儿童胃窦部结节对幽门螺杆菌感染诊断价值的重新评估。

Reassessment of diagnostic value of antral nodularity for Helicobacter pylori infection in children.

作者信息

Prasad K K, Thapa B R, Sharma A K, Nain C K, Singh K

机构信息

Division of GE Histopathology, Department of Superspeciality of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh (UT), India.

出版信息

Minerva Gastroenterol Dietol. 2008 Mar;54(1):1-6.

PMID:18299663

Abstract

AIM

Antral nodularity is considered as specific for Helicobacter pylori-associated gastritis in children as well as in adults. The aim of this study is to reassess the accuracy of using antral nodularity as a marker for H. pylori-infection in children with various gastroduodenal diseases.

METHODS

This prospective study included 725 consecutive children in whom upper digestive endoscopy was performed for gastrointestinal symptoms between June 6, 2003 and May 11, 2007 and gastric antral mucosal biopsy was taken. They were divided within three diagnoses groups: Group I, recurrent abdominal pain (N=252); Group II, celiac disease (N=358) and Group III, miscellaneous diagnoses (N=115). One hundred nineteen children were diagnosed as having antral nodularity and were included in the study. H. pylori were recognized in gastric biopsy on hematoxylin and eosin (H&E) sections; a toluidine blue stain was performed in biopsy suspicious for H. pylori. The appropriate statistical method was applied for analysis of data.

RESULTS

The prevalence of antral nodularity in children (M:F:65:54) was 16.4% (119/725). The mean age of children with antral nodularity was 9.4 years (SEM, 0.1 years; range, 2-18 years). The prevalence of antral nodularity increased gradually with age. Fifty out of 119 (42%) children with antral nodularity had recurrent abdominal pain, 26/119 (21.9%) had celiac disease and 43/119 (36.1%) had miscellaneous diagnoses. H pylori-infection was identified in 118/725 (16.3%) children. Antral nodularity had a poor accuracy rate to determine H. pylori-infection (sensitivity, 42%; positive predictive value, 42.4%) and was observed in 50 of 118 (42.4%) H. pylori-positive patients and in 69 of 607 (11.4%) H. pylori-negative patients.

CONCLUSION

The antral nodularity is a poor predictor for H pylori-infection in children. During endoscopy, gastric biopsies should always be obtained in children to establish the presence of H pylori-infection.

摘要

目的

胃窦小结节在儿童和成人中均被认为是幽门螺杆菌相关性胃炎的特征性表现。本研究旨在重新评估胃窦小结节作为各种胃十二指肠疾病患儿幽门螺杆菌感染标志物的准确性。

方法

这项前瞻性研究纳入了2003年6月6日至2007年5月11日期间因胃肠道症状接受上消化道内镜检查并进行胃窦黏膜活检的725例连续儿童。他们被分为三个诊断组：第一组，复发性腹痛（N = 252）；第二组，乳糜泻（N = 358）；第三组，其他诊断（N = 115）。119例被诊断为胃窦小结节的儿童被纳入研究。通过苏木精和伊红（H&E）切片在胃活检中识别幽门螺杆菌；对疑似幽门螺杆菌的活检组织进行甲苯胺蓝染色。采用适当的统计方法进行数据分析。

结果

儿童（男：女 = 65：54）胃窦小结节的患病率为16.4%（119/725）。胃窦小结节患儿的平均年龄为9.4岁（标准误，0.1岁；范围，2 - 18岁）。胃窦小结节的患病率随年龄逐渐增加。119例胃窦小结节患儿中，50例（42%）有复发性腹痛，26例（21.9%）有乳糜泻，43例（36.1%）有其他诊断。725例儿童中118例（16.3%）被鉴定为幽门螺杆菌感染。胃窦小结节对确定幽门螺杆菌感染的准确率较低（敏感性，42%；阳性预测值，42.4%），在118例幽门螺杆菌阳性患者中的50例（42.4%）以及607例幽门螺杆菌阴性患者中的69例（11.4%）中观察到胃窦小结节。