Strauss R M, Wang T C, Kelsey P B, Compton C C, Ferraro M J, Perez-Perez G, Parsonnet J, Blaser M J
Gastrointestinal Unit, Massachusetts General Hospital, Boston.
Am J Med. 1990 Oct;89(4):464-9. doi: 10.1016/0002-9343(90)90377-p.
To determine the prevalence of Helicobacter pylori in patients with non-ulcer dyspepsia and ulcer disease as well as in a control population undergoing endoscopic retrograde cholangiopancreatography (ERCP) for suspected pancreatic or biliary disease.
Forty-six eligible patients undergoing upper endoscopy at Massachusetts General Hospital were studied over a period of 18 months, as well as 24 patients undergoing ERCP for presumed pancreatic or biliary disease. Two biopsy specimens from the fundus and two from the antrum were taken for microbiologic and histopathologic analysis. Sera were examined by enzyme-linked immunoabsorbent assay. All specimens were processed in a blind fashion. Chi-square test with Yates' correction was used for statistical analysis.
H. pylori was found in 31 of 46 (67%) study patients and in six of 24 (25%) control patients (by microbiologic or histologic techniques) (p less than 0.01). H. pylori was found in all patients with peptic ulcer disease and in 60% of patients without ulcers. No association between H. pylori and any specific gastrointestinal symptom was observed. H. pylori was identified in the fundus as often as in the antrum, although in the antrum the organism was more often associated with histologic gastritis. Compared with histology, serologic assays for IgG and IgA antibodies to H. pylori had sensitivities of 100% and 94%, and specificities of 86% and 76%, respectively. Reexamination of selected specimens without knowledge of their identity revealed that the specificity of serology exceeded 94% while the sensitivity of histologic and microbiologic studies may have been closer to 80%.
H. pylori was more common in dyspeptic patients than in our control subjects undergoing ERCP. Multiple biopsy sites from fundus and antrum are required to exclude infection. Serologies of IgG and IgA were sensitive and specific for H. pylori, suggesting a possible role for non-endoscopic diagnosis of this infection. The frequent association of H. pylori with active inflammation rather than with quiescent gastritis is consistent with a pathologic role of this organism.
确定幽门螺杆菌在非溃疡性消化不良患者、溃疡病患者以及因疑似胰腺或胆道疾病接受内镜逆行胰胆管造影（ERCP）的对照人群中的患病率。
在18个月的时间里，对46名在马萨诸塞州综合医院接受上消化道内镜检查的符合条件的患者以及24名因疑似胰腺或胆道疾病接受ERCP的患者进行了研究。从胃底和胃窦各取两份活检标本进行微生物学和组织病理学分析。通过酶联免疫吸附测定法检测血清。所有标本均以盲法处理。采用经Yates校正的卡方检验进行统计分析。
在46名研究患者中有31名（67%）检测到幽门螺杆菌，在24名对照患者中有6名（25%）检测到幽门螺杆菌（通过微生物学或组织学技术）（p<0.01）。所有消化性溃疡病患者均检测到幽门螺杆菌，无溃疡患者中60%检测到幽门螺杆菌。未观察到幽门螺杆菌与任何特定胃肠道症状之间存在关联。幽门螺杆菌在胃底和胃窦被检测到的频率相同，尽管在胃窦该菌更常与组织学胃炎相关。与组织学检查相比，幽门螺杆菌IgG和IgA抗体的血清学检测敏感性分别为100%和94%，特异性分别为86%和76%。在不知道标本身份的情况下对选定标本进行重新检测发现，血清学的特异性超过94%，而组织学和微生物学研究的敏感性可能更接近80%。
幽门螺杆菌在消化不良患者中比在接受ERCP的对照受试者中更常见。需要从胃底和胃窦多个活检部位来排除感染。IgG和IgA的血清学检测对幽门螺杆菌敏感且具有特异性，提示其在这种感染的非内镜诊断中可能发挥作用。幽门螺杆菌与活动性炎症而非静止性胃炎的频繁关联与该菌的病理作用一致。
