Department of Pathology and Laboratory Medicine, Emory University Hospital (rm C179A), 1364 Clifton Rd, Atlanta, GA 30322, USA.
Eur J Pediatr. 2010 Jan;169(1):15-25. doi: 10.1007/s00431-009-1033-x. Epub 2009 Jul 18.
The array of tests that can be used for diagnosis of Helicobacter pylori infection is large, and it can be confusing to define which test to use particularly in children where results may not be comparable to those obtained in adult patients. Using PubMed, we reviewed the English literature from January 1999 to May 2009 to identify articles that determined sensitivity and specificity of H. pylori invasive and non-invasive diagnostic tests in children. We excluded articles that presented a review of the literature, abstracts, case reports, or series where children's results could not be separated from adult populations. Of the tissue based methods, rapid urease tests have better sensitivity than histology to detect presence of H. pylori; however, histology can detect the pathology associated with disease including gastritis, intestinal metaplasia, and other conditions that could be the cause of the child's symptoms. Culture of gastric tissues or stool has 100% specificity but sensitivity is low. Of the serologic tests, immunoblot has the best sensitivity. The urea breath tests have >75% sensitivity for detection of H. pylori before and after treatment. Immunoassays in stool using monoclonal antibodies have >95% sensitivity for detection of H. pylori before and after treatment. PCR testing can be performed in tissue and stool samples and can detect genes associated to antibiotic resistance. In summary, the current commercial non-invasive tests have adequate sensitivity and specificity for detecting the presence of H. pylori; however, endoscopy with histopathology is the only method that can detect H. pylori and lesions associated with the infection.
用于诊断幽门螺杆菌感染的检测方法很多，在儿童中，特别是在儿童的检测结果与成人患者的检测结果不可比的情况下，很难确定使用哪种检测方法。通过使用 PubMed，我们回顾了 1999 年 1 月至 2009 年 5 月的英文文献，以确定确定儿童中幽门螺杆菌侵袭性和非侵袭性诊断检测方法的敏感性和特异性的文章。我们排除了仅对文献进行综述、仅为摘要、病例报告或儿童结果不能与成人人群分开的系列文章。在组织学方法中，快速尿素酶试验比组织学具有更好的敏感性来检测幽门螺杆菌的存在；但是，组织学可以检测与疾病相关的病理，包括胃炎、肠上皮化生和其他可能导致儿童症状的病症。胃组织或粪便培养具有 100％的特异性，但敏感性较低。在血清学检测中，免疫印迹具有最高的敏感性。尿素呼吸试验在治疗前后检测幽门螺杆菌的敏感性> 75％。治疗前后使用单克隆抗体的粪便免疫测定具有> 95％的敏感性来检测幽门螺杆菌。PCR 检测可在组织和粪便样本中进行，并且可以检测与抗生素耐药性相关的基因。总之，目前的商业非侵入性检测方法具有足够的敏感性和特异性来检测幽门螺杆菌的存在；但是，只有通过内镜检查结合组织病理学才能检测到幽门螺杆菌以及与感染相关的病变。
