Peitz U, Leodolter A, Wex T, Schütze D, Wolle K, Welte T, Günther T, Schmidt U, Malfertheiner P
Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University of Magdeburg, Germany.
Z Gastroenterol. 2004 Feb;42(2):141-6. doi: 10.1055/s-2004-812836.
In peptic ulcer bleeding, the sensitivity of H. pylori tests, in particular of the rapid urease test (RUT), has been reported to be insufficient.
To validate the RUT, serology and the urea breath test were carried out in patients with bleeding peptic ulcers, and to study the influence of H. pylori suppressive treatment (HpSuT), i. e., antibiotics and proton pump inhibitors.
123 consecutive patients (mean age 65.5 years) with a relevant bleeding from gastric or duodenal ulcers were prospectively tested for H. pylori infection by directs tests (RUT, histology, culture, urea breath test) and by IgG serology as an indirect test. Positive H. pylori status was defined by positive histology or culture.
In patients without HpSuT during the preceding four weeks (N = 83), the sensitivity and specificity of RUT was 94 and 84 %, that of serology 83 and 68 % respectively. The sensitivity of urea breath test decreased from 82 to 60 % after even one day of HpSuT. In the overall group, the duration of HpSuT and preceding hospitalization were independent factors linked with negative results of all direct tests.
In peptic ulcer bleeding, RUT combined with histology is an adequate diagnostic approach. However, false negative results have to be considered following even short-term HpSuT or hospitalization. Non-invasive diagnosis based on serology alone is inaccurate and should be complemented by the urea breath test prior to starting HpSuT.
据报道，在消化性溃疡出血中，幽门螺杆菌检测，尤其是快速尿素酶试验（RUT）的敏感性不足。
对消化性溃疡出血患者进行RUT、血清学和尿素呼气试验验证，并研究幽门螺杆菌抑制治疗（HpSuT），即抗生素和质子泵抑制剂的影响。
对123例连续的（平均年龄65.5岁）有胃或十二指肠溃疡相关出血的患者，通过直接检测（RUT、组织学、培养、尿素呼气试验）和作为间接检测的IgG血清学方法，前瞻性地检测幽门螺杆菌感染情况。幽门螺杆菌阳性状态由组织学或培养阳性定义。
在过去四周内未接受HpSuT的患者（N = 83）中，RUT的敏感性和特异性分别为94%和84%，血清学的敏感性和特异性分别为83%和68%。即使仅进行一天的HpSuT后，尿素呼气试验的敏感性就从82%降至60%。在整个研究组中，HpSuT的持续时间和之前的住院时间是与所有直接检测结果为阴性相关的独立因素。
在消化性溃疡出血中，RUT联合组织学是一种合适的诊断方法。然而，即使是短期的HpSuT或住院后，也必须考虑假阴性结果。仅基于血清学的非侵入性诊断不准确，在开始HpSuT之前应通过尿素呼气试验进行补充。
