^14C-呼气试验检测幽门螺杆菌感染

本应用国产^14C-呼气试验(^14C-UBT试剂检测幽门螺杆菌(Hp)．同时应用病理组织染色、屎素酶试验、细菌培养和血清ELISA技术等方法与之进行比较。117例病人中Hp阳性率为47.9％(56/117)，^14C-UBT的敏感性与特异性分别为94.6％和93.4％。^14C-UBT由于相对于胃镜依赖的方法而言创伤性大大降低．是目前检测Hp感染，尤其是药物治疗后复查时的首选方法．     

免疫印迹试验在检测幽门螺杆菌感染中的临床价值

目的 探讨免疫印迹试验检测幽门螺杆菌(helicobacter pylori,Hp)的临床应用价值.方法 收集我院2009年2月～2011年8月171例经胃镜证实的胃十二指肠球部溃疡90例、溃疡并出血81例,采用免疫印迹试验和14C-尿素呼气试验(14C-UBT)两种方法检测患者Hp感染情况并行对比分析.结果 免疫印迹试验和14C-UBT试验检出的阳性率分别为92.2％和70％,以免疫印迹实验Hp阳性检测率高,两种方法在统计学上有显著性差异,(P=0.000).171例患者中检出Hp Ⅰ型菌株者占94.4％,Ⅱ型菌株者占5.6％,Ⅰ型较Ⅱ型感染率更高.结论 免疫印迹试验阳性率高于14C-UBT,尤其在溃疡并出血时假阳性率较14C-UBT试验要低,且它能确定Hp感染类型,虽操作方法较14C-UBT试验繁琐,但它的准确性高,安全可靠.     

几种幽门螺杆菌检测方法的比较和评价

目的检测幽门螺杆菌(Helicobacterpylori,Hp)感染的方法很多.本研究对检测Hp的病理组织学、血清学、13C呼气试验(13C-UBT)以及快速尿素酶(HpUT)试验进行比较分析和评价方法151例因各种消化道症状就诊的患者均行内镜检查,同时应用病理组织学,血清学,13C呼气试验(13CUBT)以及快速尿素酶(HpUT)等四种方法检测幽门螺杆菌.其中两项阳性被认为Hp感染存在.结果①151例患者中Hp阳性者127例,总感染率84.1%.②病理组织学、血清学、13C呼气试验、快速尿素酶检测的敏感度分别为88.1%,78.7%,88.2%,71.6%;特异度分别为100%,70.3%,95.0%,63.8%.③四种方法检测的符合率@HpUT与病理组织染色检测的符合率是77.9%.bHpUT与13C-UBT的符合率为70.6%.cHpUT与血清抗体检测的符合率为82%.d病理组织染色与13C-UBT的符合率为74.2%.⑤病理组织染色与血清抗体检测的符合率为63%.⑥13C-UBT与血清抗体检测的符合率为66.7%结论四种检测方法中病理组织染色与13C-UBT的敏感性和特异性都比较高.这两种检查能比较准确地反映体内Hp感染的真实情况.13C-UBT更能准确反映全胃Hp感染的实际情况.快速尿素酶试验和血清抗体检测的结果也较好,其操作方便,费用低,也可作为临床常用的检测手段.两种检查方法的联合为诊断Hp感染较好的选择.以13C呼气试验与HpUT联合;病理组织学W-S染色与HpUT联合的阳性率、敏感度、特异性以及诊断符合率、阳性预测值、阴性预测值同时较高     

多种方法联合检测幽门螺杆菌对诊治中重度萎缩性胃炎的意义

自从1983年澳大利亚学者Warren和Marshall首次从慢性活动性胃炎患者胃粘膜活检标本中成功分离出幽门螺杆菌(Hp)以来,Hp感染与胃、十二指肠疾病的相关性日益受到广泛重视.我们通过快速尿素酶试验(RUT)、粘膜组织检查、13C或14C呼气试验(13C-UBT、14 C-UBT)、粪便Hp抗原(HpSA)检测4种方法联合检测180例患者,旨在了解中、重度萎缩性胃炎患者Hp感染情况,探讨多种方法联合检测的可行性和必要性.     

