Kalach N, Briet F, Raymond J, Benhamou P H, Barbet P, Bergeret M, Senouci L, Maurel M, Flourié B, Dupont C
Service de Pédiatrie, Hôpital Saint Vincent de Paul, Paris, France.
J Pediatr Gastroenterol Nutr. 1998 Mar;26(3):291-6. doi: 10.1097/00005176-199803000-00010.
The purpose of the study was to determine the accuracy of the labelled 13carbon urea breath test for the diagnosis of Helicobacter pylori in children and to simplify the 13carbon urea breath test in identifying the most discriminating sampling time.
H. pylori was searched for in 100 children aged 10.5+/-4.5 years by histology, bacteriological counts, and culture on antral biopsies together with serology and 13carbon urea breath test. Breath samples were obtained before ingestion (T0) of 75 mg urea-13C and every 10 minutes after until T60. 13CO2 excess ratio was measured by isotope ratio mass spectrometry, and values expressed as delta per mil over baseline enrichment (delta 13CO2). The arithmetic mean (Mdelta 13CO2) of T20 to T60 values was calculated and the test considered positive with Mdelta 3CO2 higher than Mdelta 13CO2 + 3 SD as determined in noninfected children.
Mdelta 13CO2 of noninfected children as assessed by culture was 1.4+/-0.6 per mil, determining a positive cut-off value of 3.44 per mil. Mdelta 13CO2 was correlated in 11 children with biopsy bacteriological counts. Both culture and 13carbon urea breath test were positive in 38 of 100 children, without any discordance. Plotting 13carbon urea breath test results at each sampling time versus Mdelta 13CO2 showed weaker correlations at T20, T30, T50, and T60, than at T40. The two-sample method at T0 and T30, T40, T50, had high sensitivity and specificity. Single-sample analysis obtained at T40 gave a comparable sensitivity and a slightly reduced specificity.
13carbon urea breath test is sensitive and specific in children. Two samples collected at T0 and T40 provide the most discriminating procedure.
本研究旨在确定标记的13碳尿素呼气试验诊断儿童幽门螺杆菌感染的准确性，并简化13碳尿素呼气试验以确定最具鉴别力的采样时间。
对100名年龄为10.5±4.5岁的儿童进行幽门螺杆菌检测，检测方法包括组织学、细菌计数、胃窦活检培养、血清学检测以及13碳尿素呼气试验。在摄入75mg尿素-13C之前（T0）以及之后每10分钟采集呼气样本直至T60。通过同位素比值质谱法测量13CO2过量比值，其值以相对于基线富集的每千分率增量（δ13CO2）表示。计算T20至T60值的算术平均值（Mδ13CO2），若Mδ3CO2高于非感染儿童中确定的Mδ13CO2 + 3标准差，则该试验被视为阳性。
通过培养评估，未感染儿童的Mδ13CO2为1.4±0.6‰，确定阳性临界值为3.44‰。11名儿童的Mδ13CO2与活检细菌计数相关。100名儿童中有38名儿童的培养和13碳尿素呼气试验均为阳性，无任何不一致情况。将每个采样时间的13碳尿素呼气试验结果与Mδ13CO2绘制图表显示，T20、T30、T50和T60时的相关性比T40时弱。T0和T30、T40、T50的两点采样法具有高敏感性和特异性。在T40进行的单点分析具有相当的敏感性和略有降低的特异性。
13碳尿素呼气试验在儿童中具有敏感性和特异性。在T0和T40采集的两个样本提供了最具鉴别力的检测程序。
