粪便幽门螺杆菌抗原检测对儿童复发性腹痛病因诊断的价值

目的：慢性胃炎、消化性溃疡是引起儿童复发性腹痛(recurrent abdom inalpain,RAP)的主要原因之一,而幽门螺杆菌(helicobacterpylori,Hp)感染与慢性胃炎、消化性溃疡的相关性尚有待进一步探讨。目前国内儿科临床上缺乏一种简便、安全、经济、有效地非侵入性Hp感染检测方法。故此,该研究探讨RAP与Hp感染的关系及幽门螺杆菌粪便抗原检测(Hpstoolantigen,HpSA)在RAP病因诊断中的价值。方法：对182例RAP患儿进行13C尿素呼气试验(13Cureabreathtest,13CUBT)及HpSA检测,测定其Hp感染率,观察抗Hp治疗后RAP患儿的腹痛缓解率,并对两种检测方法进行比较。结果：RAP儿童Hp感染率为41.2%。男女比例为1∶1.143,差异无显著性。Hp阳性儿童进行抗Hp治疗后,Hp根除和未根除的患儿腹痛缓解率分别为93.4%及28.6%。两者比较差异有显著性(P<0.05)。以13CUBT作为金标准计算,HpSA检测方法的敏感性、特异性、假阳性率、假阴性率、准确率、阳性预测值、阴性预测值分别为90.7%,97.2%,2.8%,9.3%,94.5%,95.8%,93.7%。HpSA试验与13CUBT一致性用Kappa值表示为0.886,U=25.237,P=0,两者有高度一致性。结论：Hp感染与RAP有密切相关性,可能为RAP的主要致病因素;HpSA检测有较高的敏感性和特异性,还具有安全、简便可靠、经济、非侵入性等优点,在RAP病因诊断中具有良好的实用价值。

Values of Helicobacter pylori stool antigen test in the etiological diagnosis of recurrent abdominal pain in children

OBJECTIVE: Chronic gastritis and peptic ulcer are considered to be the major causes of childhood recurrent abdominal pain (RAP). It is known that Helicobacter pylori (H. Pylori) is related to chronic gastritis and pediatric peptic ulcer. However,the association between H. Pylori infection and RAP still needs to be investigated. Now there is not a safe, simple, reliable, and non-invasive method for clinical diagnosis of H. Pylori infection in pediatric practice. So the purpose was of this study to investigate the relationship between RAP and H. Pylori infection and the value of H. Pylori stool antigen (HpSA ) in the etiological diagnosis of childhood RAP. METHODS: One hundred and eighty-two children with RAP received both 13C-urea breath test( 13C -UBT )and HpSA test for the determination of H. Pylori infection. An anti-H. Pylori therapy was administered in RAP children with H. Pylori infection. The clinical symptom (abdominal pain) was observed after anti-H. Pylori treatment. RESULTS: Of the 182 children with RAP, 75(41.2%) were found to be H. Pylori-positive according to the 13C-UBT results, without gender difference in H. Pylori infection incidence. Sixty-eight RAP patients presented H. Pylori-positive in both 13C -UBT and HpSA test. After anti-H. Pylori treatment abdominal pain was alleviated in 93.4% of children whose H. Pylori eradication was successful,but only in 28.6% of those whose eradication was unsuccessful (P<0.05).When 13C-UBT served as a "gold standard", the sensitivity, specificity, accuracy, false-positive and false-negative rates, and positive predictive and negative predictive values of HpSA test were 90.7%, 97.2%, 2.8%, 9.3%, 94.5%, 95.8% and 93.7%, respectively. The concordance between HpSA test and 13C-UBT was expressed in Kappa=0.886, U=25.237, and P=0. CONCLUSIONS: H. Pylori infection is associated with RAP in children.The HpSA test is a simple, cost-effective and reliable method for the detection of H.Pylori infection and may be used in the etiological diagnosis of childhood RAP.