14C-尿素呼气试验假阴性原因探讨

背景:14C-尿素呼气试验(14C-UBT)敏感性、特异性高且为非侵入性,已广泛应用于幽门螺杆菌(Hp)感染的诊断,然而假阴性结果的存在将影响诊断准确性。目的:探讨14C-UBT结果出现假阴性的可能原因,以期提高诊断准确性。方法:纳入2014年1月至2014年8月在新疆维吾尔自治区人民医院明确14C-UBT结果为假阴性的患者82例,同期813例14C-UBT结果为真阳性的患者作为对照组。两组患者均经Warthin-Starry银染色和Hp粪便抗原检测判定为Hp感染阳性。以单因素和多因素分析筛选可能与14C-UBT假阴性结果相关的因素。结果:单因素分析中,共5个变量在病例组与对照组间差异有统计学意义(P<0.05),进入多因素分析。Logistic逐步回归分析显示,胃内胆汁反流(OR=3.961,P<0.001)、胃大部切除术史(OR=9.734,P<0.001)、Ⅱ型Hp感染(OR=1.892,P=0.012)和上消化道出血(OR=4.979,P<0.001)为14C-UBT假阴性结果的独立危险因素。结论:胃内胆汁反流、上消化道出血、胃大部切除术史和Ⅱ型Hp感染是14C-UBT假阴性结果的可能影响因素。对于有胃大部切除术史者以及合并胃内胆汁反流、上消化道出血者,如14C-UBT结果为阴性,建议采取多种方法联合检测Hp。     

粪便抗原检测临床诊断幽门螺杆菌感染的可靠性研究

背景:我国属于幽门螺杆菌(Hp)感染高发国家。在众多Hp感染检测方法中,Hp粪便抗原(HpS A)检测具有非侵入性、敏感性和特异性较高、操作简便、价格低廉等优势。目的:评价HpS A检测试剂盒临床诊断Hp感染的可靠性。方法:340例行13C-尿素呼气试验(13C-UBT)的受试者同时留取粪便标本,以待评估的酶联免疫法HpS A检测试剂盒检测Hp感染。以13C-UBT为金标准,计算待评估试剂盒诊断Hp感染的阳性符合率、阴性符合率、总符合率和κ系数。结果:与13C-UBT结果比对,待评估HpS A检测试剂盒诊断Hp感染的阳性符合率为96.3%,阴性符合率为75.8%,总符合率为87.4%,κ系数为0.737 522。结论:待评估的HpS A检测试剂盒用于临床诊断Hp感染,与金标准13C-UBT具有较高的符合率和一致性,结果可靠,可在临床上推广应用。     

14C-UBT和RUT诊断慢性胃炎Hp感染11O例分析

幽门螺杆菌(Helicobacter Pyloft简称Hp)是一微需氧的革兰氏阴性杆菌.自1993年Warren和Mashall从慢性胃炎病人的胃粘膜中分离及培养出Hp以来的十多年间,在Hp的诊断治疗方面取得了巨大的进展.Hp显著的生物学特征之一是具有分泌尿素酶的功能,尿素酶可迅速降解尿素成为二氧化碳和氨.医学界在Hp的诊断方面相继出现了胃粘膜尿素酶试验(RUT)和同位素13C和14C尿素酶呼气试验(即13C和14CUBT).现就我院消化科从1988年以来开展RUT检测Hp感染十年多的基础上自1998年2月2日开展了14C-UBT法检测Hp,并对慢性胃炎、消化性溃疡、胃粘膜相关淋巴瘤(MALT)等胃部疾病用14C-UBT和RUT两种方法共检测660余例次,本文就此两种方法检测慢性胃炎病例Hp感染110例的资科的结果对比和统计分析如下.     

