上消化道症状儿童~(13)C-尿素呼气试验联合胃镜诊断的临床分析

目的探讨成都地区因上消化道症状就诊患儿行~(13)C-尿素呼气试验(~(13)C-UBT)检测幽门螺杆菌(Hp)感染及行胃镜检查的临床意义。方法对4 490例有上消化道症状的患儿行~(13)C-UBT检查,比较不同性别、年龄、症状患儿的~(13)C-UBT阳性率。对阳性患者再行胃镜检查,取胃黏膜行快速尿素酶试验。结果有上消化道症状的4 490例儿童中,~(13)C-UBT总阳性率为17.22%,儿童Hp感染无明显下降趋势;男女阳性率差异无统计学意义(P0.05);5~11岁组和11~17岁组患儿阳性率分别为20.39%和19.97%,以腹痛为主要症状者阳性率为22.18%,差异有统计学意义(P0.05)。在~(13)C-UBT阳性患儿中有736例(95.21%)接受胃镜检查,快速尿素酶试验与~(13)C-UBT阳性符合率为95.24%。~(13)C-UBT阳性患儿的胃镜下改变以慢性浅表性胃炎和慢性十二指肠炎最多见,消化性溃疡其次。结论 2011~2013年成都地区儿童Hp感染无明显下降趋势。~(13)C-UBT阳性率与性别无关,但与年龄及症状相关,~(13)C-UBT对5岁以上以腹痛为主要表现的患儿寻找病因有重要的临床意义;同时可提高患儿及家长对胃镜检查的接受度,对阳性者再行胃镜检查有助于进一步明确诊断。     

Results of the 13C-urease breath test in patients with dyspepsic syndrome

Helicobacter pylori infection alone or in combination with other factors is an important factor predisposing to dyspeptic disorders. Eradication of H. pylori fully eliminated dyspeptic syndrome or reduced its severity in the presence of concomitant factors. The efficacy of H. pylori eradication after first line therapy amounted to 85-90% based on the results of 13C-urease breath test, i.e. resistance to antibiotics did not exceed 10-15%. Repeated infection was very rare (2%).     

Muscle glycogen does not interfere with a 13CO2 breath test to monitor liver glycogen oxidation

Naturally ¹³C‐enriched carbohydrate has been used to label the liver glycogen pool for metabolic studies. The utilization of this glycogen was then monitored by the appearance of ¹³CO₂ in breath. Using this method, it is assumed that during sedentary fasting the contribution of muscle glycogen towards oxidation is negligible. We investigated the influence of a different level of ¹³C enrichment of muscle glycogen on the ¹³C enrichment of breath CO₂ while the breath test was carried out. In six healthy volunteers, the muscle glycogen stores were grossly depleted by a cycling exercise prior to consumption of the ¹³C‐enriched diet which was given over a 10 h period. The oxidation of liver glycogen was measured during an 18 h sedentary fast. The results were compared with a control group who had not depleted their muscle glycogen before labelling. A higher ¹³C enrichment of muscle glycogen did not interfere with two parameters of liver glycogen oxidation, i.e. the duration of the plateau phase of ¹³CO₂ and the return to baseline time. It was also shown that the ¹³C‐labelled muscle glycogen was still available after the 18 h fast because a strenuous exercise led to a rapid ¹³CO₂ enrichment. It is concluded that muscle glycogen ¹³C enrichment does not invalidate a ¹³CO₂ breath test to measure liver glycogen oxidation during a sedentary fast.     

