化后）和蛋白质印迹法在确定幽门螺杆菌感染状况时的敏感性（特异性）分别为94.8%（89.5%）和100%（96.4%）。基于ELISA或蛋白质印迹法来确定幽门螺杆菌血清学状态的筛查策略分别能检测出95%或100%的明显病变，且每种策略为单纯消化不良患者“节省”了47%的内镜检查。血清对CagA蛋白的识别能检测出95%的明显病变并“节省”55%的内镜检查，而对VacA蛋白的识别仅能检测出81%的病变。通过幽门螺杆菌血清学检查加上“低”（<55 ng/ml）或“高”sPGI（>125 ng/ml）进行筛查仅能检测出57%的明显病变，尽管仅有的1例癌症患者包含在仅11例患者的低胃蛋白酶原血症亚组中。
在55岁及以下无并发症的单纯消化不良患者中，通过幽门螺杆菌血清学检查可识别出95% - 100%有明显胃十二指肠病变的患者，同时可能节省46.9%的内镜检查。血清对CagA蛋白的识别能检测出95%的病变，与基本血清学检查相比还能额外节省一定数量的内镜检查（7.9%）。sPGI的测定诊断价值有限。
