Rowland M, Lambert I, Gormally S, Daly L E, Thomas J E, Hetherington C, Durnin M, Drumm B
Department of Paediatrics, University College Dublin, Ireland.
J Pediatr. 1997 Dec;131(6):815-20. doi: 10.1016/s0022-3476(97)70026-x.
Helicobacter pylori infection is mainly acquired in childhood, and studies on the epidemiology of this infection depend on the availability of a noninvasive diagnostic test for use in children. The aim of this study was to determine whether the carbon 13-labeled urea breath test (UBT) can be used in children by evaluating: (1) its sensitivity and specificity compared with either culture or both rapid urease test and histologic examination, (2) whether a test meal or a prolonged fast is required, (3) the usefulness after treatment for H. pylori. Eighty-eight children (mean age, 10.6 +/- 4.19 years) who were undergoing upper endoscopy were studied while fasting, not fasting, and after treatment. Children were given 50 mg of 13C-urea if they weighed less than 50 kg or 75 mg of 13C-urea if they weighed more than 50 kg with 50 mg of a glucose polymer solution in 7.5 ml of water. Breath samples were collected at baseline and at 15, 30, 45, and 60 minutes. In 63 fasting children the UBT was 100% sensitive and 97.6% specific at 30 minutes with a cutoff value of 3.5 delta 13CO2 per mil. Nonfasting tests in 23 children, performed between 1 and 2 hours after their usual meal, were 100% sensitive and 91.6% specific. In 13 children fed directly before the UBT, the sensitivity of the test was reduced to 50%. Thirty minutes was the optimal sampling time. There was a significant decrease in specificity when samples were obtained at 15 minutes, possibly caused by the interference of oral urease-producing organisms. The test was 100% sensitive and specific in 20 children after treatment for H. pylori infection. The UBT is a highly sensitive and specific test for the diagnosis of H. pylori infection in children. Neither a prolonged fast nor a test meal is required.
幽门螺杆菌感染主要在儿童期获得，关于这种感染的流行病学研究依赖于可用于儿童的非侵入性诊断测试。本研究的目的是通过评估以下方面来确定碳13标记尿素呼气试验（UBT）是否可用于儿童：（1）与培养或快速尿素酶试验及组织学检查相比，其敏感性和特异性；（2）是否需要试餐或长时间禁食；（3）幽门螺杆菌治疗后的效用。对88名接受上消化道内镜检查的儿童（平均年龄10.6±4.19岁）在禁食、非禁食及治疗后进行了研究。体重小于50 kg的儿童给予50 mg 13C-尿素，体重大于50 kg的儿童给予75 mg 13C-尿素，并加入50 mg葡萄糖聚合物溶液于7.5 ml水中。在基线及15、30、45和60分钟采集呼气样本。在63名禁食儿童中，UBT在30分钟时敏感性为100%，特异性为97.6%，临界值为每毫升3.5 δ13CO2。23名儿童在正常餐后1至2小时进行的非禁食测试敏感性为100%，特异性为91.6%。在13名UBT前直接进食的儿童中，测试敏感性降至50%。30分钟是最佳采样时间。在15分钟采集样本时特异性显著降低，可能是由口腔产尿素酶微生物的干扰所致。在20名幽门螺杆菌感染治疗后的儿童中，该测试敏感性和特异性均为100%。UBT是诊断儿童幽门螺杆菌感染的高度敏感和特异的测试。既不需要长时间禁食也不需要试餐。