The 13C/2H-glucose test for determination of small intestinal lactase activity

To diagnose hypolactasia, determination of lactase enzyme activity in small intestinal biopsy material is considered to be the golden standard. Because of its strongly invasive character and the sampling problems, alternative methods have been looked for. We analysed the 13C-glucose response in serum after consumption of 25 g of naturally enriched 13C-lactose. As an internal standard, 0.5 g of 2H-glucose was added and the 2H-glucose response in serum was measured simultaneously. The studies were performed in healthy volunteers with a background of genetically determined lactase nonpersistence (n = 12; low lactase activity) and lactase persistence (n = 27; high lactase activity). The results were compared with those of the lactose hydrogen breath test, the lactose 13CO2 breath test and the previously described 13C-lactose digestion test. After consumption of 13C-lactose and 2H-glucose, the mean ratio 13C-glucose/2H-glucose concentration in serum at 45-75 min was 0.26 +/- 0.09 in the low lactase activity group and 0.93 +/- 0.17 in the high lactase activity group (P < 0.01). Threshold of the ratio between digesters and maldigesters was calculated as 0.46. Accuracy of the new test was superior to all other tests. We conclude that the 13C/2H-glucose test has the potential of determining the small intestinal lactase activity in vivo and of estimating the amount of lactose which is digested in the small intestine.     

Single breath CO measurements normalized to 5% CO2 in Coombs' test positive neonates

A portable, prototype instrument that measures peak CO, CO2 and H2 concentrations of breath samples was evaluated on 58 antibody positive, blood group incompatible infants. The reproducibility of 108 duplicate breath CO determinations improved when the result was normalized (CO(n)) for the simultaneously measured CO2 concentration (r = 0.97 versus r = 0.87). The average CO(n) for 18 antibody positive, ABO incompatible infants who received phototherapy was 1.2 ppm higher than the average for 32 who did not receive phototherapy (p < 0.001). There was a positive correlation between CO(n) and the duration of phototherapy (r = 0.75). Sodium acetate infusion and breath H2 did not affect the CO(n) results. In antibody positive infants, single breath CO to CO2 ratios provided more reproducible results than CO determinations that were not adjusted for the CO2 concentration. Therefore, a portable instrument that measures both gases on the same aliquot of exhaled air and that is not affected by H2 should have clinical utility as an indicator of heme catabolism and bilirubin production that is not distorted by hyper- or hypoventilation.     

Gastric emptying measurement of liquid nutrients using the 13C-octanoate breath test in critically ill patients: a comparison with scintigraphy

Purpose

Scintigraphy is considered the most accurate technique for the measurement of gastric emptying (GE) but, for patients in the intensive care unit, it is technically demanding, involves radiation and can interfere with care. The ¹³C-octanoate breath test (¹³C-OBT) is a simple, non-invasive technique that does not involve radiation exposure.

Aim

To evaluate the performance of the ¹³C-OBT in the assessment of GE in critically ill patients.

Methods

The GE was assessed in 33 mechanically ventilated patients (23 M; 54.3 ± 3.0 yrs; APACHE II: 22.0 ± 1.1). Following test meal administration (100 ml Ensure^®), concurrent scintigraphic measurement and breath samples (¹³C-OBT) were collected over 4 h. Scintigraphic meal retention was determined and the gastric emptying coefficient (GEC) and half emptying time [t50_(BT)] were calculated for the ¹³C-OBT. Delayed GE was defined as meal retention >13 % at 180 min.

Results

Delayed GE was identified in 27/33 patients. Meal retention correlated modestly with t50_(BT) (r = 0.55–0.66; P < 0.001) and well with GEC (r = ?0.63 to ?0.74; P < 0.0001). The strength of agreement between the two techniques was highest between GEC and retention at 120 min. The best cut-off GEC for defining delayed GE was 3.25 (AUC = 0.75; 95 % CI = 0.52–0.99; P = 0.05), with 89 % sensitivity and 67 % specificity to detect delayed GE. The GE was delayed in all (23/23) patients with feed intolerance (GRV > 250 ml) on scintigraphy and 91 % (21/23) patients on ¹³C-OBT.

Conclusion

In critical illness, there was a correlation between ¹³C-OBT and gastric scintigraphy, with GEC performing as a better and more sensitive marker of detecting delayed GE than t50. However the relatively wide 95 % confidence intervals suggest that ¹³C-OBT is more suitable as a technique to assess GE in a group setting for research studies rather than for individual patients in clinical practice.     

