Efficiency of Immunological Methods in the Diagnosis of Active Tuberculosis in Children

Nowadays, no clear diagnostic criteria for tuberculosis in children exist as absolute majority of tuberculosis cases in childhood have no bacterial excretion, unlike adults where bacterial excretion is observed not rarely. This fact leads to necessity to implement immunological methods in diagnostic complex in children. Tuberculin test is a routine one which is used for diagnosis of tuberculosis, However, there are a number of factors which interfere with the diagnostic value of tuberculin test. This study helped to ascertain the superiority ofDST （Diaskintest） and QFT-G （QuantiFERON-TB Gold IT） with respect to the wealth of information they provide when compared with the TST （tuberculin screening test） in determining the activity of tuberculosis infection in children. The evaluation parameters of diagnostic value （DSS （diagnostic sensitivity）, the DSC （diagnostic specificity）, PPV （positive predictive value） and NPV （negative predictive value）, and DE （diagnostic efficiency）） with DST, QFT and TST （tuberculin skin test） were： DSS--84.3%, DSC--59.1%, PPV--61.9%, NPV--82.7%, DE--71.7%） with QFT （DSS--78.4%, DSC--68.2%, PPV--57.7%, NPV--85.1%, DE--73.3%） were significantly higher than with TST （DSS--91.5%, DSC--15.7%, PPV--74.4%, NPV--45.8%, DE--53.6%）. New immunologic methods DST and QFT-G have higher specificity and diagnostic value in comparison with TST that makes their implementation in the diagnosis of TB in children essential.     

Recent changes in the prevalence of Helicobacter pylori infection among children and adults in high- or low-incidence regions of gastric cancer in China

Background The prevalence of Helicobacterpylori （H. pylon） infection varies by geographic locations. Studies indicate that the infection rate of H. pylori was previously high in China but that rates had been declining worldwide over recent decades. The aims of our study were： （1） to determine the current prevalence of H. pylori infection among children and adults residing in areas with high （Muping County, Shandong） and low （Yanqing County, Beijing） incidences of gastric cancer in China, and （2） to compare the prevalence for 2006 with the prevalence for the early 1990s. Methods Using Warthin-Starry silver staining of gastric mucosal biopsy specimens and H. pylori stool antigen tests （HpSA）, we tested a total of 2065 asymptomatic children aged 8-15 years and adults aged 40-79 years in the above two regions from May to July 2006. We evaluated 520 children and 526 adults from Muping, and 516 children and 503 adults from Yanqing. Subjects were selected randomly and H. pylori status was determined by HpSA in children and either HpSA or histology of gastric biopsies in adults. Data obtained in the early 1990s in the same two areas of China were also collected and studied. Results For children, the prevalence of H. pylori infection was significantly higher in Muping （37.69%） than it was in Yanqing （25.58%, P〈0.001）. In both regions, the prevalence of H. pyloriincreased with age but was not related to gender A significant difference was observed between 8-9-years old and 10-11-years old （P 〈0.05）, but not between other adjoining age groups （P 〉0.05）. From 1991 to 2006 H. pylori prevalence among 8-10-year-old children decreased in Muping （60.00% vs 32.07%, P 〈0.001）, but not Yanqing （24.06% vs 19.10%, P 〉0.05）. In the adult group, H. pylori prevalence was 50.95% in Muping, which was significantly higher than the 41.35% positive rate in Yanqing （P 〈0.01）. But there were no statistically significant differences between different age groups of 40-49, 50-59, and 60-79 years, or between males and females. A significant decrease in H. pylori prevalence in both regions was observed when the results of 2006 were compared with the data obtained in 1990 in Muping （50.95% vs 73.78%, P 〈0.001） and in 1992 in Yanqing （41.35% vs 55.35%, P〈0.01）. Conclusions After fifteen years, the prevalence of H. pylori infection among both children and adults remained significantly higher in areas with a high incidence of gastric cancer in China compared with that in areas with a low incidence of gastric cancer. H. pylori infection rates have decreased in the general Chinese population during recent years.     