清除幽门螺杆菌对老年COPD患者肺功能检测小气道参数的影响

目的探讨清除幽门螺杆菌(Hp)对老年慢性阻塞性肺病(COPD)患者肺功能检测小气道参数的影响。方法稳定期COPD患者行~(13)C-尿素呼气试验(~(13)C-UBT)检测,选取40例~(13)C-UBT阳性患者,即Hp感染的COPD病例为研究对象。再次进行肺功能检查,测定小气道参数[最大呼气中期流量(MMEF)、呼出用力肺活量50%时流速(FEF50%)、FEF75%]。所有患者均进行Hp的根除治疗2 w。1个月后复查~(13)C-UBT,剔除阳性病例,重新测定小气道参数。比较治疗前后患者小气道参数的变化情况。结果 40例患者Hp均根除成功,根除率为100.00%;根除Hp后MMEF、FEF50、FEF25~75、FEF75分别为(2.68±0.71)ml、(72.52±22.52)%、(70.24±21.02)%、(67.74±20.08)%,均明显高于根除Hp前(1.85±0.62)ml、(22.52±15.23)%、(22.31±14.98)%、(18.56±11.25)%(P<0.05)。结论清除Hp可显著提高老年COPD患者小气道参数,改善患者肺功能,促进患者身体恢复。     

残胃对~(14)C-尿素呼气试验影响的研究

目的:评估用 ~(14)C-尿素呼气试验(~(14)C-UBT)检测残胃幽门螺杆菌(HP)感染的准确性。方法:残胃32例及对照组40例病人先用金标准(胃镜检查时于胃窦和胃体各取两块粘膜活组织,作快速尿素酶试验和常规病理切片5张,Giemsa 染色镜检 HP)定性,再用(~14)C-UBT 检测 HP。用 X~2检验两组结果的准确性。结果:用金标准检测的残胃和对照组的阴性病人(分别为20例和14例)再用~(14)C-UBT 检测未出现假阳性,而残胃组的12例和对照组的26例阳性病人用~(14)C-UBT 检测各出现一例假阴性。两种方法检测的准确性无显著性差别,X~2=0.315,P>0.5。结论:残胃对用~(14)C-UBT 检测 HP 的准确性无影响。     

幽门螺杆菌粪便抗原快速检测在幽门螺杆菌感染诊疗前后应用的初步评价

目的 评估幽门螺杆菌(Hp)粪便抗原(HpSA)快速检测卡在Hp感染诊疗前后的临床应用价值.方法 用HpSA快速免疫检测卡检测217例(A组)患者的粪便标本,以快速尿素酶试验、病理组织学染色、13C尿素酶呼气试验(13C-UBT)联合检测结果作为"金标准"评价HpSA试验的准确性,并从中选择符合"金标准"Hp阳性的患者78例(B组),治疗后复查HpSA检测及13C-UBT,并以13-UBT结果为标准检测HpSA试验的准确度.结果 A、B两组HpSA检测敏感度分别为92.9%、90.0%;特异度为94.4%、94.8%;阳性预测值为95.9%、85.7%;阴性预测值为90.4%、96.5%;准确率为93.5%、93.5%.结论 HpSA快速检测卡试验对抗Hp感染诊疗前后均有较高的准确性.     

粪便抗原检测诊断幽门螺杆菌现症感染

目的 评价应用免疫酶联吸附试验(ELISA)检测粪便中幽门螺杆菌(Helicobacter pylori)抗原诊断H.pylori现症感染的敏感性和特异性。方法 应用^14C呼气试验以及幽门螺杆菌粪便抗原(HpSA)试验，对100例因上消化道不适就诊，怀疑有H.pylori感染的患者进行检测，观察两种检查的符合率。结果 ^14C呼气试验和HpSA同时阳性者38例，^14C呼气试验阳性而HpSA阴性者4例；^14C呼气试验和HpSA同时阴性者57例，^14C呼气试验阴性而HpSA阳性1例。以^14C呼气试验作为金标准计算，HpSA检测方法的敏感性为90．48％，特异性为98．28％。结论 幽门螺杆菌抗粪便原检测与^14C呼气试验有较高的符合率，而且简便易行，不需特殊设备，解决了无法进行呼气试验的婴幼儿和有肺部疾患者的非侵人性幽门螺杆菌现症感染诊断问题，是一种非侵入性幽门螺杆菌现症感染诊断的新方法。     

14C-urea breath test for assessment of gastric Helicobacter pylori colonization and eradication.