Role of Helicobacter pylori in cirrhotic patients with dyspepsia: a 13C-urea breath test study

The role ofHelicobacter pylori in dyspeptic, cirrhotic patients remains unclear. This prospective outpatient study, conducted to assess the relationship of gastroduodenal disease andH. pylori as determined by the (¹³C) urea breath test, enrolled 109 consecutive cirrhotic patients with dyspepsia. All patients underwent upper-gastrointestinal endoscopy, which revealed respective prevalences of peptic ulcer, gastric ulcer, and duodenal ulcer of 41.3%, 23.9%, and 22.9%;H. pylori infection was found in 52.3%. The rate of peptic ulcer disease in theH. pylori-positive (45.6%) and -negative (36.5%) groups was not significantly different; neither was the prevalence ofH. pylori in patients with or without portal hypertensive gastropathy and with or without esophageal varices. The relationship between peptic ulcer disease andH. pylori in dyspeptic patients with cirrhosis appears to be weak. Likewise, no significant relationship was evident betweenH. pylori and portal hypertensive gastropathy or esophageal varices. This organism may not be a major pathogenetic factor in gastroduodenal diseases in dyspeptic patients with cirrhosis.     

13C-美沙西丁呼气试验对肝硬化病人的临床价值分析及护理

13C-美沙西丁呼气试验,采用红外线能谱分析仪对肝细胞微粒体氧化酶体系进行量化评定,它能在细胞器、酶与蛋白分子水平代表性地反映肝细胞的存活状态,肝细胞的功能、整体肝细胞储备(数量)以及留存肝细胞的代偿能力或失代偿的程度。现2结果(见表1)将13C-美沙西丁呼气试验方法在肝     

13C-尿素呼气试验在基层医院幽门螺杆菌检测中的应用

目的探讨¹³C-尿素呼气试验在基层医院的应用价值。 方法回顾性分析2017年1月1日至2017年12月31日兵器工业北京北方医院内科门诊通过¹³C-尿素呼气试验检测的幽门螺杆菌（Hp）感染患者820例,采用χ²检验统计分析不同年龄组、不同性别胃部疾病患者Hp感染情况,对¹³C-尿素呼气试验阳性患者在上级医院的胃镜检查结果进行随访。 结果820例患者¹³C-尿素呼气试验总阳性率为28.3%。不同年龄组试验阳性率具有差异：71岁~年龄组患者阳性率为15.8%,低于其他年龄组,差异有统计学意义（P<0.05）;其他年龄组间阳性率比较,差异无统计学意义（P>0.05）。按照性别分组,男性患者阳性率为28.6%,女性患者阳性率为28.1%,二者差异无统计学意义（P>0.05）。203名¹³C-尿素呼气试验检测阳性者赴上级医院行电子胃镜检查,对该群体人员进行随访、统计并记录病理诊断和Hp检查结果,发现203例患者均存在胃肠道疾病,Hp均为阳性。¹³C-尿素呼气试验与电子胃镜两种方法检测结果完全一致。 结论¹³C-尿素呼气试验在基层医院可用于门诊胃病患者Hp感染的筛查,是一种非侵入性检查方法,结果稳定可靠,有利于基层医院胃部疾病患者Hp感染的早期发现和及时治疗。     

Influence of acotiamide on 13C-urea breath test for Helicobacter pylori diagnosis

The Helicobacter pylori infection and functional dyspepsia are often coexisted. The effect of acotiamide, a drug for functional dyspepsia, on the result of Helicobacter pylori diagnosis has yet to be studied. We evaluated the influence of acotiamide on the results of Helicobacter pylori diagnosis in the ¹³C-urea breath test. Twenty patients with Helicobacter pylori-positive functional dyspepsia were treated with 100 mg of acotiamide three times a day for two weeks. Changes in ¹³C-urea breath test were investigated before and after administration, and two weeks after administration as the follow-up period. The ¹³C-urea breath test and the medical questionnaire of modified frequency scale for the symptoms of gastroesophageal reflux disease were conducted at every period. Nineteen patients were included for analysis. No patients showed negative in ¹³C-urea breath test at Weeks 2 and 4. On the symptom scale, dyspepsia and total scores decreased from Week 0 to Week 2 and increased from Week 2 to Week 4, and the improvement rates of the dyspepsia score at Week 2 was 63%. In conclusion, we confirmed that acotiamide is unlikely to influence the result of ¹³C-urea breath test and it may improve the symptoms of functional dyspepsia during Helicobacter pylori eradication treatment.     