Novel agent for Helicobacter pylori infection management

Tto the editor： We read with interest several papers discussing the role of Helicobacter pylori （H. pylori） in gastric disease.This infecting organism is so important due to its etiological and pathogenetic role in gastroduodenal ulcer disease, gastric carcinoma, MALT lymphoma, and other diseases of the stomach and other organs. Complex, expensive and not convenient for use in many parts that the infection is endemic, resistance to common antibiotics has made numerous lifelong H. pylori infections complicating the management of them. This is also due to the lack of effective therapeutic interventions or vaccines.     

Changes in the intestinal microflora of children with Helicobacter pylori infection and after Helicobacter pylori eradication therapy

Helicobacter pylori （H. pylori） infection is a common etiological factor leading to chronic gastritis and peptic ulcer. In addition, there is a close relationship between H. pylori infection and non-ulcer dyspepsia or gastric cancer. The high incidence of H. pylori infection in pediatric patients in developing countries is thought to inhibit their physical development because of malnutrition, anaemia and growth retardation. Anti-H. pylori therapy is recommended in children with H. pylori-induced gastritis and ulcer. The intake of high-dose broad-spectrum antibiotics may cause serious side effects including the alteration of intestinal flora, fungal infection, impaired liver function, and drug resistance. In recent years, simultaneous administration of probiotics has been used to alleviate the side effects of drug therapy and boost the therapeutic effectiveness of H. pylori eradication. In this study, we investigated changes in the intestinal microbial flora in H. pylori infected children and after H. pylori eradication therapy. We attempted to establish a basis for future research into the role of probiotics in anti- H. pylori treatment.     

Analysis of Translocation of the CagA Protein and Induction of a Scattering Phenotype in AGS Cells Infected with Helicobacterpylori

Objective To investigate whether the presence of structured CagA proteins in Western- and Eastern-type Helicobacter pylori （H. pylori） induces different incidences of gastric diseases. Methods CagA and phosphorylatd CagA were expressed in AGS gastric epithelial cells infected with wild type and mutant strains. The ability of individual CagA was determined by immunoprecipitation and Western blot assay. Morphological changes of these cells were observed under microscope to evaluate the appearance of elongation hummingbird phenotype. Results The sizes of CagA proteins in different strains were different, and no phosphorylated CagA proteins were detected in wild-type strains. Meanwhile, the kinetics of CagA status in AGS infected with H. pylori was detected. The molecular weight of phosphorylated CagA with the same size of CagA proteins in H. pylori was different in infections with different wild-type strains. CagA and phosphorylated CagA increased in a time-dependent manner after the infection. The hummingbird phenotype with H. pylori for time-course was observed under microscope. Instead of HPK5 strain, the wild-type 26695 strain induced hummingbird phenotype in a time-dependent manner. Conclusion Translocation and phosphorylation of CagA are necessary, but not sufficient, for the induction of hummingbird phenotype in AGS cells.     

ASSOCIATION OF HELICOBACTER PYLORI INFECTION WITH PRECANCEROUS LESIONS AND STOMACH CANCER. A CASE-CONTROL STUDY IN YANGZHONG COUNTY

Previous study has raised H. pylori infection as a suspected biologic risk factor for gastric cancer. A comparative case-control study involving precancerous lesions and gastric cancer was conducted in Yanzhong county, an area with one of the highest rates of gastric cancer in China to study the relationship between the H. pylori infection and gastric cancer. Subjects in the study were all randomly selected participants of a screening program for gastric cancer sponsored by the Cancer Institute of CAMS in cooperation with Yangzhong county Hospital. Totally, 125 normal controls, 108 superficial gastritis, 111 atrophic gastritis and 110 gastric cancer patients were included in our study according to endoscopy and pathology, result. Status of H. pylori infection was evaluated by measuring Ig G antibody in plasma with ELISA assay.Our result showed Odds ratios of H. pylori infection were higher among gastritis and cancer groups, 4.5(95% CI 2. 5-7.9) for superficial gastritis, 6.3 (95% CI 3.4-12) for atrophic gastritis, 3. 3 (95% CI 1.9-5.9) for gastric cancer. It was found in our study that consumption of pickled vegetables and drinking dirty water increased the relative risk of H. pylori infection for both precancerous lesions and gastric cancer and that H. pylori infection had higher risk of atrophic gastritis and gastric cancer for males and also higher risk of atrophic gastritis for olders. Our results strongly support the casual role played by H, pylori infection in the carcinogenic process of gastric mucosa.     