BACKGROUND AND OBJECTIVE: Urea breath test (UBT) is a reliable noninvasive technique for detecting gastric Helicobacter pylori colonization. 14C isotope-based test requires simple equipment and is inexpensive. We studied the utility of 14C-UBT in diagnosis of gastric H. pylori infection. METHODS: Presence of H. pylori was studied using antral histology and culture in patients with rapid urease test (RUT)-positive peptic ulcer. 14C-UBT was performed using a 185-kBq dose. Radioactivity in 15-min breath samples was measured using a beta-scintillation counter and result expressed as % dose recovered/mmol CO2. H. pylori was considered positive when any two tests were positive. All tests were repeated one month after completion of H. pylori eradication therapy. RESULTS: Among 41 patients (duodenal ulcer 36, gastric ulcer 5), H. pylori was detected by histology in 23 (56%) and by culture in 27 (66%). Overall, H. pylori was detected in 28 (68%) patients. Follow-up assessment was possible in 28 patients: 26 cleared the infection (all three tests negative). Mean 14C recovery values at 15 minutes associated with H. pylori-positive status were significantly higher (12.3 [SD 6.8] x 10(-3); n=30; p<0.001) than those associated with H. pylori-negative status (2.1 [0.9] x 10(-3); n=26). Using receiver-operating-characteristic analysis of 15-minute 14C recovery values, a cut-off of 6.5x10(-3) gave the best separation of H. pylori-positive and -negative cases. 14C-UBT had 93% sensitivity, 96% specificity and 95% accuracy. CONCLUSION: 14C-UBT appears to be a reliable noninvasive test for diagnosis of H. pylori infection.     

Scintigraphic evaluation of gallbladder motor functions in H pylori positive and negative patients in the stomach with dyspepsia

AIM：To evaluate the relationship between gallbladder （GB） motor function and H pylori infection in the stomach.
METHODS： All cases （86） underwent the 14C urea breath test （UBT）. ^14C-UBT was found as positive in 58 and negative in 28 dyspeptic patients. ^14C- UBT was accepted as a gold standard test. Clo test and histopathologic examination were compared with the results of ^14C-UBT in cases who tolerated upper gastrointestinal endoscopy procedure. Cholescintigraphy with ^99mTc-mebrofenin was used to determine the parameters of GB motor function （GB filling and emptying time, half of the emptying time, ejection fraction at 30th and 60th min） in all patients.
RESULTS： We found the sensitivity and specificity as 88% and 86% for Clo test and as 89% and 80% for histologic evaluation, respectively. The parameters of GB function were not significantly different in H pylori positive and negative patients. The GB emptying was normal in both groups. Minimum GB filling time was 30 min in 34 of 86 cases （39.5%）, filling was not observed in 2 cases. The GB ultrasonography （USG） results were normal for all cases and bile composition abnormality was not determined.
CONCLUSION： Our study showed that ^14C-UBT is highly reliable method to detect the presence of H pylori. The presence of H pylori infection does not directly affect the GB function.     

Diagnosis of Helicobacter pylori infection in patients with atrophic gastritis: comparison of histology, 13C-urea breath test, and serology

BACKGROUND: Atrophic gastritis, a risk factor for gastric cancer, is a late consequence of Helicobacter pylori infection in approximately one-third of the infected patients. It has been suggested that gastric cancer would develop less frequently if H. pylori were eradicated. However, the prevalence of H. pylori infection may be underestimated in patients with atrophic gastritis and intestinal metaplasia if only biopsy-based diagnostic methods are used. METHODS: We compared histology, 13C-urea breath test (13C-UBT), and serology in H. pylori diagnostics in 50 male patients with atrophic corpus gastritis. RESULTS: H. pylori was detected in 15 (30%) patients by histology and in 14 (28%) by 13C-UBT, whereas increased serum antibody levels indicating H. pylori infection were found in 41 (82%) patients (P < 0.0001 between serology and both histology and 13C-UBT). H. pylori infection was associated with atrophic corpus gastritis in 84% of the present patients (in one patient with normal antibody titres H. pylori was defined histologically). CONCLUSIONS: H. pylori infection would have been missed in most patients with atrophic gastritis without the analysis of H. pylori antibodies. Therefore, in patients with atrophic gastritis, the use of serology is encouraged in diagnosing H. pylori infection.     