Temperature of a test solution influences abdominal symptoms in lactose tolerance tests

In lactose maldigesters, retarding gastric emptying (food/pharmaceuticals) improves tolerance to lactose. The role of temperature of test solution on the indicators of lactose intolerance was studied. After an overnight fast, 10 lactose maldigesters ingested, in three sessions, 50 g lactose in a randomized cross-over trial. The solutions were at temperatures of 20-21°C (room temperature), 2-3°C (cold) and 55-58°C (hot). Gastrointestinal symptoms and indicators measuring lactose absorption were recorded. Abdominal pain was noticeably increased by the modification of temperature. The cold solution reduced flatulence and abdominal bloating, whereas the hot solution increased bloating and borborygmi. Breath hydrogen excretion tended to be augmented and retarded after cold solution. The temperature of the solution used in a lactose tolerance test affects the gastrointestinal symptoms, but has only minor effects on the other indicators of lactose maldigestion. The constant tendencies observed suggest that a room temperature solution is to be recommended for testing lactose digestion.     

Temperature of a test solution influences abdominal symptoms in lactose tolerance tests

In lactose maldigesters, retarding gastric emptying (food/pharmaceuticals) improves tolerance to lactose. The role of temperature of test solution on the indicators of lactose intolerance was studied. After an overnight fast, 10 lactose maldigesters ingested, in three sessions, 50 g lactose in a randomized cross-over trial. The solutions were at temperatures of 20-21 degrees C (room temperature), 2-3 degrees C (cold) and 55-58 degrees C (hot). Gastrointestinal symptoms and indicators measuring lactose absorption were recorded. Abdominal pain was noticeably increased by the modification of temperature. The cold solution reduced flatulence and abdominal bloating, whereas the hot solution increased bloating and borborygmi. Breath hydrogen excretion tended to be augmented and retarded after cold solution. The temperature of the solution used in a lactose tolerance test affects the gastrointestinal symptoms, but has only minor effects on the other indicators of lactose maldigestion. The constant tendencies observed suggest that a room temperature solution is to be recommended for testing lactose digestion.     

Delayed gastric emptying in ventilated critically ill patients: measurement by 13 C-octanoic acid breath test

OBJECTIVE: To measure gastric emptying in ventilated critically ill patients with a new noninvasive breath test. DESIGN: Single-center, open study. SETTING: Combined medical and surgical intensive care unit of a university hospital. SUBJECTS: Thirty unselected mechanically ventilated critically ill patients receiving gastric feeding and 22 healthy volunteers. INTERVENTIONS: None. PATIENTS: After 4 hrs without feeding, intragastric infusion of 100 mL of a liquid meal (Ensure) labeled with 100 microL 13C-octanoic acid. End-expiratory breath samples were collected into evacuated tubes from the respirator circuit every 5 mins for the first hour, then every 15 mins for 3 hrs. End-expiratory breath samples were also collected from volunteers studied supine after an overnight fast following an identical infusion via a nasogastric tube. Breath 13CO2 was measured with an isotope ratio mass spectrometer. MEASUREMENTS AND MAIN RESULTS: Performance of the breath test posed no difficulty or interference with patient care. The CO2 level was >1% in 1297/1300 breath samples, indicating satisfactory end-expiratory timing. Data are median and interquartile range. Gastric emptying was slower in patients compared with volunteers: gastric emptying coefficient 2.93 (2.17-3.39) vs. 3.58 (3.18-3.79), p <.001 and gastric half emptying time, derived from the area under the 13CO2 curve, 155 min (130-220) vs. 133 min (120-145), p <.008. Fourteen of the 30 patients had a gastric emptying coefficient <95% of all volunteers and 11 had a gastric half emptying time longer than 95% of all volunteers. The Acute Physiology and Chronic Health Evaluation (APACHE II) score (median 22, range 13-43) either at admission or on the day of the study did not correlate with gastric emptying coefficient. CONCLUSION: Gastric emptying of a calorie-dense liquid meal is slow in 40% to 45% of unselected mechanically ventilated patients in a combined medical and surgical intensive care unit. The 13C-octanoic acid breath test is a novel and useful bedside technique to measure gastric emptying in these patients.     

