Abdel-Monem Mohamed H, Magdy Emad A, Nour Yasser A, Harfoush Reem A, Ibreak Alnagy
Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Int J Pediatr Otorhinolaryngol. 2011 Apr;75(4):568-72. doi: 10.1016/j.ijporl.2011.01.021. Epub 2011 Feb 15.
Contradictory results have been reported regarding Helicobacter pylori (H. pylori) detection in adenotonsillar tissue. The aims of this study were to investigate whether adenotonsillar tissue of symptomatic children with chronic adenotonsillitis harbors the H. pylori organism, using two biopsy-based invasive methods namely; rapid urease test (RUT) and polymerase chain reaction (PCR) as well as blood serology and to compare the results obtained from each of these methods to the "gold standard".
This prospective clinical study was carried out on 20 children aged between 2 and 10 years scheduled for tonsillectomy +/- adenoidectomy in a tertiary referral center. Exclusion criteria included: use of antacids, H(2) blockers or antibiotics during the previous month before surgery and adenotonsillectomy for obstructive sleep apnea. Core biopsy samples from resected adenotonsillar tissue was tested for H. pylori detection using both RUT and PCR assay for the ureC gene. Preoperative patient venous blood samples were also tested for H. pylori IgG antibodies. As a "gold standard", examined tissue was considered to be H. pylori infected if the two biopsy specimen-based methods (RUT and PCR) yielded positive results.
Thirty adenotonsillectomy specimens were tested (20 tonsils and 10 adenoids). RUT was positive in 16 (53.3%) specimens (12 tonsils and 4 adenoids). According to the "gold standard", 11/16 were considered false-positive, yielding this test sensitivity 100% and specificity 56%. The ureC gene sequence was detected by PCR in 5 (16.6%) specimens (3 tonsils and 2 adenoids), all of which were also positive by RUT, thus were considered H. pylori infected. Accordingly, PCR had a 100% sensitivity and specificity. Serology testing was positive for H. pylori IgG antibodies in 4/20 patients (20%), only two of them were found to have H. pylori infected adenotonsillar tissue.
Based on our findings it seems that adenotonsillar tissue may constitute an extra-gastric reservoir for H. pylori in symptomatic children with chronic adenotonsillitis. RUT was found to be of less accuracy than PCR in H. pylori detection in an extra-gastric location, thus results of previous studies using this test alone for detection of oral H. pylori should be treated with caution.
关于在腺样体扁桃体组织中检测幽门螺杆菌（H. pylori），已有相互矛盾的结果报道。本研究的目的是使用两种基于活检的侵入性方法，即快速尿素酶试验（RUT）和聚合酶链反应（PCR）以及血清学检测，来调查患有慢性腺样体扁桃体炎的有症状儿童的腺样体扁桃体组织中是否存在幽门螺杆菌，并将这些方法得到的结果与“金标准”进行比较。
这项前瞻性临床研究在一家三级转诊中心对20名年龄在2至10岁、计划进行扁桃体切除术+/-腺样体切除术的儿童进行。排除标准包括：手术前一个月内使用抗酸剂、H2受体阻滞剂或抗生素，以及因阻塞性睡眠呼吸暂停进行腺样体扁桃体切除术。使用RUT和针对ureC基因的PCR检测法对切除的腺样体扁桃体组织的核心活检样本进行幽门螺杆菌检测。术前还对患者静脉血样本进行幽门螺杆菌IgG抗体检测。作为“金标准”，如果两种基于活检标本的方法（RUT和PCR）结果均为阳性，则检查的组织被认为感染了幽门螺杆菌。
共检测了30份腺样体扁桃体切除标本（20份扁桃体和10份腺样体）。RUT检测中16份标本（53.3%）呈阳性（12份扁桃体和4份腺样体）。根据“金标准”，16份中有11份被认为是假阳性，该检测的敏感性为100%，特异性为56%。PCR检测在5份标本（16.6%）中检测到ureC基因序列（3份扁桃体和2份腺样体），所有这些标本RUT检测也呈阳性，因此被认为感染了幽门螺杆菌。相应地，PCR的敏感性和特异性均为100%。血清学检测中4/20例患者（20%）的幽门螺杆菌IgG抗体呈阳性，其中只有2例被发现腺样体扁桃体组织感染了幽门螺杆菌。
根据我们的研究结果，似乎在患有慢性腺样体扁桃体炎的有症状儿童中，腺样体扁桃体组织可能构成幽门螺杆菌的胃外储存库。在胃外部位检测幽门螺杆菌时，发现RUT的准确性低于PCR，因此对于先前仅使用该检测来检测口腔幽门螺杆菌的研究结果应谨慎对待。
