Tang Jui-Hsiang, Liu Nai-Jen, Cheng Hao-Tsai, Lee Ching-Song, Chu Yin-Yi, Sung Kai-Feng, Lin Cheng-Hui, Tsou Yung-Kuan, Lien Jau-Min, Cheng Chi-Liang
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei, Taiwan.
J Clin Gastroenterol. 2009 Feb;43(2):133-9. doi: 10.1097/mcg.0b013e31816466ec.
To assess the efficacy of rapid urease test (RUT) in patients with bleeding ulcers, as well as the effects of visible blood in the stomach and short-term (<24 h) use of standard-dose proton pump inhibitor (PPI) on RUT sensitivity.
The sensitivity of RUT in the diagnosis of Helicobacter pylori in upper gastrointestinal bleeding has been reported with conflicting results.
This was a prospective case-control study evaluating 324 consecutive patients with bleeding peptic ulcers (study group) and 164 with uncomplicated ulcers (control group). The presence of H. pylori infection was determined by both RUT and histology. Prevalence of H. pylori infection and the RUT sensitivity in diagnosing the bacteria between study and control groups were conducted.
The prevalence of H. pylori infection in those with bleeding ulcers was significantly lower than that of controls (53.7% vs. 65.2%, P=0.015). The false-negative rate of RUT in the study group was significantly greater than that of the control group (16.7% vs. 5.6%, P=0.006), whereas the sensitivity rates in the study group with or without gastric blood were significantly lower than those of the controls (79.6% vs. 94.4%, P=0.005; 84.8% vs. 94.4%, P=0.019). There was no significant difference in RUT sensitivity between study group with or without visible gastric blood (P=0.41). The RUT sensitivity rate was also not significantly different between those treated with PPI and those without in patients with bleeding ulcers (82.7% vs. 85.7%, P=0.67).
This study shows that the sensitivity of RUT in patients with bleeding ulcers is reduced. The presence of blood in the stomach and the short-term use of standard-dose PPI do not affect the RUT sensitivity in bleeding ulcers.
评估快速尿素酶试验（RUT）在出血性溃疡患者中的疗效，以及胃内可见血液和短期（<24小时）使用标准剂量质子泵抑制剂（PPI）对RUT敏感性的影响。
关于RUT在上消化道出血中诊断幽门螺杆菌的敏感性，报道结果相互矛盾。
这是一项前瞻性病例对照研究，评估了324例连续的出血性消化性溃疡患者（研究组）和164例无并发症溃疡患者（对照组）。通过RUT和组织学检查确定幽门螺杆菌感染情况。比较了研究组和对照组中幽门螺杆菌感染的患病率以及RUT诊断该细菌的敏感性。
出血性溃疡患者中幽门螺杆菌感染的患病率显著低于对照组（53.7%对65.2%，P = 0.015）。研究组中RUT的假阴性率显著高于对照组（16.7%对5.6%，P = 0.006），而研究组中有或无胃内血液时的敏感性率均显著低于对照组（79.6%对94.4%，P = 0.005；84.8%对94.4%，P = 0.019）。研究组中有或无可见胃内血液时RUT敏感性无显著差异（P = 0.41）。出血性溃疡患者中接受PPI治疗和未接受PPI治疗的患者之间RUT敏感性率也无显著差异（82.7%对85.7%，P = 0.67）。
本研究表明，RUT在出血性溃疡患者中的敏感性降低。胃内有血液以及短期使用标准剂量PPI不影响出血性溃疡中RUT的敏感性。