Evaluation of 13C-urea breath test to confirm eradication of Helicobacter pylori]

This study aimed to evaluate the effectiveness of the 13C-urea breath test (UBT) for assessment of Helicobacter pylori eradication after treatment. One hundred twenty six patients were enrolled with 85 receiving proton pomp inhibitor based triple therapy. They were underwent upper gastrointestinal endoscopy with biopsies for diagnosis and assessment of H. pylori infection using culture, histology, rapid urease test (RUT) and 13C-UBT. Assessment of eradication needs to be performed 4 weeks or more after completion of treatment. Breath samples were taken 15 minutes after the ingestion of 100 mg 13C-urea. Breath samples were analyzed on a mass spectrometer system. The gold standard for H. pylori infection was a positive culture or positive histology + positive RUT; negative for infection was defined as negative results of all three biopsy tests. Based on ROC curves, the most appropriate cut-off value for diagnosis of H. pylori infection was identified as 2.5/1000, which provided 96.2% sensitivity, 100% specificity, and 96.8% accuracy as judged by the gold standard. However, when confirming the eradication of H. pylori, it was 3.5/1000, which provides for 100%, 95.8%, and 96.5%, respectively. Ten patients (11.8%) had delta13C values that were 2.5-5.0/1000 4-12 weeks after therapy. Eight patients were considered cured of H. pylori infection, and 2 were considered to still have H. pylori infection following 13C-UBT, serology, and H. pylori specific antigen test. The false-positive rate of 13C-UBT was 9.4% (8/85). When the grey zone of 13C-UBT was set at a level of 2.5 to 5.0/1000 (2.5 > : negative, 5.0 < or = : positive) after eradication therapy, the sensitivity and specificity of 13C-UBT was 100% and 98.4% compared to the gold standard. It was concluded that to avoid false-positive results of 13C-UBT, the grey zone of 13C-UBT needs to be set at a level of 2.5 to 5.0/1000; thus improving the accuracy of test for the assessment of eradication of H. pylori infection.     

Validity of a modified 13C-urea breath test for pre- and posttreatment diagnosis of Helicobacter pylori infection in the routine clinical setting

OBJECTIVE: Citric acid meets the criteria of an optimal test drink for the 13C-urea breath test (13C-UBT) because it permits rapid, high level recovery of the 13C administered. In a previous study we reported that administration of 13C-urea dissolved in a citric acid solution provides results similar to those obtained with standard administration of the substrate 10 min after the test drink. The aim of this study was to evaluate the accuracy of this modified 13C-UBT for both primary and posttreatment diagnosis of Helicobacter pylori (H. pylori) infection in a large patient population in clinical practice. METHODS: The 13C-UBT was performed in 553 patients with dyspeptic symptoms by giving them 75 mg of 13C-urea either 10 min after administration of 200 ml of a test drink comprising 0.1 mol/L citric acid solution (protocol 1, n = 320) or dissolved in the same amount of this test drink (protocol 2, n = 233). All patients underwent an upper gastrointestinal endoscopy and the H. pylori-status was assessed by histology, rapid urease test, and culture. Sixty patients with proven H. pylori infection were reinvestigated by both endoscopy and 13C-UBT (protocol 2) 4 wk after completing eradication therapy. RESULTS: The accuracy of the two test protocols in the pretreatment diagnosis of H. pylori infection (95.6% and 96.6%), as well as of the modified 13C-UBT in the posttreatment evaluation of the infection (98.3%) was similar. More meaningful are the high PPV (>96%) and NPV (>93%) of the 13C-UBT under pre- and posttreatment conditions. CONCLUSIONS: The administration of 13C-urea dissolved in a citric acid solution simplifies the 13C-UBT, while preserving the high accuracy in the diagnosis of H. pylori infection. This modified 13C-UBT has equal accuracy in the pre- and the posttreatment situations.     

