13C-尿素呼气试验诊断儿童幽门螺杆菌感染：系统评价和荟萃分析。

13C-urea breath test for the diagnosis of Helicobacter pylori infection in children: a systematic review and meta-analysis.

机构信息

Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad de Mérida, Instituto Mexicano del Seguro Social, Mérida, Yuc, México.

出版信息

Helicobacter. 2011 Aug;16(4):327-37. doi: 10.1111/j.1523-5378.2011.00863.x.

DOI:10.1111/j.1523-5378.2011.00863.x

PMID:21762274

Abstract

BACKGROUND

The (13) C-urea breath test ((13) C-UBT) is a safe, noninvasive and reliable method for diagnosing H. pylori infection in adults. However, the test has shown variable accuracy in the pediatric population, especially in young children. We aimed to carry out a systematic review and meta-analysis to evaluate the performance of the (13) C-UBT diagnostic test for H. pylori infection in children.

METHODS

We conducted a systematic review of the PubMed, Embase and Liliacs databases including studies from January 1998 to May 2009. Selection criteria included studies with at least 30 children and reporting the comparison of (13) C-UBT against a gold standard for H. pylori diagnosis. Thirty-one articles and 135 studies were included for analysis. Children were stratified in subgroups of <6 and ≥6 years of age, and we considered variables such as type of meal, cutoff value, tracer dose, and delta time for the analysis.

DISCUSSION

The (13) C-UBT performance meta-analyses showed 1, good accuracy in all ages combined (sensitivity 95.9%, specificity 95.7%, LR+ 17.4, LR- 0.06, diagnostic odds ratio (DOR) 424.9), 2, high accuracy in children >6 years (sensitivity 96.6%, specificity 97.7%, LR+ 42.6, LR- 0.04, DOR 1042.7), 3, greater variability in accuracy estimates and on average a few percentage points lower, particularly specificity, in children ≤6 years (sensitivity 95%, specificity 93.5%, LR+ 11.7, LR- 0.12, DOR 224.8). Therefore, the meta-analysis shows that the (13) C-UBT test is less accurate for the diagnosis of H. pylori infection in young children, but adjusting cutoff value, pretest meal, and urea dose, this accuracy can be improved.

摘要

背景

13C-尿素呼气试验（13C-UBT）是一种安全、非侵入性和可靠的方法，可用于诊断成人幽门螺杆菌感染。然而，该试验在儿科人群中的准确性存在差异，尤其是在幼儿中。我们旨在进行系统评价和荟萃分析，以评估 13C-UBT 诊断试验在儿童中诊断幽门螺杆菌感染的性能。

方法

我们对 PubMed、Embase 和 Liliacs 数据库进行了系统评价，纳入了 1998 年 1 月至 2009 年 5 月的研究。选择标准包括至少有 30 名儿童的研究，并报告了 13C-UBT 与幽门螺杆菌诊断的金标准比较。有 31 篇文章和 135 项研究被纳入分析。儿童分为<6 岁和≥6 岁亚组，并考虑了餐型、截断值、示踪剂剂量和 delta 时间等变量进行分析。

讨论

13C-UBT 性能荟萃分析显示，1. 所有年龄组的准确性均较高（敏感度 95.9%，特异度 95.7%，LR+ 17.4，LR- 0.06，诊断比值比（DOR）424.9），2. 6 岁以上儿童的准确性较高（敏感度 96.6%，特异度 97.7%，LR+ 42.6，LR- 0.04，DOR 1042.7），3. 6 岁以下儿童的准确性估计值差异较大，特异性平均低几个百分点，特别是 6 岁以下儿童（敏感度 95%，特异度 93.5%，LR+ 11.7，LR- 0.12，DOR 224.8）。因此，荟萃分析表明，13C-UBT 试验在诊断幼儿幽门螺杆菌感染时准确性较低，但通过调整截断值、预试验餐和尿素剂量，可以提高其准确性。