Castro-Fernández M, Sánchez-Muñoz D, García-Díaz E, Miralles-Sanchiz J, Vargas-Romero J
Services of Digestive Diseases, Valme University Hospital, Seville, Spain.
Rev Esp Enferm Dig. 2004 Jun;96(6):395-8; 398-401. doi: 10.4321/s1130-01082004000600005.
The endoscopic diagnosis of Helicobacter pylori infection in patients with bleeding peptic ulcer is limited by a decreased sensitivity in standard invasive tests, rapid urease test and histology. There is controversy about the convenience of using one, neither, or both diagnostic tests.
To evaluate the results of simultaneously performed rapid urease test and histology in the diagnosis of Helicobacter pylori infection (H. pylori) in patients with bleeding peptic ulcer.
We included 173 patients, 98 male and 75 female, with an average age of 62 years (18-88), with upper gastrointestinal bleeding secondary to duodenal ulcer (115) or gastric ulcer (58), diagnosed within 24 hours after hospital admission. None of the patients had received treatment for H. pylori, proton pump inhibitors or antibiotics in the two weeks prior to the upper gastrointestinal bleeding episode. H. pylori infection was investigated in all patients by two antral biopsy samples for histological study (hematoxilin-eosin) and one or two antral biopsies for rapid urease test (Jatrox-H.p.-test). In cases with a negative urease test and histology, a 13C urea breath test was performed. Infection was considered present when at least one invasive test or the breath test was positive, whereas both invasive tests and the breath test had to be negative to establish an absent infection.
152 patients (88%) showed H. pylori infection, 104 patients (90%) with duodenal ulcer and 48 patients (83%) with gastric ulcer. In all 119 cases (78%) were diagnosed by the urease test and 112 cases (74%) by histology. Both methods were used to diagnose 134 of 152 cases (88%) (p < 0.05), these being positive in 97 cases and negative in 39 cases. In 18 of these 39 cases, the breath test was positive.
Histology and urease test have similar diagnostic values for the identification of H. pylori in patients with bleeding peptic ulcer. Due to its rapid results, the urease test should be the method of choice. However, additional biopsies should be performed, and, when negative, a histological study should be carried out, since a combination of both methods allows a more precise diagnosis.
标准侵入性检测（快速尿素酶试验和组织学检查）对消化性溃疡出血患者幽门螺杆菌感染的内镜诊断敏感性降低，限制了其应用。对于使用一种、不使用或同时使用这两种诊断检测的便利性存在争议。
评估同时进行快速尿素酶试验和组织学检查在诊断消化性溃疡出血患者幽门螺杆菌感染中的结果。
我们纳入了173例患者，其中男性98例，女性75例，平均年龄62岁（18 - 88岁），因十二指肠溃疡（115例）或胃溃疡（58例）继发上消化道出血，在入院后24小时内确诊。在上消化道出血发作前两周内，所有患者均未接受过幽门螺杆菌、质子泵抑制剂或抗生素治疗。对所有患者取两块胃窦活检样本进行组织学研究（苏木精 - 伊红染色），并取一块或两块胃窦活检样本进行快速尿素酶试验（Jatrox - H.p. - test）以检测幽门螺杆菌感染。尿素酶试验和组织学检查结果均为阴性的病例，进行¹³C尿素呼气试验。当至少一项侵入性检测或呼气试验呈阳性时，认为存在感染；而侵入性检测和呼气试验均为阴性时，才能确定无感染。
152例患者（88%）显示幽门螺杆菌感染，其中十二指肠溃疡患者104例（90%），胃溃疡患者48例（83%）。尿素酶试验诊断出119例（78%），组织学检查诊断出112例（74%）。152例中的134例（88%）（p < 0.05）同时采用了两种方法进行诊断，其中97例呈阳性，39例呈阴性。在这39例阴性病例中，18例呼气试验呈阳性。
组织学检查和尿素酶试验在诊断消化性溃疡出血患者幽门螺杆菌感染方面具有相似的诊断价值。由于尿素酶试验结果快速，应作为首选方法。然而，应进行额外的活检，当结果为阴性时，应进行组织学研究，因为两种方法结合可实现更精确的诊断。