胃食管反流病与幽门螺杆菌感染的关系探讨

为了探讨胃食管反流病(GERD)与幽门螺杆菌(Helicobacter pylori, H.pylori)感染的关系,我们将经过电子胃镜确诊的GERD患者115例及对照组轻度慢性浅表性胃炎患者90例予活检胃窦组织快速尿素酶法及14C呼气试验法进行H.pylori检测,对比两组H.pylori感染情况.结果 显示:115例GERD组H.pylori感染率为37.39%,90例对照组H.pylori感染率为62.22%,GERD组H.pylori感染率明显低于对照组,有显著性差异(P＜0.01).     

Recurrence of Helicobacter pylori infection 1 year after successful treatment: prospective cohort study in the Republic of Yemen

OBJECTIVES: To investigate the prevalence of Helicobacter pylori infection in dyspeptic patients in the Republic of Yemen and the recurrence rate 1 year after apparently successful eradication. METHODS: A total of 275 patients with chronic dyspepsia seen in one clinic were enrolled. Gastric biopsies were obtained at endoscopy and H. pylori infection was diagnosed using the rapid urease test. Patients with H. pylori infection were given either clarithromycin or metronidazole-based triple therapy. Six weeks later H. pylori status was assessed using the C-urea breath test (C-UBT). Those who were negative for H. pylori had a further C-UBT after 1 year to establish the recurrence rate. RESULTS: The prevalence of H. pylori infection at entry to the study was 82.2% [95% confidence interval (CI) 78-87%]. The overall eradication rate 6 weeks after treatment was 49.1% (95% CI 42.6-55.6%) by intention-to-treat analysis, and 60% (95% CI 53-67%) by per-protocol analysis. Recurrence rate of H. pylori infection at 1 year was 34% (95% CI 14-45%) and the only predictor of recurrence was an excess delta C-UBT value less than 3.5 per million but equal to or greater than 2.5 per million at 6 weeks after treatment (odds ratio 2.28; 95% CI 1.17-4.44; P = 0.028). CONCLUSION: The prevalence of H. pylori infection in dyspeptic patients in Yemen is very high, the eradication rate with standard triple therapy was unsatisfactory probably because of widespread bacterial resistance due to unrestricted antibiotic use. The recurrence rate of infection at 1 year was high, as a result of recrudescence of incompletely eradicated organisms rather than reinfection.     

Helicobacter pylori stool antigen (HpSA) test--a simple, accurate and non-invasive test for detection of Helicobacter pylori infection

BACKGROUND/AIMS: To access the reliability of a newly developed test, the Helicobacter pylori (H. pylori) stool antigen (HpSA) test was used for detection of H. pylori infection. METHODOLOGY: Stool specimens were collected from 33 consecutive patients (19 males and 14 females, age range: 16-73 years, mean: 49 years) who received upper gastrointestinal endoscopic examination for gastrointestinal symptoms. The H. pylori status was evaluated based on six different tests: culture, histology, biopsy urease test, 13C-urea breath test (13C-UBT), serology, and HpSA test. A commercial kit using an enzyme-linked immunosorbent assay examined HpSA in the stool. H. pylori status was defined as positive when the culture was positive or concordance of three of the other four tests (histology, biopsy urease test, 13C-UBT, and serology) was positive. RESULTS: Twenty patients were diagnosed as H. pylori-positive. The HpSA test was positive in 19 patients and negative in 14 patients. The sensitivity and specificity were 95.0% and 100%, respectively. The overall accuracy rate was 96.3%. CONCLUSIONS: The HpSA test is a new, simple, non-invasive method for accurate diagnosis of H. pylori infection.     

门脉高压性胃病与幽门螺杆菌相关性研究

为了解门脉高压性胃病(PHG)与幽门螺杆菌(HP)的关系,采用尿素酶试验、血清HP抗体检测和14C呼吸试验等方法检测50例肝硬化PHG患者HP的感染率,并与非PHG肝硬化(NPHG)、十二指肠球部溃疡(DU)、功能性消化不良(FD)三组患者比较.PHG组HP感染率为36%,与NPHG组(38%)、FD组(44%)分别比较差异无显著性(P＞0.05),与DU组(94%)比较差异有显著性(P＜0.01).说明HP感染对PHG发病影响不大.