Bermejo F, Boixeda D, Gisbert J P, Sanz J M, Cantón R, Defarges V, Martín-de-Argila C
Department of Gastroenterology, Ramón y Cajal Hospital, University of Alcalá, Madrid, Spain.
J Clin Gastroenterol. 2000 Sep;31(2):137-41. doi: 10.1097/00004836-200009000-00009.
Our aim was to determine concordance between 13C-urea breath test and serology in detecting Helicobacter pylori and to study their potential use for monitoring eradication in patients with gastric ulcer. We prospectively studied 73 gastric ulcer patients. On endoscopy, biopsies were taken for hematoxylineosin staining and rapid urease testing. Blood samples were drawn for immunoglobulin G antibody determination by enzyme-linked immunosorbent assay (ELISA). A 13C-urea breath test was performed as well. Histology, serology, and urea breath tests were all repeated 1, 6, and 12 months after therapy completion in 56 infected patients. A proportion of positive agreement between serology and breath test results as high as 0.95 was found. McNemar statistic was 3 (p = 0.08), whereas kappa statistic was 0.83 (p < 0.0001). At month 6, significant differences in patients successfully treated relative to baseline serologic values were observed (chi2 = 11.7; p < 0.001). The area under the receiver operating characteristic (ROC) curve for diagnostic efficiency was 0.76, sensitivity was 74%, and specificity was 90% (for H. pylori eradication) when the fall of at least one category in serologic levels was considered as cut-off point. No further decreases in serologic levels were noted over the next 6 months, and 48.8% of patients remained seropositive 1 year after completion of successful treatment. A high concordance between serology and 13C-urea breath test results is observed when the two procedures are used for H. pylori infection diagnosis in patients with gastric ulcer. Also, serology can be successfully used for monitoring H. pylori eradication 6 months after therapy completion.
我们的目的是确定¹³C - 尿素呼气试验与血清学检测幽门螺杆菌的一致性，并研究它们在监测胃溃疡患者根除治疗方面的潜在用途。我们对73例胃溃疡患者进行了前瞻性研究。在内镜检查时，取活检组织进行苏木精 - 伊红染色和快速尿素酶检测。采集血样，通过酶联免疫吸附测定（ELISA）测定免疫球蛋白G抗体。同时进行¹³C - 尿素呼气试验。对56例感染患者在治疗完成后1个月、6个月和12个月重复进行组织学、血清学和尿素呼气试验。发现血清学和呼气试验结果之间的阳性一致性比例高达0.95。McNemar统计量为3（p = 0.08），而kappa统计量为0.83（p < 0.0001）。在第6个月时，观察到成功治疗的患者相对于基线血清学值有显著差异（χ² = 11.7；p < 0.001）。当将血清学水平至少下降一个类别作为截断点时，诊断效率的受试者工作特征（ROC）曲线下面积为0.76，敏感性为74%，特异性为90%（用于幽门螺杆菌根除）。在接下来的6个月中未观察到血清学水平进一步下降，成功治疗完成后1年，48.8%的患者血清学仍呈阳性。当使用这两种方法对胃溃疡患者进行幽门螺杆菌感染诊断时，血清学和¹³C - 尿素呼气试验结果具有高度一致性。此外，血清学可成功用于监测治疗完成后6个月的幽门螺杆菌根除情况。
