Eshun J K, Black D D, Casteel H B, Horn H, Beavers-May T, Jetton C A, Parham D M
Department of Pediatrics, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis 38103, USA.
Pediatr Dev Pathol. 2001 Jan-Feb;4(1):82-8. doi: 10.1007/s100240010129.
We compared immunohistochemical and silver stains of pediatric gastric biopsy sections for the identification of Helicobacter pylori infection with chronic inflammation and a negative urease screening test. Thirty-seven patients (age range 10 months to 21 years) whose gastric antral biopsies were negative for the rapid urease test (CLO(R)) but positive for lymphocytic infiltration were selected for a retrospective study. Specimens had been subjected to a rapid urease test (CLO(R)) and hematoxylin and eosin staining, and Dieterle silver staining and immunohistochemical staining specific for H. pylori were also performed. Twelve additional patients with urease-positive biopsies were used as controls. With Dieterle staining, 8/37 (22%) urease-negative biopsies contained organisms morphologically compatible with H. pylori, 21/37 (56%) contained organisms not compatible with H. pylori, and 8/37 (22%) were negative for organisms. Immunostaining confirmed 6/8 (75%) Dieterle-positive cases as being H. pylori, was negative in 2/8 (25%) Dieterle-positive cases, and was positive in 2/8 (25%) Dieterle-negative cases. Biopsies from 8/12 (67%) urease-positive specimens contained organisms seen with both Dieterle and immunohistochemical stains, and 4/12 (33%) were negative with both stains. Although both stains yielded comparable results with H. pylori-positive biopsies, Dieterle staining was potentially confusing because of nonspecific staining of other organisms. A significant proportion of (CLO(R))-negative biopsies was positive for H. pylori with special stains. We therefore recommend the use of immunohistochemical staining rather than silver staining in the evaluation of urease-negative gastric biopsies demonstrating chronic inflammation in children.
我们比较了小儿胃活检切片的免疫组织化学染色和银染色，以确定幽门螺杆菌感染伴慢性炎症且尿素酶筛查试验为阴性的情况。选取37例患者（年龄范围10个月至21岁）进行回顾性研究，这些患者的胃窦活检快速尿素酶试验（CLO(R)）为阴性，但淋巴细胞浸润为阳性。标本已进行快速尿素酶试验（CLO(R)）和苏木精-伊红染色，还进行了针对幽门螺杆菌的迪特尔勒银染色和免疫组织化学染色。另外12例尿素酶阳性活检患者用作对照。迪特尔勒染色显示，8/37（22%）尿素酶阴性活检标本含有形态上与幽门螺杆菌相符的微生物，21/37（56%）含有与幽门螺杆菌不相符的微生物，8/37（22%）未发现微生物。免疫染色证实，6/8（75%）迪特尔勒染色阳性病例为幽门螺杆菌感染，2/8（25%）迪特尔勒染色阳性病例为阴性，2/8（25%）迪特尔勒染色阴性病例为阳性。8/12（67%）尿素酶阳性标本的活检组织在迪特尔勒染色和免疫组织化学染色中均可见微生物，4/12（33%）两种染色均为阴性。虽然两种染色在幽门螺杆菌阳性活检组织中结果相当，但由于其他微生物的非特异性染色，迪特尔勒染色可能会造成混淆。相当一部分（CLO(R)）阴性活检标本经特殊染色后幽门螺杆菌呈阳性。因此，我们建议在评估显示儿童慢性炎症的尿素酶阴性胃活检组织时，使用免疫组织化学染色而非银染色。