Diagnostic values of combination of free running asthma screening test and total serum allergen IgE level in children with asthma

Background A free running asthma screening test is usually used for screening exercise-induced bronchoconstriction.The total serum allergen IgE level can reveal the patient＇s atopy characteristics.Our study is to evaluate the diagnostic values of the combination of the two tests in asthmatic children and compare this new diagnostic method with the Intemational Study of Asthma and Allergies in Childhood （ISSAC） questionnaires and the bronchial provocation test,which are popular diagnostic tool for pediatric asthma.Methods A total of 773 school children were recruited in this study.The children＇s asthma was diagnosed by means of a combination of the free running asthma screening test and total serum allergen IgE level.The new diagnostic method value was assessed using receiver operating characteristic （ROC） curves and compared with other diagnostic tools such as ISSAC questionnaires and the bronchial provocation test.Results The AUC of this new diagnostic method was higher than 0.9.When the cut-off value of total serum allergen IgE level was ≥47 KU/L,the sensitivity and the specificity were 71.4％ and 85.1％,respectively,which were better than those of either the ISSAC questionnaires or bronchial provocation test.Conclusion The combination of the free running asthma screening test and total serum allergen IgE level may be an effective diagnostic tool for children＇s asthma.     

Sporadic fundic gland polyps are not associated with proton pump inhibitors therapy but negatively correlate with Helicobacter pylori infection in China

Background Sporadic fundic gland polyps （FGPs） are common gastric polyps.Some studies reported that FGPs dramatically increased due to proton pump inhibitors （PPIs） use and a decreased prevalence of Helicobacter pylori （H.pylon） infection in Western countries.However,data are still controversial.This study aimed to identify the relationships between these two factors and FGPs in China.Methods Consecutive patients with FGPs detected were retrospectively analyzed.Data including patients＇ age,sex,symptoms,H.pylori infection,history of PPIs use,and the polyps were documented.Each patient was compared with two randomly selected age-and sex-matched controls with similar symptoms in the same period.Results During the period from March 2011 to March 2012,a total of 328 patients were diagnosed as FGPs in 23 047 patients who underwent routine esophagogastroduodenoscopy and 656 patients without FGPs as controls.The mean age was （55.12±12.61） years,and 75.91％ were women.The prevalence of H.pylori in patients with FGPs was significantly lower than in those without FGPs （22.30％ （64/287） vs.42.26％ （224/530）,P ＜0.001,OR 0.392,95％ Cl 0.283-0.544）.Overall,a total of 54 patients with FGPs （54/328,16.46％） and 136 patients without FGPs （136/656,20.73％） received PPIs therapy （P=0.110）.According to the different duration of PPIs use,no significant differences of PPIs use were found between the cases and controls among all subgroups.Moreover,the PPIs use was also similar,regardless of age,sex,H.pylori infection,and the number of polyps.Conclusion Sporadic FGPs may not be induced by PPIs therapy but negatively correlate with H.pylori infection in China,which is not the same with the data in Western countries.     

