Sanchez-Mete L, Zullo A, Hassan C, Rinaldi V, Magno M S, Festuccia F, Morini S, Attili A F
Department of Clinical Medicine-Gastroenterology, La Sapienza University, Rome, Italy.
Dig Liver Dis. 2003 Aug;35(8):566-70. doi: 10.1016/s1590-8658(03)00273-1.
In cirrhotics, Helicobacter pylori infection is the major cause of peptic lesions, which are an important cause of upper intestinal haemorrhage in these patients. However, some diagnostic methods are not accurate for H. pylori detection in cirrhotics.
The study assessed the accuracy of different diagnostic methods for H. pylori detection in cirrhotics with and without gastroduodenal lesions.
The study population comprised of 53 cirrhotics. All patients underwent upper endoscopy: three biopsies were taken in the antrum and three in the gastric body. Four biopsies were used for Giemsa staining, while two were used for a rapid urease test. A blood sample was obtained for serology using Western blotting, and a [13C]urea breath test was performed in all patients. Histological assessment was regarded as the gold standard for diagnosis of H. pylori infection.
H. pylori infection was detected at histological assessment in 28 (52.8%) patients. The [13C]urea breath test, rapid urease test, and serology were positive in 27 (51%) patients, 23 (43.4%) patients, and 34 (64.1%) patients, respectively. Sensitivity and specificity were 92.9 and 96% for the [13C]urea breath test, 78.6 and 96% for the rapid urease test, and 78.6 and 52% for serology.
The [13C]urea breath test is very accurate in cirrhotics, whilst both serology and the rapid urease test give disappointing results.
在肝硬化患者中，幽门螺杆菌感染是消化性病变的主要原因，而消化性病变是这些患者上消化道出血的重要原因。然而，一些诊断方法在肝硬化患者中检测幽门螺杆菌并不准确。
本研究评估了不同诊断方法在有或无胃十二指肠病变的肝硬化患者中检测幽门螺杆菌的准确性。
研究人群包括53例肝硬化患者。所有患者均接受了上消化道内镜检查：在胃窦取3块活检组织，在胃体取3块活检组织。4块活检组织用于吉姆萨染色，2块用于快速尿素酶试验。采集血样进行蛋白质印迹血清学检测，并对所有患者进行[13C]尿素呼气试验。组织学评估被视为诊断幽门螺杆菌感染的金标准。
组织学评估发现28例（52.8%）患者存在幽门螺杆菌感染。[13C]尿素呼气试验、快速尿素酶试验和血清学检测分别在27例（51%）患者、23例（43.4%）患者和34例（64.1%）患者中呈阳性。[13C]尿素呼气试验的敏感性和特异性分别为92.9%和96%，快速尿素酶试验为78.6%和96%，血清学检测为78.6%和52%。
[13C]尿素呼气试验在肝硬化患者中非常准确，而血清学检测和快速尿素酶试验的结果令人失望。
