Schrader J A, Peck H V, Notis W M, Shaw P, Venezia R A
Department of Pathology and Laboratory Medicine, Albany Medical College, New York.
Am J Gastroenterol. 1993 Oct;88(10):1729-33.
In this study, our objective was to determine the presence of Helicobacter pylori and other rapid urease-positive (RUP) organisms in gastric biopsies in 70 patients, 30 of whom had ulcers or erosions. A retrospective chart review was undertaken to correlate diagnostic tests (culture and direct urease) with results of endoscopic examination and the patient's clinical information. Eleven of 70 (15.7%) patients' biopsies were positive by both culture and direct urease for H. pylori, seven (10%) patients' biopsies were positive by culture only, and eight (11.4%) biopsies by direct urease only. Of 30 patients with ulcers (esophageal, antral, stomach, or duodenal), 15 had evidence of H. pylori infection by culture and/or direct urease test. In addition, patients with a positive direct urease test but a negative culture for H. pylori were more likely to have other rapid urease-positive organisms (RUP) isolated from their gastric biopsy cultures than patients with negative results from both tests.
As a result of problems associated with commonly used diagnostic tests, a combination of tests performed on multiple biopsies is more sensitive and specific for the diagnosis of H. pylori infection than any single test. The common occurrence of RUP streptococcal and staphylococcal species in gastric biopsy tissue is demonstrated and proposed as a cause of false-positive direct urease tests.
在本研究中，我们的目的是确定70例患者胃活检中幽门螺杆菌及其他快速尿素酶阳性（RUP）微生物的存在情况，其中30例患者有溃疡或糜烂。进行了一项回顾性病历审查，以将诊断测试（培养和直接尿素酶试验）与内镜检查结果及患者的临床信息相关联。70例患者中有11例（15.7%）的活检组织经培养和直接尿素酶试验均显示幽门螺杆菌阳性，7例（10%）患者的活检组织仅培养阳性，8例（11.4%）活检组织仅直接尿素酶试验阳性。在30例患有溃疡（食管、胃窦、胃或十二指肠）的患者中，15例通过培养和/或直接尿素酶试验有幽门螺杆菌感染的证据。此外，直接尿素酶试验阳性但幽门螺杆菌培养阴性的患者，比两项试验结果均为阴性的患者，更有可能从其胃活检培养物中分离出其他快速尿素酶阳性微生物（RUP）。
由于常用诊断测试存在问题，对多个活检组织进行多种测试组合，比任何单一测试对幽门螺杆菌感染的诊断更敏感、更具特异性。胃活检组织中常见RUP链球菌和葡萄球菌属，这被证明并被认为是直接尿素酶试验假阳性的原因。
