Rollán A, Giancaspero R, Arrese M, Figueroa C, Vollrath V, Schultz M, Duarte I, Vial P
Gastroenterology Department, Centro de Investigaciones Médicas, Faculty of Medicine, Catholic University of Chile, Santiago.
Am J Gastroenterol. 1997 Aug;92(8):1268-74.
To compare the diagnostic accuracy of the most widely available tests for diagnosis of Helicobacter pylori infection after antibiotic treatment.
A total of 59 H. pylori-positive, duodenal ulcer patients (mean age, 40.7 +/- 11.7 yr; 40 male and 19 female) were treated for 2 wk with either amoxicillin-metronidazole (n = 36) or omeprazole-amoxicillin-tinidazole (n = 23), and after 4 wk, were tested for H. pylori infection by [14C]urea breath test (UBT), serum IgG antibody level, and multiple antral biopsies for rapid urease testing, histology, Warthin-Starry stain, and polymerase chain reaction to detect H. pylori DNA. Infection status was established by a concordance of test results.
H. pylori was eradicated in 47 patients (80%). UBT and rapid urease testing had the best sensitivity and specificity, although not statistically different to Warthin-Starry stain and polymerase chain reaction. Serology and histology had little diagnostic value in this setting due to high proportion of false-positive results.
Noninvasive UBT is as accurate in predicting H. pylori status after antibiotic treatment as rapid urease testing and Warthin-Starry stain. Especially for duodenal ulcer patients, UBT could be considered the gold standard to confirm eradication of H. pylori.
比较抗生素治疗后诊断幽门螺杆菌感染最常用检测方法的诊断准确性。
共59例幽门螺杆菌阳性的十二指肠溃疡患者（平均年龄40.7±11.7岁；男性40例，女性19例），分别接受阿莫西林-甲硝唑治疗2周（n = 36）或奥美拉唑-阿莫西林-替硝唑治疗2周（n = 23），4周后通过[14C]尿素呼气试验（UBT）、血清IgG抗体水平以及多处胃窦活检进行快速尿素酶检测、组织学检查、Warthin-Starry染色和聚合酶链反应检测幽门螺杆菌DNA，以检测幽门螺杆菌感染情况。通过检测结果的一致性确定感染状态。
47例患者（80%）幽门螺杆菌被根除。UBT和快速尿素酶检测具有最佳的敏感性和特异性，尽管与Warthin-Starry染色和聚合酶链反应在统计学上无差异。由于假阳性结果比例较高，血清学和组织学在这种情况下诊断价值不大。
抗生素治疗后，非侵入性UBT在预测幽门螺杆菌状态方面与快速尿素酶检测和Warthin-Starry染色一样准确。特别是对于十二指肠溃疡患者，UBT可被视为确认幽门螺杆菌根除的金标准。
