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     

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。     

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。     

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.     

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.     

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.     

Comparison of Helicobacter pylori prevalence in symptomatic patients in northeastern Mexico with the rest of the country: its association with gastrointestinal disease

BACKGROUND: Prevalence of Helicobacter pylori varies among different geographic regions. The aim of this study was to assess H. pylori prevalence in symptomatic patients in northeastern Mexico and its possible association of H. pylori with disease. METHODS: We studied 261 symptomatic patients (female/male 1.44, mean age 53 years) who underwent gastrointestinal endoscopy at Hospital Universitario Dr. José Eleuterio González in Monterrey, Nuevo León, Mexico. Among patients included in this study, 209 (80.1%) had nonulcer dyspepsia (NUD), 30 (11.5%) peptic ulcer disease (PUD), and 22 (8.4%) high-grade dysplasia or gastric cancer. H. pylori status was determined by histology, positive rapid urease test, culture, or IgG whole-cell anti-H. pylori. Specific IgG antibodies for CagA status were determined by ELISA as previously described. Patients were defined as infected with H. pylori by positive results of two or more diagnostic tests used. RESULTS: Overall prevalence of H. pylori was 67.8%. According to clinical presentation, gender (male) was related with gastric cancer (p <0.01) and with PUD (p <0.05). Of 177 patients infected with H. pylori, 90 (50.8%) were seropositive for CagA antigen; in addition, H. pylori CagA+ was more common in patients with PUD (77.8%) than with NUD (43.2%) (p <0.05). However, no association was found between gastric cancer patients and presence of CagA+ H. pylori strains. CONCLUSIONS: H. pylori prevalence in symptomatic patients in northeastern Mexico is as high as the prevalence reported for the entire country. We confirmed that patients with gastric cancer and PUD are more likely to be male. CagA+ strains were associated with patients who presented PUD but not gastric cancer.     

酶免疫法检测幽门螺杆菌粪便抗原及临床意义

目的　探讨酶免疫法 (ELISA)检测幽门螺杆菌 (H pylori)粪便抗原的特异性及敏感性。 方法　用酶免疫试剂盒对 10 9例接受胃镜检查并取活检组织的患者粪便标本进行H pylori粪便抗原检测 ,确认试验为胃粘膜组织H pylori培养或 /和尿素酶试纸快速试验及H pylori形态学 (涂片检查、组织学染色 )检查 ,若结果均阳性则确认为H pylori感染。将粪便抗原检查结果与确认试验的结果比较 ,判断其敏感性、特异性和准确性。 结果　 10 9例患者中确认为H pylori阳性的 6 9例 ,阳性率为 6 3 3% ,其中消化性溃疡、胃炎、胃癌的阳性率分别为 6 2 2 %、 6 7 9%、5 7 1%。H pylori阳性的 6 9例患者中H pylori粪便抗原阳性的 6 6例 ;H pylori阴性的 40例患者中H pylorio粪便抗原阴性的 38例 ,其敏感度为 95 7%、特异度为 87 5 %、准确度为 92 7%。kappa一致性系数k =0 84。结论　酶免疫法检测H pylori粪便抗原 ,方法可靠 ,易于推广     

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…     

Antibiotic sensitivity of Helicobacter pylori in Jamaica

Helicobacter pylori infection is one of the commonest chronic infections worldwide. Eradication regimes usually contain two antibiotics, however resistance is increasing and this decreases treatment success. This study reports on the sensitivity and resistance of H pylori to several antibiotics in patients undergoing upper gastrointestinal endoscopy in Jamaica. The rapid urease test (CLO) was positive in 128 (38%) of 336 patients. Fifty patients (39%; 50/128) with positive CLO tests had positive cultures for H pylori. Two-thirds (32/48) of islolates were sensitive to metronidazole and one-third (16/48) were resistant. Ninety-seven per cent of isolates (31/32) were sensitive to erythromycin. The sensitivity for clarithromycin was 92% (11/12) with one isolate (8%) resistant. All strains of H pylori (48/48) were sensitive to ampicillin and amoxicillin - clavulanate. Metronidazole resistance is present in one-third of H pylori isolates and resistance to macrolides is relatively low in Jamaican patients. It is important to monitor antibiotic resistance in order to provide clinicians with data on the most appropriate and cost effective eradication regimes for H pylori.     

