幽门螺旋杆菌检测方法及其应用价值的研究进展

幽门螺旋杆菌（Hp）是一种定植于人类胃部并对机体造成一定损害的病原菌。多年来针对Hp的各类检测技术不断被研发改进并被应用于临床Hp感染的诊断中，以组织病理切片法为代表的侵入性检测方法因有创性而使其应用范围受限，以^13/14C呼气试验为代表的非侵入性检测方法因无创和简便等特点更易被患者接受，但不同检测方法均存在一定的局限性，因此需考虑患者年龄、既往史、当地医疗条件、检测方法的可靠性和检测成本等因素选择适合患者的Hp检测方法，可以帮助临床医生及时并准确地做出诊断。近年来对于Hp检测技术的研究已不仅局限于Hp的定性检测，定量检测、基因检测和分型检测方法也在不断探索和更新，家用检测试剂盒的开发也为Hp检测带来了更多的可能性。现从侵入性和非侵入性2个方面就近年来Hp检测方法的检测原理、检测灵敏度和特异度等进行综述，为Hp感染的临床诊疗和科学研究提供参考。     

两种非侵入性方法检测儿童幽门螺杆菌感染

幽门螺杆菌（Hp）感染与慢性胃炎、消化性溃疡的发生及复发关系密切，也是小儿慢性胃炎和消化性溃疡的主要致病菌。目前诊断Hp感染的方法较多，可分为侵入性检查和非侵入性检查。儿童对侵入性检查依从性差，难以开展，故选择理想的非侵入性检查方法是必然趋势。本文以侵入性检查中活组织切片染色法及快速尿素酶法为金标准，同时与非侵入性检测唾液抗Hp IgG及粪便Hp抗原（HpSA）作比较，旨在观察其诊断儿童Hp感染的临床价值。     

幽门螺杆菌感染诊断方法的评价与诊断标准

幽门螺杆菌 (Hp)感染是慢性胃炎和消化性溃疡发病及迁延不愈的重要原因 ,常规检测Hp并根除Hp感染是治愈胃炎和溃疡、防止复发的重要措施。一、Hp主要诊断方法及其分类Hp感染的诊断有多种较为可靠的方法 ,依据其对受检者的创伤、检测的原理和意义有如下分类方法。1 按对人体的影响程度或创伤大小主要分为二类 :侵入性诊断方法和非侵入性诊断方法。侵入性诊断方法主要是依赖胃镜活检的方法 ,包括 :快速尿素酶试验 (RUT)、胃黏膜直接涂片革兰染色镜检、胃黏膜组织切片染色镜检、Hp培养、Hp基因检测方法 (如PCR、寡核苷酸探针杂交等 )。而…     

幽门螺杆菌感染诊断方法的比较

幽门螺杆菌（Hp）感染与、十二指肠疾病密切相关这一事实已为世界瞩目。目前用于诊断Hp感染的方法很多，大致可分为侵入性及非侵入性两类。侵入性诊断即在进行胃镜检查时取胃粘膜活检作快速尿素酶实验（简称RUT）、组织学检查（Warthin-Stary或Giemsa等染色）及Hp培养法。非侵入性诊断法包括血清Hp抗体检测及^13C-^14C-尿素呼吸实验（UBT）。     

幽门螺杆菌感染检测方法的评价

目前诊断幽门Hp螺杆菌(Hp)感染的方法众多,大致可分为两大类:非侵入性检查方法,包括血清学方法,同位素标记的尿素呼气试验和胃液PCR技术等;侵入性检查法,均须经胃镜检查,包括组织中细菌形态学、细菌培养、快速尿素酶试验和分子生物学方法等。Hp感染检测既用于诊断,也用于疗效评估,现就这些方法的应用价值作一概述。     

HpSA免疫快检卡检测幽门螺杆菌粪便抗原的临床价值

目的评价HpSA免疫快检卡检测Hp粪便抗原诊断Hp感染的可靠性.方法收集53例接受胃镜检查患者的粪便标本,用HpSA免疫快检卡检测HpSA;以尿素酶试验、组织学染色和培养检测Hp作为"金标准",其中两项试验阳性定为Hp感染.结果 HpSA免疫快检卡检测诊断Hp感染的敏感性为92.6%(25/27),特异性为88.5%(23/26),阳性预测值为89.3%(25/28),阴性预测值为92%(23/25),总的检测准确性为90.6%(48/53).结论 HpSA免疫快检卡是一种准确、简便的非侵入性Hp感染检测方法.     

