Weston A P, Campbell D R, Hassanein R S, Cherian R, Dixon A, McGregor D H
Department of Veterans Affairs Medical Center, Kansas City, Missouri 64128-2226, USA.
Am J Gastroenterol. 1997 Aug;92(8):1310-5.
To determine prospectively the effect of aspirin, nonsteroidal anti-inflammatory drugs, H2-receptor antagonists, proton pump inhibitors, alcohol intake, race, age, history of Helicobacter pylori eradication attempts, and gastric biopsy location on CLOtest performance.
Biopsy specimens were obtained from the antrum, greater curve, and proximal stomach. One biopsy specimen from each site (except for the proximal stomach) was used for the CLOtest and two or more specimens were used for histopathology. Giemsa staining was used for the definitive determination of H. pylori status.
One hundred seventeen patients were included in the study, and 50 of these were infected with H. pylori. The sensitivity and specificity of an antral CLOtest, based on the results of Giemsa-stained sections from the antrum alone, were 72.7 and 98.6%, respectively, whereas they were 66.0 and 100% when based on the results of Giemsa-stained sections from all three gastric biopsy sites. The sensitivity and specificity of a body CLOtest, based on the results of Giemsa-stained sections from the body alone, were 80.5% and 93.4%, whereas they were 76.0% and 100% when based on the results of Giemsa-stained sections from all three gastric biopsy sites. Combining CLOtest results from the antrum and body increased CLOtest sensitivity to 82.0%. Univariate analysis revealed only one factor significantly associated with CLOtest concordance: absence of alcohol consumption (p < 0.02). Stepwise logistic regression demonstrated that absence of alcohol use again was independently associated with the concordance between overall CLOtest and all Giemsa-stained biopsy specimen results (p < 0.03) as well as between body CLOtest and body Giemsa-stained biopsy specimen results (p < 0.03). Additional independent and significant associations were noted between antral CLOtest-antral Giemsa-stained biopsy specimen results and no history of H. pylori eradication attempts (p = 0.04) and between body CLOtest-body Giemsa-stained biopsy specimen results and race (African-American) (p < 0.03).
Obtaining a gastric biopsy specimen from the antrum as well as from the body increased CLOtest detection of H. pylori. CLOtest performance was shown to be affected by several demographic and clinical factors.
前瞻性地确定阿司匹林、非甾体抗炎药、H2受体拮抗剂、质子泵抑制剂、酒精摄入、种族、年龄、幽门螺杆菌根除治疗史以及胃活检部位对CLO检测结果的影响。
从胃窦、胃大弯和胃近端获取活检标本。每个部位（胃近端除外）的一份活检标本用于CLO检测，两份或更多标本用于组织病理学检查。吉姆萨染色用于最终确定幽门螺杆菌感染状态。
117例患者纳入本研究，其中50例感染幽门螺杆菌。仅基于胃窦吉姆萨染色切片结果的胃窦CLO检测的敏感性和特异性分别为72.7%和98.6%，而基于所有三个胃活检部位吉姆萨染色切片结果时，其敏感性和特异性分别为66.0%和100%。仅基于胃体吉姆萨染色切片结果的胃体CLO检测的敏感性和特异性分别为80.5%和93.4%，而基于所有三个胃活检部位吉姆萨染色切片结果时，其敏感性和特异性分别为76.0%和100%。将胃窦和胃体的CLO检测结果相结合可使CLO检测的敏感性提高到82.0%。单因素分析显示，仅一个因素与CLO检测结果一致性显著相关：不饮酒（p<0.02）。逐步逻辑回归表明，不饮酒再次独立地与总体CLO检测结果和所有吉姆萨染色活检标本结果之间的一致性相关（p<0.03），以及与胃体CLO检测结果和胃体吉姆萨染色活检标本结果之间的一致性相关（p<0.03）。在胃窦CLO检测-胃窦吉姆萨染色活检标本结果与无幽门螺杆菌根除治疗史之间（p=0.04）以及胃体CLO检测-胃体吉姆萨染色活检标本结果与种族（非裔美国人）之间（p<0.03）还发现了其他独立且显著的关联。
从胃窦和胃体获取胃活检标本可提高CLO检测对幽门螺杆菌的检出率。CLO检测结果受多种人口统计学和临床因素的影响。
