Cutler A F, Havstad S, Ma C K, Blaser M J, Perez-Perez G I, Schubert T T
Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA.
Gastroenterology. 1995 Jul;109(1):136-41. doi: 10.1016/0016-5085(95)90278-3.
BACKGROUND & AIMS: Multiple tests are available for determining Helicobacter pylori infection. Our aim was to compare the sensitivity, specificity, and negative and positive predictive value of the most widely available tests for diagnosis of H. pylori.
A total of 268 patients (mean age, 53.7 +/- 15.8 years; 142 male and 126 female; 125 white and 143 nonwhite) was tested for H. pylori infection by [13C]urea breath test (UBT), measurement of serum immunoglobulin (Ig) G and IgA antibody levels, and antral biopsy specimens for CLO test, histology, and Warthin-Starry stain. No patient received specific treatment for H. pylori before testing. The infection status for each patient was established by a concordance of test results.
Warthin-Starry staining had the best sensitivity and specificity, although CLO test, UBT, and IgG levels were not statistically different in determining the correct diagnosis. The absence of chronic antral inflammation was the best method to exclude infection. Stratification of results by clinical characteristics showed that UBT and chronic inflammation were the best predictors of H. pylori status in patients older than 60 years of age. IgA was a better predictor in white patients.
The noninvasive UBT and IgG serology test are as accurate in predicting H. pylori status in untreated patients as the invasive tests of CLO and Warthin-Starry.
有多种检测方法可用于确定幽门螺杆菌感染。我们的目的是比较最常用的幽门螺杆菌诊断检测方法的敏感性、特异性、阴性预测值和阳性预测值。
共有268例患者（平均年龄53.7±15.8岁；男性142例，女性126例；白人125例，非白人143例）接受了幽门螺杆菌感染检测，检测方法包括[13C]尿素呼气试验（UBT）、血清免疫球蛋白（Ig）G和IgA抗体水平测定，以及取胃窦活检标本进行CLO检测、组织学检查和Warthin-Starry染色。所有患者在检测前均未接受过针对幽门螺杆菌的特异性治疗。通过检测结果的一致性确定每位患者的感染状态。
Warthin-Starry染色的敏感性和特异性最佳，不过在确定正确诊断方面，CLO检测、UBT和IgG水平在统计学上并无差异。无慢性胃窦炎症是排除感染的最佳方法。按临床特征对结果进行分层显示，在60岁以上患者中，UBT和慢性炎症是幽门螺杆菌感染状态的最佳预测指标。在白人患者中，IgA是更好的预测指标。
在预测未治疗患者的幽门螺杆菌感染状态方面，非侵入性的UBT和IgG血清学检测与侵入性的CLO检测和Warthin-Starry染色一样准确。