Hydrogen breath test in the diagnosis of lactose malabsorption: accuracy of new versus conventional criteria

Increased hydrogen excretion in the breath after carbohydrate ingestion, an expression of carbohydrate malabsorption, represents the pathophysiologic basis of the hydrogen breath test, a simple, noninvasive, reproducible test for the diagnosis of this condition. Few data are available concerning the breath hydrogen response that most accurately identifies carbohydrate malabsorption. In this article we report our application for the first time in clinical practice of 2 recently described, more accurate criteria for the diagnosis of lactose malabsorption (ie, breath hydrogen excretion value > 6 parts per million (ppm) 6 hours after carbohydrate load and a sum greater than 15 ppm for the breath hydrogen values obtained 5, 6, and 7 hours after carbohydrate load). On 3 separate days, we subjected 84 consecutive patients with functional or organic gastrointestinal disease to measurement of hydrogen excretion in the breath after the administration of lactose to test for lactose malabsorption; after the administration of lactulose as a means of ruling out false-negative results resulting from hydrogen-nonproducer status; and after the administration of a nonabsorbable electrolyte solution as a means of ruling out false-positive results caused by the mixing of intestinal content and release of preformed hydrogen trapped in the feces. According to the conventional criterion, 51% of the subjects proved to be lactose malabsorbers. Positive results were obtained with the use of the 6th-hour criterion in 76% of patients, and positive results were found in 80% when the sum of the excretion at hours 5, 6, and 7 was used as the criterion (P < .05 for both comparisons). Ten of 21 and 11 of 25, respectively, showed intolerance symptoms. It was therefore possible for us to diagnose lactose malabsorption in 24% and 27% of patients, respectively, who tested negative according to the conventional criterion. The conventional criterion must be abandoned and these new criteria adopted.     

PCR法和14C呼气试验检测幽门螺杆菌的比较

用聚合酶链反应（ＰＣＲ）和１４Ｃ呼气试验（１４Ｃ－ＵＢＴ）对６６例上消化道疾病患者进行幽门螺杆菌（Ｈｐ）检测，结果ＰＣＲ检出率为６９．７％，１４Ｃ－ＵＢＴ检出率为７１．２％，ＰＣＲ、１４Ｃ－ＵＢＴ两种方法诊断Ｈｐ感染的敏感性均为１００％，特异性分别为９５．２％和９０．５％，精确性分别为９８．５％和９７．０％；慢性萎缩性胃炎和慢性浅表性胃炎Ｈｐ检出率分别为７７．８％和６５．０％，两者无显著性差异；Ｈｐ感染无性别差异。研究结果表明，１４Ｃ－ＵＢＴ和采用自制的采样器获取胃粘膜组织进行ＰＣＲ检测Ｈｐ均具有非创伤性、简便、高敏感性和特异性的优点，后者还可进行Ｈｐ细胞毒株和非细胞毒株的区分，克服了１４Ｃ－ＵＢＴ具有一定的放射性和使用有毒试剂的缺点     

A rapid screening test for detection of IgA deficiency

A solid-phase red cell adherence (SPRCA) assay has been developed to screen blood donors for IgA deficiency, and 6117 donor sera have been screened by this method. Eighteen sera were found to be IgA deficient, which represents a frequency of 1 in 340. Seventeen of these sera were retested by passive hemagglutination inhibition, which has a sensitivity of approximately 0.1 mg per dL. Eight sera were confirmed as IgA deficient, and nine were found to contain low levels of IgA (less than 1 mg/dL). The approximate sensitivity of the SPRCA assay is 1 mg per dL. The speed, simplicity, and sensitivity of this assay make it a good alternative to conventional methods of screening.     