Evaluation of serum specific IgE for the diagnosis of allergic rhinitis with multi-allergens

Background Objective evaluation of allergic rhinitis （AR） requires in vivo and in vitro tests. In vitro tests are important to assist or ensure the main allergens in multi-allergen-sensitive patients. The aim of this study was to evaluate the utility of serum specific IgE （slgE） in the diagnosis of AR patients with multi-allergens in the Chinese population.Methods Combining a positive skin prick test （SPT） and clinical history as the diagnostic reference criteria of AR, we estimated concentrations of slgE produced in response to the 7 most frequent allergens among 85 AR patients, using the UniCAP assay system.Results Among 85 individuals with positive SPT results and allergen-specific nasal symptoms, slgE concentration correlated well with SPT classes among all the tested allergens. Based on a clinical diagnosis and SPT results using a positive cut-off value of a class 1 score, the CAP test performed well and the sensitivity for different allergens ranged from 0.5 （giant ragweed） to 0.91 （Dermatophagoides pteronyssinus （Der p） and Dermatophagoides farinae （Der f）, while specificity ranged from 0.93 （Der f） to 1.0 （animal hair, Derp and mugwort）. When the cut-off score was adjusted to class 2, the sensitivity showed an increase overall while the remaining assessed items, including specificity, positive predictive value, negative predictive value and efficiency, showed an unacceptable decline.Conclusions Well-established serum slgE tests correlated well with SPTs. Setting a class 1 cut-off for positivity of SPT results was better than a class 2 setting for assessing the AR diagnostic value.     

Changes in serum ammonia concentration in cirrhotic patients with Helicobacter pylori infection

Objective To study whether liver cirrhosis associated with Helicobacter pylori (H. pylori) infection will induce increased serum ammonia and whether the peripher al serum ammonia reflects the level of portal vein serum ammonia. Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H. pylori infection and non-cirrhotic patients (splenic rupture) with and without H. pylori infection, and the serum ammonia was measured.Results The mean levels of serum ammonia in the group of cirrhotic patients with H. pylori infection were 167.82±8.97 μmol/L (portal vein) and 142.2±13.35 μmol/L (cubital vein). They were increased significantly as compared with cirrhotic patients without H. pylori infection (47.68±12.03 μmol/L portal vein and 37.23±7.04 μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H. pylori infection ( P <0.01). There was no significant difference between the serum ammonia level of the cubital vein and portal vein (P>0.05).Conclusions H. pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method. Eradication of H. pylori in cirrhotic patients may prevent hepatic encephalopathy (HE).     

Diagnostic utility of invasive tests and serology for the diagnosis of Helicobacter pylori infection in different clinical presentations

BACKGROUND: Invasive and noninvasive tests are used for the diagnosis of Helicobacter pylori infection. The aim of this study was to determine the diagnostic utility of rapid urease test (RUT), culture, histology and serology for the diagnosis of H. pylori in patients with different clinical presentations. METHODS: We studied 527 consecutive patients (mean age, 52.5 years; F:M, 1.3; age range 15-89 years) enrolled at the Hospital Universitario, Universidad Autónoma de Nuevo León. Patients had gastric cancer (GC, 9.1%), non-ulcer dyspepsia (NUD, 81.4%), or peptic ulcer disease (PUD, 9.1%). The infection by H. pylori was determined by histology, rapid urease test, culture, and serology. Patients were determined as infected with H. pylori if at least a) two invasive tests were positive and b) two tests were positive (invasive or non-invasive). Diagnostic utility was calculated for each assay. RESULTS: Prevalence of infection in the whole studied population was 50.9%. In NUD patients the prevalence was 51.3%, in PUD patients 58.3%, and in GC patients 39.6%. When we used the first diagnostic criteria, for the whole studied population, the RUT was the most reliable test, followed by the culture. Histology had the best sensitivity for the whole studied population and NUD patients and RUT had the best sensitivity value for the GC patients. In the whole studied population, NUD and GC patients, RUT and culture had the best specificity, accuracy and PPV. For PUD patients, serology had the best performance. When we used the second diagnostic criteria, histology and serology had a better performance compared with the results obtained with the first diagnostic criteria. CONCLUSIONS: Diagnostic utility of the tests varies according to the clinical presentations, which should be considered in the selection of the diagnostic test for the detection of H. pylori.     