14C尿素呼气试验在诊断儿童幽门螺旋杆菌感染的临床应用

目的：探讨14C尿素呼气试验（14C UBT）对诊断儿童幽门螺杆菌（Hp）感染的临床应用.方法：对150例有消化道症状（7～14岁）的患儿进行胃镜检查,同时采用胃黏膜病理组织学、快速尿素酶（RUT法）及14C尿素呼气试验（14C UBT）进行Hp检测,并对3种方法进行比较.结果：14C UBT、病理组织学、快速尿素酶检测的阳性率分别为59.3％、58％、51.3％;敏感性分别为95.6％、97.8％、84.6％;特异性分别为93.6％、96.7％、80.8％.结论：因此认为14C UBT和病理组织学是检测Hp感染较准确的方法,而14C UBT是非侵入性操作,更能反映“全胃”的Hp感染状况,同时无创伤、费用低,易被患儿及家长接受和配合,因此便于在诊断儿童Hp感染的临床应用中推广.     

幽门螺杆菌感染的诊断方法评估及诊断标准(上)

幽门螺杆菌(Helicobacter pylori,Hp)感染是导致慢性胃炎及消化性溃疡的主要致病因素,并且与胃癌的发生密切相关,检测和治疗Hp感染对处理Hp相关性疾病具有重要的临床意义。自1982年Hp被成功地分离培养以来,国内外学者相继开发了多种用于Hp感染的诊断方法。依据取材有无创伤性,现将Hp的诊断方法分为两类：①侵入性的检测方法：即依赖胃镜取材的检测方法。包括组织学检测、细菌培养、快速尿素酶试验、分     

幽门螺杆菌感染诊断方法的研究进展

幽门螺杆菌(Hp)在全球的感染率较高,与多种胃肠道内外疾病相关。准确诊断Hp感染对相关疾病的预防和治疗至关重要。在临床及科研工作中有多种检测方法,每种检测方法都有其优缺点和限制性。若胃活组织标本被取出,快速尿素酶试验被推荐为诊断Hp的首选方法,此外,内镜检查可提供胃黏膜清晰的图像,组织学是Hp相关胃炎评估的标准,细菌培养主要用于科学研究;尿素呼气试验被认为是非侵入性方法中Hp诊断的金标准,粪便抗原检测为次选,若检测前不能停止服用对Hp有影响的药物,血清学和聚合酶链反应可作为选择。临床上应针对不同的患者情况、实验室水平、操作者技术等选择合适的检测方法。     

ASSURE(R)快速血清学检测试剂盒在北京地区诊断幽门螺杆菌现症感染的价值

目的:通常血清学抗体检测被认为不能诊断幽门螺杆菌的现症感染,因此,缺乏一种简便、可靠、价廉的非侵入性的检测方法.本研究评价了一种新的血清学方法(ASSURE(R) HpIgG抗体检测试剂盒)在北京地区诊断幽门螺杆菌现症感染的敏感性、特异性及准确性.方法:纳入半年内未进行根除Hp治疗,一月内没有服用质子泵抑制剂,H2-受体阻断剂,铋剂及任何抗生素的门诊患者,以ASSURE(R) HpIgG抗体检测试剂盒诊断幽门螺杆菌现症感染,并同时与13C-尿素呼气试验比较,计算该药盒在北京地区诊断幽门螺杆菌现症感染的敏感性、特异性及准确性.结果:98例符合纳入标准的患者,13C-尿素呼气试验阳性34例,阴性64例;ASSURE(R)HpIgG抗体检测-CIM带检测阳性45例,阴性53例.该试剂盒检测诊断Hp现症感染的敏感性为88.2%,特异性为75.4%,准确性80.6%.该试剂盒对半年前曾经接受幽门螺杆菌根除治疗者诊断Hp现症感染的敏感性100%,特异性68.4%,准确性76.9%.对从未接受过幽门螺杆菌根除治疗者诊断Hp现症感染的敏感性85.2%,特异性80%,准确性81.9%.结论:ASSURE(R)HpIgG抗体快速测定检测是一种操作简便、快捷、经济、安全的新型的非侵入性的诊断幽门螺杆菌感染的方法,其敏感性为88.2%,适合于临床上患者的初次筛查,尤其适合于从未接受过幽门螺杆菌根除治疗的患者现症感染的诊断.     

Diagnosis of Helicobacter pylori infection： A meta-analysis

Objective： To evaluate effects of diagnostic tests for Helicobacter pylori （H. pylori） infection. Methods ： A meta-analysis was conducted in 22 identified studies through Chinese literature searching which were published after 1995 and evaluated diagnostic tests for Helicobacter pylori （H. pylori） infection. Results： Polymerase chain reaction （PCR） had the best performance with diagnostic odds ratio （DOR） of 6.7 （5. 5-7. 8）, followed by ^13C urea breath test and Enzyme-linked immunosorbent assay （ELISA） quantitative serological test, with DOR being 6.4 （5.4-7. 4） and 4.5 （3. 8-5.2）, respectively. Conclusion： Non-invasive tests are the appropriate methods for screening H. pylori infection, whereas invasive tests are the best methods for ascertaining the suspected patients.     