The caffeine CO2 breath test: dose response and route of N-demethylation in smokers and nonsmokers

The optimal conditions for performing the caffeine CO2 breath test (CBT) were investigated in smokers and nonsmokers. Caffeine labeled with 13C or 14C in all three (1, 3, and 7) methyl groups or specifically in the 1-, 3-, or 7-methyl groups were orally administered to healthy adults and the expiration of labeled CO2 was measured for 8 or 24 hr. The absolute rate of labeled CO2 excretion from trilabeled caffeine was proportional to the dose up to 3 mg/kg in all subjects. In smokers, the rate of labeled CO2 excretion averaged twice that in nonsmokers at all doses. A correlation was observed between the 2-hr cumulative CO2 excretion from trilabeled caffeine and the apparent oral metabolic clearance rate (MCR) of caffeine (R = 0.90). Monolabeled CBTs in smokers and nonsmokers demonstrated that 80% +/- 4% of labeled CO2 expired in the breath during the first 2 hr of a trilabeled CBT was derived from the 3 position; at 6 to 8 hr equal amounts were derived from the 3 and 7 positions. Little N-demethylation was observed from the 1 position at any time during the 8-hr test. The results indicate that the 2-hr cumulative excretion of labeled CO2 could be used to accurately predict the metabolic clearance rate of caffeine is the best CBT parameter for detecting the effect of smoking on caffeine N-demethylation. The data suggest that the primary routes of caffeine metabolism are 3-N-demethylation and ring hydroxylation and confirm that caffeine metabolites are N-demethylated primarily in the 3 and 7 positions.     

13C-美沙西汀呼气试验评估早期重症肝病患者血浆置换前后肝储备功能的变化

目的 通过13C-美沙西汀呼气试验评估早期重症肝病患者血浆置换前后肝储备功能的变化,判断血浆置换的疗效.方法 治疗组和对照组患者各30例,均给予药物和支持治疗,治疗组同时行血浆置换,于治疗前及治疗1周时行13C-美沙西汀呼气试验,记录40 min前代谢速率峰值(MVmax40)、40 min 13CO<,2>累积呼出丰度(CUM40)和120 min 13CO<,2>累积呼出丰度(CUM120),同时观察患者临床症状、血清ALT和总胆红素(TBiL)及血浆凝血酶原活动度(PTA)的变化.结果 治疗组治疗前后MVmax40分别为(6.46±1.17)%与(8.04±2.93)%,CUM40分别为(3.00±0.66)%与(3.77±1.47)%,CUM120分别为(6.93±1.36)%与(8.97±3.51)%,PTA分别为(34.6±2.5)%与(45.5±12.9)%,ALT分别为(538.1±136.4)U/L与(314.2±213.3)U/L,TBiL分别为(401.2±62.6)μmol/L与(218.3±160.5)μmol/L;治疗组治疗后较治疗前MVmax40(t=4.679)、CUM40(t=4.752)、CUM120(t=5.048)及PTA(t=5.413)显著提高(P均<0.01);ALT(t=6.208)和TBiL(t=7.413)显著降低(P均<0.01);治疗组治疗后较时照组[MVmax40(6.47±2.43)%,CUM40(2.99±1.21)%,CUM120(6.98±2.67)%,PTA(33.8±9.3)%.AIJT(496.9±222.2)U/L,TBiL(374.5±170.1) μmol/L]更有效升高MVmax40(t=2.260)、CUM40(t=2.247)、CUM120(t=2.476)及PTA(t=4.017),降低ALT(t=3.250)和TBiL(t=3.658,P均<0.05);治疗组总有效率为83.3%(25/30),对照组为43.3%(13/30),2组比较差异有统计学意义(χ210.335,P<0.01).结论早期重症肝病患者血浆置换后肝储备功能有显著改善,血浆置换是治疗早期重症肝病的有效方法 .     

^13C-美沙西丁呼气试验对肝硬化病人的临床价值分析及护理

^13C-美沙西丁呼气试验，采用红外线能谱分析仪对肝细胞微粒体氧化酶体系进行量化评定，它能在细胞器、酶与蛋白分子水平代表性地反映肝细胞的存活状态，肝细胞的功能、整体肝细胞储备（数量）以及留存肝细胞的代偿能力或失代偿的程度。现将^13C-美沙西丁呼气试验方法在肝硬化病人中肝细胞的储备功能方面及评估肝功能的代偿期和失代偿期方面进行比较、研究，并将护理介绍如下。