快速尿素酶试验和¹³C尿素呼气试验在诊断幽门螺杆菌感染中的准确性。

The accuracy of the rapid urease test and 13C-urea breath test in the diagnosis of Helicobacter pylori infection.

作者信息

Ho A S, Young T H, Shyu R Y, Yeh C, Tseng H H, Lee S C, Lee M S, Hsu C T

机构信息

Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.

出版信息

Zhonghua Yi Xue Za Zhi (Taipei). 1996 Dec;58(6):400-6.

PMID:9068206

Abstract

BACKGROUND

Helicobacter pylori (H. pylori) is an important predisposing factor in peptic ulcer disease. Many tests have been proposed, but there is no generally accepted single method for the detection of H. pylori. This study compared the four available methods in the detection of H. pylori.

METHODS

One hundred and thirteen patients were studied with endoscopic biopsy. Biopsy specimens were examined with modified Giemsa stain and rapid urease (CLO) test. Serology (ELISA) and 13C-urea breath test (13C-UBT) were also performed. The 13C-UBT results were expressed at an excess delta 13CO2 excretion of 5 per mil as the upper limit. Multiple breath samples were collected 15, 30 and 60 minutes following 13C-urea ingestion (t = 15, 30, 60) in the first 60 patients. Gastric inflammatory changes were graded according to the Whitehead classification. The diagnostic gold standard was defined when three or more of the four test parameters showed positive.

RESULTS

According to this diagnostic gold standard, the positive rates of H. pylori were 97.9% for duodenal ulcer, 81.8% for gastric ulcer, 47.6% for symptomatic gastritis and 13.6% for asymptomatics. Rapid urease test and the 13C-UBT had better sensitivity (93.6% and 96.2%) and accuracy (93.8% and 93.8%). The specificity and positive predictive value for rapid urease test was better than 13C-UBT (94.3% v.s. 88.6%, 97.3% v.s. 94.9% respectively). Modified Giemsa stain had the lowest sensitivity (87.2%), and the ELISA test had the lowest specificity (71.4%). Severity of the gastric inflammatory processes was directly correlated with the excess delta 13CO2 (r = 0.576).

CONCLUSIONS

Both the CLO and 13C-UBT had higher accuracy in the detection of H. pylori. When the CLO test result is positive, there is little additional diagnostic benefit from performing other tests. If patients refuse endoscopic examination, 13C-UBT is a good alternative for the detection of H. pylori, either during diagnosis or follow-up after therapy.

摘要

背景

幽门螺杆菌（H. pylori）是消化性溃疡病的一个重要诱发因素。已经提出了许多检测方法，但目前尚无一种被普遍接受的单一检测幽门螺杆菌的方法。本研究比较了四种可用的检测幽门螺杆菌的方法。

方法

对113例患者进行了内镜活检研究。活检标本采用改良吉姆萨染色和快速尿素酶（CLO）试验进行检查。还进行了血清学（ELISA）和13C-尿素呼气试验（13C-UBT）。13C-UBT结果以上升的δ13CO2排泄量5‰为上限。在前60例患者中，在摄入13C-尿素后15、30和60分钟（t = 15、30、60）采集多个呼气样本。根据怀特黑德分类法对胃炎性变化进行分级。当四个检测参数中的三个或更多显示阳性时，定义为诊断金标准。

结果

根据该诊断金标准，十二指肠溃疡患者幽门螺杆菌阳性率为97.9%，胃溃疡患者为81.8%，症状性胃炎患者为47.6%，无症状患者为13.6%。快速尿素酶试验和13C-UBT具有较好的敏感性（分别为93.6%和96.2%）和准确性（分别为93.8%和93.8%）。快速尿素酶试验的特异性和阳性预测值优于13C-UBT（分别为94.3%对88.6%，97.3%对94.9%）。改良吉姆萨染色的敏感性最低（87.2%），ELISA试验的特异性最低（71.4%）。胃炎性病变的严重程度与δ13CO2升高直接相关（r = 0.576）。