Feydt-Schmidt A, Rüssmann H, Lehn N, Fischer A, Antoni I, Störk D, Koletzko S
Dr v Haunerches Kinderspital, Ludwig-Maximilians University, Munich, Germany.
Aliment Pharmacol Ther. 2002 Dec;16(12):2073-9. doi: 10.1046/j.1365-2036.2002.01382.x.
To compare the results of culture and epsilometer test with fluorescence in situ hybridization for the detection of Helicobacter pylori and the presence of clarithromycin-susceptible and clarithromycin-resistant strains in antral biopsies from children.
Antral biopsies from 149 unselected children were investigated prospectively; 15 had previously received anti-H. pylori therapy. H. pylori status was defined by histology, rapid urease test and 13C-urea breath test. Fluorescence in situ hybridization was applied on fresh tissue with probes specific for the clarithromycin-susceptible wild type and three clarithromycin-resistant mutants. Susceptibility to clarithromycin was tested by epsilometer test in two laboratories.
Culture and fluorescence in situ hybridization gave negative results in all 66 H. pylori-negative children (specificity, 100%). Of 83 infected children, cultures were successful in 75 (90%), epsilometer test in 71 (86%) and fluorescence in situ hybridization in 77 (93%). Eleven children (13%) showed discrepant results between the applied methods, indicating mixed infection. Clarithromycin-resistant isolates were identified in 16 of 73 previously untreated children.
Primary resistance to clarithromycin is common (22%) in H. pylori isolates from children living in Germany. Fluorescence in situ hybridization is an excellent, fast method for the detection of H. pylori and clarithromycin-resistant mutants in gastric biopsies. Multiple biopsies identify mixed infections, indicating that clarithromycin-resistant and clarithromycin- susceptible strains are not evenly distributed within the stomach.
比较培养法、E试验与荧光原位杂交法检测儿童胃窦活检组织中幽门螺杆菌及克拉霉素敏感和耐药菌株的结果。
对149例未经选择的儿童的胃窦活检组织进行前瞻性研究；其中15例之前接受过抗幽门螺杆菌治疗。幽门螺杆菌感染状态通过组织学、快速尿素酶试验和¹³C尿素呼气试验确定。应用针对克拉霉素敏感野生型和三种克拉霉素耐药突变体的探针，对新鲜组织进行荧光原位杂交。在两个实验室通过E试验检测克拉霉素敏感性。
在所有66例幽门螺杆菌阴性儿童中，培养法和荧光原位杂交法均得出阴性结果（特异性为100%）。83例感染儿童中，75例（90%）培养成功，71例（86%）E试验成功，77例（93%）荧光原位杂交成功。11例儿童（13%）所应用的方法结果存在差异，提示混合感染。在73例之前未接受治疗的儿童中，16例鉴定出克拉霉素耐药菌株。
在德国生活的儿童幽门螺杆菌分离株中，对克拉霉素的原发性耐药很常见（22%）。荧光原位杂交是检测胃活检组织中幽门螺杆菌及克拉霉素耐药突变体的一种优秀、快速的方法。多次活检可识别混合感染，表明克拉霉素耐药菌株和克拉霉素敏感菌株在胃内分布不均。
