Archimandritis A, Tzivras M, Sougioultzis S, Papaparaskevas I, Apostolopoulos P, Avlami A, Davaris P S
Department of Pathophysiology, University of Athens Medical School, Greece.
J Gastroenterol Hepatol. 2000 Apr;15(4):369-73. doi: 10.1046/j.1440-1746.2000.02171.x.
The validity of the rapid urease (CLO) test to diagnose Helicobacter pylori infection in patients with bleeding ulcers has been questioned. The aim of this paper is to evaluate the validity of the CLO test in comparison with histology in diagnosing H. pylori infection in patients with acute upper gastrointestinal bleeding (UGB), irrespective of non-steroidal anti-inflammatory drug (NSAID) use.
Upper gastrointestinal endoscopy was performed within 24 h of admission for all patients with UGB admitted to the Department of Pathophysiology, Medical School, Athens, for a period of 12 months. Patients with variceal bleeding, previous gastric operation, recent treatment with proton pump inhibitors (< 2 months) and those with a history of H. pylori eradication therapy were excluded from the study. At least four biopsies (two from the antrum and two from the body) were obtained for the CLO test and histology (modified Giemsa).
Seventy-two consecutive patients (aged 18-90 years, 51 men, 21 women) were included. Forty-six patients (64%) used NSAID. Thirty-two patients (44%) were found to be positive for H. pylori infection by the CLO test, while 44 patients (61%) were found to be positive on histology (P<0.045, 95% CI, 0.004-0.331). The sensitivity and specificity of the CLO test were 68 and 93% respectively; positive and negative predictive values were 94 and 65%, respectively. The age of the patient and visible blood in the stomach did not influence results of either the CLO or histology.
The CLO test, performed within 24 h of hospital admission in patients with UGB, irrespective of NSAID use, is unreliable for the detection of H. pylori infection. The age of the patient and the presence of blood in the stomach do not seem to influence these results.
快速尿素酶（CLO）试验用于诊断出血性溃疡患者幽门螺杆菌感染的有效性受到质疑。本文旨在比较CLO试验与组织学检查在诊断急性上消化道出血（UGB）患者幽门螺杆菌感染方面的有效性，无论患者是否使用非甾体抗炎药（NSAID）。
对雅典医学院病理生理学系收治的所有UGB患者在入院24小时内进行上消化道内镜检查，为期12个月。静脉曲张出血患者、既往有胃部手术史、近期接受质子泵抑制剂治疗（<2个月）以及有幽门螺杆菌根除治疗史的患者被排除在研究之外。至少获取四块活检组织（两块取自胃窦，两块取自胃体）用于CLO试验和组织学检查（改良吉姆萨染色）。
共纳入72例连续患者（年龄18 - 90岁，男性51例，女性21例）。46例患者（64%）使用NSAID。CLO试验发现32例患者（44%）幽门螺杆菌感染呈阳性，而组织学检查发现44例患者（61%）呈阳性（P<0.045，95%置信区间，0.004 - 0.331）。CLO试验的敏感性和特异性分别为68%和93%；阳性预测值和阴性预测值分别为94%和65%。患者年龄和胃内可见血液均未影响CLO试验或组织学检查结果。
对于UGB患者，在入院24小时内进行CLO试验，无论是否使用NSAID，在检测幽门螺杆菌感染方面都不可靠。患者年龄和胃内血液的存在似乎不影响这些结果。