幽门螺杆菌粪便抗原检测及其与胃粘膜抗原检测的对比研究

目的 评价幽门螺杆菌（Ｈｐ）粪便抗原检测方法的可靠性及准确性。方法 用ＥＬＩＳＡ试剂盒对２２４例接受胃镜检查患者的粪便标本进行幽门螺杆菌抗原检测,同时对部分病例进行胃粘膜活组织抗原的检测,以快速尿素酶试验、组织学染色和培养检测Ｈｐ作为“金标准”,三项检查中至少两项阳性判定为Ｈｐ感染。结果 “金标准”诊断Ｈｐ感染阳性１３７例,阴性８７例。“金标准”阳性的１３７例中１３２例粪便抗原检测阳性,阴性８７例     

Management of Helicobacter pylori infection--a Working Party Report of the Malaysian Society of Gastroenterology and Hepatology

The Working Party Report on the Management of Helicobacter pylori serves as a clinical practice guideline for Malaysian doctors. H. pylori is not uncommon in the Malaysian population. Marked racial differences and the consistently low prevalence rates amongst Malays are noted. The working party recommends that if endoscopy is to be performed, a rapid urease test should be used for diagnosis. Where suspicion of the infection is strong and the urease test is negative, histology should be performed on gastric biopsies. Culture should be used to monitor resistance patterns to antibiotics and regional laboratories should assume this responsibility. The urea breath tests are highly accurate tests for diagnosis of H. pylori but is as yet not widely available in Malaysia. The working party strongly recommends that all peptic ulcer patients infected with H. pylori whether active, in remission and complicated ulcers should be treated for the infection. Patients with low-grade gastric mucosal lymphoid tissue lymphoma should also be treated for H. pylori infection. It is considered advisable that patients on long term nonsteroidal antinflammatory drug (NSAID) treatment with a history of peptic ulcers or dyspepsia and patients following resection of early gastric cancer or those with a family history of gastric cancer should also be tested and treated for H. pylori. The working party recommends, as first line treatment a 7-day combination therapy of a proton pump inhibitor, clarithromycin and metronidazole or amoxicillin. High metronidazole resistance rates locally may adversely affect regimens containing the antibiotic. It should also be noted that regimens that yield lower eradication rates may result in higher long term expenditure.     

HpSA: Assessment of a new non-invasive diagnostic assay for helicobacter pylori infection in an Irish population

Background  The diagnosis of Helicobacter pylori is an essential element in the management of many common gastrointestinal pathologies. Previously diagnosis was dependent on the availability of endoscopic biopsy samples. The advent of non invasive assays such as the C13Urea breath test and Elisa serology have enabled diagnosis, and treatment to be undertaken in the primary care setting. The isolation of Helicobacter pylori antigen from stool has led to the development of a new non-invasive test. Aim  A prospective study was designed to assess and compare the performance of Premier Platinum HpSA with current gold standard tests. Methods  Consecutive patients undergoing a gastroscopy for investigation of dyspepsia at the Meath and Adelaide hospitals were enrolled. At endoscopy gastric biopsies were taken for histology, microbiology and rapid urease testing. In addition all subjects had C13UBT, serology and stool tests performed. Individuals who were H. pylori positive received standard proton pump inhibitor based triple therapy. Following treatment all tests, apart from serology were repeated. Results  54 patients were enrolled, 46 per cent were H. pylori positive. HpSA had a sensitivity and specificity and positive and negative predicted values of 96 per cent, 75 per cent and 80.6 per cent, 75.8 per cent respectively and compared favourably with all other tests. The sensitivity and specificities of the other tests were, histology 79.2 per cent and 100 per cent, culture 68 per cent and 100 per cent, rapid urease test 75 per cent and 100 per cent, serology 75 per cent and 96 per cent and C13 urea breath test 100 per cent and 96.6 per cent. Conclusion  The detection of H. pylori antigen in stool by means of a HpSA assay is a new and effective non-invasive means of diagnosis which can be performed in a routine laboratory setting. It is simple to perform and has possible advantages over other non-invasive tests, detecting actual antigen indicating current active infection.     

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.     

