Chung Woo Chul, Jeon Eun Jung, Oh Jung Hwan, Park Jae Myung, Kim Tae Ho, Cheung Dae Young, Kim Byung Wook, Kim Sung Soo, Kim Jin Il
Division of Gastroenterology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, St. Paul Hospital, The Catholic University of Korea, Republic of Korea.
Dig Liver Dis. 2016 Aug;48(8):899-903. doi: 10.1016/j.dld.2016.04.012. Epub 2016 Apr 27.
In patients with peptic ulcer bleeding (PUB), diagnostic tests for Helicobacter pylori (H. pylori) infection have low sensitivity. The aim of our study was to investigate the diagnostic yield of dual-priming oligonucleotide-based multiplex (DPO)-PCR using tissue samples from the rapid urease test (RUT, CLO(®)test) kit in patients with PUB.
We prospectively enrolled patients with PUB. During second-look endoscopy, gastric biopsy specimens for histology and RUT were obtained from a total of 170 patients. DPO-PCR tests were performed on tissue samples obtained from the CLO(®)test kit. If testing for H. pylori was negative, endoscopy with re-biopsy was performed 8 weeks after the bleeding episode.
H. pylori-associated bleeding was confirmed in 64.1% (109/170) of the patients. At the bleeding episode, the diagnostic sensitivities of RUT, histology, and DPO-PCR test were 47.7% (52/109), 71.6% (78/109) and 97.2% (106/109), respectively (p<0.01). The specificity of the DPO-PCR test was 91.8% (56/61). The positive predictive value (PPV) of the DPO-PCR test was 95.5% (106/111), and its negative predictive value (NPV) was 94.9% (56/59).
In patients with PUB, the DPO-PCR test could be a useful diagnostic tool for H. pylori infection. Particularly given a negative RUT result, subsequent DPO-PCR testing of tissue samples from the CLO(®)test kit could be of considerable benefit.
在消化性溃疡出血（PUB）患者中，幽门螺杆菌（H. pylori）感染的诊断测试灵敏度较低。我们研究的目的是探讨使用快速尿素酶试验（RUT，CLO®试验）试剂盒的组织样本进行双引物寡核苷酸多重（DPO）-PCR在PUB患者中的诊断率。
我们前瞻性纳入了PUB患者。在二次内镜检查时，从总共170例患者中获取用于组织学检查和RUT的胃活检标本。对从CLO®试验试剂盒获得的组织样本进行DPO-PCR检测。如果幽门螺杆菌检测为阴性，则在出血事件发生8周后进行再次活检的内镜检查。
64.1%（109/170）的患者确诊为幽门螺杆菌相关性出血。在出血事件发生时，RUT、组织学检查和DPO-PCR检测的诊断灵敏度分别为47.7%（52/109）、71.6%（78/109）和97.2%（106/109）（p<0.01）。DPO-PCR检测的特异性为91.8%（56/61）。DPO-PCR检测的阳性预测值（PPV）为95.5%（106/111），阴性预测值（NPV）为94.9%（56/59）。
在PUB患者中，DPO-PCR检测可能是诊断幽门螺杆菌感染的有用工具。特别是在RUT结果为阴性的情况下，随后对CLO®试验试剂盒的组织样本进行DPO-PCR检测可能会有很大益处。