Accuracy of three diagnostic tests used alone and in combination for detecting Helicobacter pylori infection in patients with bleeding gastric ulcers

SinceHelicobacterpylori (H pylori)wasfirstreportedbyMarshallandWarrenin 1 983 ,ithasbeenthoughttobethemainetiologicfactorin pepticulcerdisease 1,2Despitedramaticadvancesindiagnosisandmanagementoverthepast 2decades,pepticulcerdiseaseremainsamajorandserioushealthcareproblemleadingtosignificantmorbidityandmortality 3　DiagnosisofH pyloriinfectioniscrucialtotheshort termandlong termmanagementof patientswithbleedingulcers 4EradicationofH pyloriinfectionhasbeenshowntochangethenaturalcourseofdiseas…     

幽门螺杆菌粪便抗原检测——一种新的非侵入性检查

目的：了解幽门螺杆菌粪便抗原捡测方法(Helicobacter pylori stool Antigen HpSA)的准确性与可靠性。方法：采用酶联免疫分析“双抗体夹心法”对303例因上消化道症状而进行胃镜检查的患的粪便标本进行幽门螺杆菌捡测,以快速尿素酶试验,组织学染色和培养捡测Hp,以三项检查中至少两项阳性或Hp培养捡测阳性判定为Hp感染作为“金标准。结果：“金标准”诊断Hp感染阳性182例,阴性121例。“金标准”阳性的182例中176例HpSA检测阳性,阴性的121例中100例HpSA检测阴性,HpSA敏感度为96．7％(176／182),特异度为82．6％(100／121)。结论：HpSA检测是一种简便易行,准确性高的非侵人性诊断Hp的方法,值得临床进一步推广。     

Comparison of invasive and noninvasive methods for the diagnosis and evaluation of eradication of Helicobacter pylori infection in children

BACKGROUND: Acquisition of Helicobacter pylori infection occurs mainly during childhood. To study the events associated with H. pylori colonization in children it is important to have reliable diagnostic methods. Our objective was to validate invasive and noninvasive tests for diagnosis of H. pylori infection in children before and after antimicrobial treatment. METHODS: Before treatment, invasive rapid urease test (RUT) culture and histology, as well as the noninvasive carbon-13 urea breath test (13C-UBT) and serology were validated in 59 children. The gold standard for H. pylori infection was any of three positives of the five tests. After antimicrobial treatment culture, histology, and 13C-UBT were validated in 43 children to determine eradication. The gold standard for eradication was negative in all three tests. RESULTS: For primary diagnosis, RUT was the most sensitive and specific test, followed by 13C-UBT, which performed better than serology, culture, and histology. Concordance tests also showed that RUT and 13C-UBT performed better. For determination of eradication, 13C-UBT and histology were better than culture, which showed poor sensitivity. CONCLUSIONS: RUT performed better for primary diagnosis. However, as endoscopy might not be indicated in most children, 13C-UBT could be the test of choice for diagnosis of H. pylori infection both before and after eradication treatment.     

幽门螺杆菌感染非侵入性诊断方法的评价及研究进展

幽门螺杆菌（Hp）感染的非侵入性诊断方法以其无创优势倍受青睐.尿素呼吸实验和粪抗原被称为是Hp感染活动性检测;而血清和尿液抗体是检测Hp的标记物,并不能说明感染是否正在进行,所以被称之为被动检测.非侵入性检测被广泛推荐用于初次感染的诊断,选择合适的检测方法主要依赖于初筛感染的可能性、检测方法的特性及其性价比.作者对现在的非侵入性检测方法进行评价.     

