Colin R, Czernichow P, Baty V, Touzé I, Brazier F, Bretagne J F, Berkelmans I, Barthélémy P, Hemet J
Groupe de Recherche de l'Appareil Digestif, CHU, Rouen.
Gastroenterol Clin Biol. 2000 Jan;24(1):31-5.
A high false negative rate for antral infection with Helicobacter pylori when assessed by rapid urease test has recently been reported in patients with bleeding ulcer. This result could partly explain the differing prevalence of H. pylori infection in bleeding and non-bleeding ulcers.
To evaluate the accuracy of a rapid urease test (UT), histology and culture for detection of H. pylori in antral biopsies from acute bleeding peptic ulcer patients using a serological test as reference.
All consecutive patients with active bleeding gastric or duodenal ulcer at endoscopic examination admitted in six university hospitals in France were considered for inclusion. Five antral biopsies were taken during the diagnostic endoscopy for UT, culture and histology. A blood sample was taken for H. pylori serology.
One hundred and eighty one patients were included and 129 (71%) had a positive serology. The sensitivity of UT, histology and culture for detection of H. pylori infection were 41%, 33% and 34%, respectively. The sensitivity and specificity of the combination of the three invasive tests were 48.8% (95% CI: 40.2-57.4) and 90.6% (95% CI: 82. 6-99) respectively. In the 52 serologically negative patients, only 5 had at least one invasive positive test. The sensitivity of the invasive tests decreased significantly with age but was not influenced by NSAIDs intake. Of 80 patients with a positive serological test and negative histological evaluation for H. pylori, chronic antral inflammation was found in 70 patients (87%). In 46 patients with both negative serological test and H. pylori negative test according to histology, only 13 (28%) had chronic antral inflammation.
The sensitivity of invasive tests for detection of H. pylori is low during acute ulcer bleeding, and they should be used with caution in this condition. A serological test is recommended to identify patients with H. pylori infection in spite of negative invasive tests.
最近有报道称，在出血性溃疡患者中，通过快速尿素酶试验评估胃窦幽门螺杆菌感染时假阴性率较高。这一结果可以部分解释出血性溃疡和非出血性溃疡中幽门螺杆菌感染患病率的差异。
以血清学检测为参照，评估快速尿素酶试验（UT）、组织学检查和培养法检测急性出血性消化性溃疡患者胃窦活检标本中幽门螺杆菌的准确性。
纳入法国六所大学医院内镜检查时所有连续的活动性出血性胃溃疡或十二指肠溃疡患者。在诊断性内镜检查时取五块胃窦活检组织用于UT、培养和组织学检查。采集血样进行幽门螺杆菌血清学检测。
纳入181例患者，129例（71%）血清学检测呈阳性。UT、组织学检查和培养法检测幽门螺杆菌感染的敏感性分别为41%、33%和34%。三种侵入性检测联合使用的敏感性和特异性分别为48.8%（95%可信区间：40.2 - 57.4）和90.6%（95%可信区间：82.6 - 99）。在52例血清学检测阴性的患者中，只有5例至少有一项侵入性检测呈阳性。侵入性检测的敏感性随年龄显著降低，但不受非甾体抗炎药摄入的影响。在80例血清学检测呈阳性但幽门螺杆菌组织学评估为阴性的患者中，70例（87%）发现有慢性胃窦炎。在46例血清学检测和幽门螺杆菌组织学检测均为阴性的患者中，只有13例（28%）有慢性胃窦炎。
急性溃疡出血期间，侵入性检测幽门螺杆菌的敏感性较低，在此情况下应谨慎使用。尽管侵入性检测为阴性，仍建议使用血清学检测来识别幽门螺杆菌感染患者。
