对于胃溃疡患者，在检测幽门螺杆菌感染方面，来自胃非溃疡部位的快速尿素酶试验优于溃疡部位的组织学检查。

Rapid urease test from non-ulcer part of stomach is superior to histology from ulcer in detection of Helicobacter pylori infection in patients with gastric ulcer.

作者信息

Ho Chiu-Yung, Chen Tseng-Shing, Chang Full-Young, Lee Shou-Dong

机构信息

Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taiwan, ROC.

出版信息

Hepatogastroenterology. 2004 Nov-Dec;51(60):1877-80.

PMID:15532848

Abstract

BACKGROUND/AIMS: Helicobacter pylori is the major pathogenesis of peptic ulcer disease. It is important for the endoscopists to detect H. pylori infection during endoscopy. Only one endoscopic diagnostic method can be used due to the limitation of health insurance payments in Taiwan. Most endoscopists use the tissue obtained from the ulcer margins for histopathological examination and detection of H. pylori infection in patients with gastric ulcer. Whether this is suitable deserves study.

METHODOLOGY

A total of 103 consecutive subjects with gastric ulcer were recruited. Biopsy specimens from the margins of gastric ulcer were sent for histological examination with modified Giemsa stain. Two biopsy specimens from the antrum and greater curvature site of mid body were embedded in rapid urease test (CLOtest). A patient was classified as H. pylori positive if either CLOtest or histology were positive.

RESULTS

57 patients had H. pylori infection. The detection rate of rapid urease test and histological examination was 96.5% (55/57) and 59.6% (35/57), respectively. Of the 3 patients who had positive histological examinations and negative urease test, only one was confirmed again to have H. pylori infection. The detection rates of rapid urease test and histological examination in different locations of ulcer (antrum/angularis/proximal stomach) were 92.6%/100%/100% and 81.5%/42.1%/36.4%, respectively.

CONCLUSIONS

Our study shows that rapid urease test has higher detection rate than histological examination of the biopsy specimens obtained from the margins of gastric ulcer in diagnosis of H. pylori infection. Under the consideration of the health insurance payments limitation and elimination of false-negative detection rate of H. pylori infection, we strongly recommend the rapid urease test from the antrum and body specimens rather than from the ulcer margins for detection of the bacteria in patients with gastric ulcer disease.

摘要

背景/目的：幽门螺杆菌是消化性溃疡疾病的主要发病机制。对于内镜医师而言，在内镜检查期间检测幽门螺杆菌感染非常重要。由于台湾地区医疗保险支付的限制，只能使用一种内镜诊断方法。大多数内镜医师使用从溃疡边缘获取的组织进行组织病理学检查，以检测胃溃疡患者的幽门螺杆菌感染。这是否合适值得研究。

方法

共招募了103例连续的胃溃疡患者。将胃溃疡边缘的活检标本送去用改良吉姆萨染色进行组织学检查。从胃窦和胃体中部大弯处获取的两份活检标本用于快速尿素酶试验（CLOtest）。如果CLOtest或组织学检查结果为阳性，则将患者分类为幽门螺杆菌阳性。

结果

57例患者感染了幽门螺杆菌。快速尿素酶试验和组织学检查的检出率分别为96.5%（55/57）和59.6%（35/57）。在3例组织学检查阳性但尿素酶试验阴性的患者中，只有1例再次被证实感染了幽门螺杆菌。溃疡不同部位（胃窦/胃角/胃近端）的快速尿素酶试验和组织学检查的检出率分别为92.6%/100%/100%和81.5%/42.1%/36.4%。