幽门螺杆菌感染诊断效果的统计综合评价

目的：综合分析有关幽门螺杆菌（H.pylori)感染诊断方法的研究文献，评价幽门螺杆菌感染的诊断方法的现况，方法：检索1995年以来的相关文献资料，对比研究各种诊断方法，并对其作总体评价，结果：目前临床常用的各种诊断方法各有优劣，结论：建议临床上采用何种诊断方法，应根据具体情况的不同要求来决定。     

幽门螺杆菌粪便抗原检测在儿童中的应用价值研究

目的：幽门螺杆菌粪便抗原（Helicobacter pylori stool antigen，HpSA）检测诊断儿童Hp感染的应用价值进行探讨。方法：以快速尿素酶、组织学和细菌培养作为诊断的Hp的金标准（快速尿素酶试验、组织学和细菌培养其中2项阳性判定为Hp阳性，细菌培养1项为阳性也判定为Bp阳性），采用ELISA法检测40例因上消化道症状接受胃镜检查患儿的HpSA，评价HpSA检测诊断儿童Hp感染的敏感性、特异性。同时在29例患儿中以^13C-UBT作对照，评价HpSA检测诊断Hp感染的准确性。结果：在40例患儿中，HpSA检测的敏感性、特异性和准确性分别94.44%，90.91%和92.50%；在29例患儿中以^13C-UBT作标准，HpSA检测诊断Hp感染敏感性、特异性和准确性分别为91.67%，88.23%和89.66%。结论：HpSA检测是一种方便、简单、准确的诊断儿童Hp感染的方法。     

儿童幽门螺杆菌感染多种检测方法比较

目的比较分析多种儿童幽门螺杆菌感染检测效果。方法从2009年6月至2011年5月在我院诊治的消化道不适儿童中筛选出符合本次研究的患儿97例,实施病理组织切片、细菌培养、14C尿素呼气试验、快速尿素酶检测等4种方法检测。结果病理组织切片、细菌培养、14C尿素呼气试验、快速尿素酶检测的敏感性分别达95.0%、96.7%、95.0%、91.7%,特异性分别达100%、100%、97.3%、78.4%,差异不具显著性。结论儿童幽门螺旋杆菌感染检测可以考虑以非侵入性14C尿素呼气试验为主,以病理组织切片、细菌培养为辅。     

Role of Helicobacter pylori in causation of diabetic gastropathies and non-gastrointestinal complications in type 2 diabetes

A cross-sectional case-control study was conducted in 80 diabetic patients, to evaluate the incidence of gastropathy by endoscopy in type 2 diabetes mellitus. An association between Helicobacter pylori infection and non-gastrointestinal complication of diabetes mellitus was also looked into. Gastric biopsies were subjected to rapid urease test for demonstration of Helicobacter pylori. The fasting blood glucose levels among Helicobacter pylori positive diabetes were 175 +/- 36.5 mg %, and in Helicobacter pylori negative diabetics were 138 +/- 39.4 mg %. The prevalence of endoscopically detectable gastro-intestinal complications were higher in Helicobacter pylori infected diabetics (odd's ratio 4:2; p < 0.05). The total prevalence of Helicobacter pylori positive in diabetics by rapid urease test was statistically significant (p < 0.05). Coronary heart disease was more prevalent in diabetics with Helicobacter pylori infection than those without Helicobacter pylori (57%). The prevalence of H. pylori positivity in other complications such as peripheral vascular diseases, cerebrovascular diseases was not significant. The association between nephropathy, retinopathy and neuropathy with Helicobacter pylori, was also observed and the strong association was seen in diabetic retinopathy (p < 0.001), diabetic neuropathy (p < 0.01) and nephropathy (p < 0.001).     

胃溃疡与胃癌患者Hp感染与血清学检测

目的:研究血清学检测在诊断胃溃疡与胃癌患者幽门螺杆菌(Helicobacterpylori,Hp)感染中的意义。方法:对144例胃溃疡患者与86例胃癌患者行抗Hp-IgG抗体血清学检测与快速尿素酶试验,比较检测结果。结果:胃溃疡患者快速尿素酶试验及血清抗Hp-IgG抗体检测阳性率分别为74.3%和88.2%,而胃癌患者分别为41.9%和72.1%。结论:胃癌和胃溃疡患者血清抗Hp-IgG抗体阳性率明显高于快速尿素酶试验,在胃溃疡及胃癌患者中单独应用快速尿素酶试验有可能影响Hp的检出率。