幽门螺杆菌二种检测方法比较

目的评价幽门螺杆菌（Hp）抗体酶联免疫法的可靠性及准确性。方法用胃HppH指示剂诊断试剂法对123例接受胃镜检查恶者的胃粘膜进行Hp抗原检测，同时对其血清进行抗体酶联免疫检测。结果以pH指示剂法作为检测Hp标准。诊断Hp感染率为41．5％，敏感度为76．5％（39／51），特异度为90．3％（65／72）。结论抗Hp抗体酶联免疫法是一种简便、易行的诊断方法，适于普查。     

幽门螺杆菌临床检测研究进展

准确可靠的检测方法是诊断胃Hpylofi感染和评价临床疗效的关键。按检测取材方式的不同可分为侵入性和非侵入性,前者包括微生物学方法、形态学检查、尿素酶依赖性试验,而后者包括血清免疫学、基因分子生物学检测、粪便Hpylori抗原检测等。     

幽门螺杆菌粪便抗原检测在儿童和老年患者中的诊断价值

目的:探讨幽门螺杆菌粪便抗原(HELICOBACTER PYLORI STOOL ANTIGEN,HPSA)检测在诊断儿童和老年患者HP感染的应用价值。方法:采用ELISA(ENZYME-LINKED IMMUNOSORBENT ASSAY,ELISA)法检测30例和48例因上消化道症状接受胃镜检查的儿童和老年患者的粪便标本(以快速尿素酶试验、细菌培养和组织学W ARTHIN-STARRY染色作为诊断HP的“金标准,”3项检测中有2项试验阳性则诊断为HP感染,3项检测均阴性则诊断为HP阴性)。结果:在30例儿童和48例老年患者中,“金标准”诊断HP感染阳性43例,阴性35例;“金标准”诊断43例阳性中HPSA检测有40例阳性,阴性3例;“金标准”诊断35例阴性中HPSA检测有33例阴性,阳性2例。HPSA检测的敏感性为93.0%(40/43)、特异性为94.3%(33/35)、诊断的准确性为93.6%(73/78),阳性预测值为95.2%(40/42)和阴性预测值为91.7%(33/36)。结论:HPSA检测是一种简便、易行、准确的诊断儿童和老年患者HP感染的非侵入性方法。     

含现症感染条带血清抗体检测幽门螺杆菌现症感染的多中心临床研究

目的 评价应用Genelabs安速TM试剂盒的现症感染条带(CIM)检测诊断幽门螺杆菌(Hp)现症感染的可行性.方法 采用全国性多中心开放性平行对照临床研究,研究对象为未接受过Hp根除治疗的需要接受Hp感染检测患者.共有7个中心参加本项研究,2007年1至12月纳入300例符合入选标准的被检测者,平均年龄(41±16)岁,其中男128例,女172例.对所有患者均采用13C-尿素呼气试验及Genelabs安速TMHp快速检测试剂盒CIM检测Hp感染情况.13C-尿素呼气试验阳性即认为存在Hp现症感染,13C-尿素呼气试验阴性判断为Hp阴性.结果 经13C-尿素呼气试验检测阳性131例,阴性169例.Genelabs安速TM试剂盒血清抗体检测Hp现症感染的敏感度为87.8%(115/131),特异度为89.9%(152/169),阳性预测值为87.1%(115/132),阴性预测值为90.5%(152/168),准确度为89.0%(267/300).结论 Genelabs安速TMHp快速检测试剂盒可以用于Hp现症感染的筛查,对于既往未接受过根除治疗的患者,其检测阳性可以认为存在Hp现症感染.

Abstract：

Objective To evaluate the performance of the ASSURETM Helwobacter pylori (H.pylori)rapid test[current infection marker(CIM)kit,Genelabs Diagnostics]in detecting the current infection marker CIM for the diagnosis of H.pylori in adult patients.Methods For this multicenter and controlled clinical trial,a total of 300 patients with an average age of(41±16)years old were recruited from 7 participating hospitals.There were 128 men and 172 women.never received any H.pylori eradication therapy.Each subject received a 13C-urea breath test(13C-UBT)and a CIM test.Such performance parameters as sensitivity,specificity,positive and negative predictive values and accuracy were determined by 13C-UBT for the diagnosis of current H.pylori infection.Results According to the gold standard,there were 131 positive and 169 negative subjects.The accuracy rate,sensitivity,specificity,positive and negative predictive values of CIM test were 89.0%(267/300),87.8%(115/131),89.9%(152/169),87.1%(115/132)and 90.5%(152/168)respectively.Conclusion As a simple,rapid,accurate and affordable assay.CIM test may be useful for a non-invasive diagnosis of H.pylori infection in cases without eradication therapy.     

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…