多种方法检测幽门螺杆菌感染的评价

目的:评价多种方法检测幽门螺杆菌(H.pylori)感染的准确性.方法:对82例因上消化道症状接受胃镜检查患者应用酶免疫反应试验原理进行粪抗原(HpSA)试验,同步进行胃粘膜快速尿素酶试验(RUT)和组织学(MB法)检测,其中67例患者进行14C-呼气试验(14C-UBT)检测H.pylori,以快速尿素酶试验和组织学联合检测作为金标准.结果:HpSA检测诊断Hpylori感染的敏感性93.30%,特异性92.50%,阳性预测值90.30%,阴性预测值94.87%,准确性92.90%;14C-UBT检测诊断H.pylori感染的敏感性81.81%,特异性81.08%,阳性预测值72.00%,阴性预测值88.24%,准确性81.36%.结论:HpSA试验、14C-UBT试验是诊断H.pylori感染的简便、准确和非侵入性的检查方法.     

Prevalence of active Helicobacter pylori infection among patients referred for endoscopy in Brunei Darussalam

INTRODUCTION: The prevalence of Helicobacter pylori (H. pylori) infection has been reported to vary between and even within countries. We retrospectively assessed the prevalence among patients referred for endoscopy in our local setting. METHODS: 4,700 patients, who had endoscopy and H. pylori testing for the first time over a five-year period, were reviewed. RESULTS: The mean age was 45.4 +/- 17.1 years (male 51.1 percent), with racial breakdown similar to the national breakdown. The main indications for endoscopy were dyspepsia (59.6 percent), anaemia (12.6 percent), gastrointestinal bleeding (9.4 percent) and gastro-oesophageal reflux (7.6 percent). The overall prevalence of H. pylori was 26.9 percent, highest in the 30-39 years (30.3 percent) age group. This was higher in males compared to females (30.3 percent versus 23.3 percent, p-value is less than 0.001). Among the racial groups, the expatriate (35.3 percent, p-values are less than 0.001) and the indigenous (31.3 percent, p-values are less than 0.001) groups had significantly higher prevalence rates compared to the Malays (25.9 percent) and the Chinese (23.2 percent). Patients with dyspepsia had the highest prevalence (29.8 percent) compared to the other indications. In patients with peptic ulcer disease, the prevalence rate was 46.9 percent. Over the five-year period, there was a decline in prevalence from 32.3 percent to 25.6 percent. This trend was seen in the Malays and the Chinese, but not the indigenous and the expatriate groups. CONCLUSION: Similar to reported data from the regions, prevalence of H. pylori infection varies, with the Malays and the Chinese having the lowest prevalence rate. The prevalence among those with peptic ulcer disease was lower than reported. There was also a decline in the overall prevalence.     

胃黏膜病变根除幽门螺杆菌后转归的研究

目的探讨清除幽门螺杆菌后对胃黏膜病变转归的影响。方法人选患者均经胃镜和临床病理诊断为慢性胃炎、萎缩性胃炎伴肠上皮化生,并确定有Hp感染的状态。患者分两组：幽门螺杆菌根治组慢性胃炎42例、萎缩性胃炎伴肠上皮化生45例,未行Hp治疗组慢性胃炎41例、萎缩伴肠上皮化生38例;于根除幽门螺杆菌后1年行胃镜随访,在同一部位取活检,根据病理结果的不同分为好转和无好转。结果治疗Hp1年后慢性胃炎根治组逆转率54．52％（23／42）,未根治组19．51％（8／41）,组间比较有非常明显差异（χ^2=11．06,P〈0．01）;Hp根治组萎缩性胃炎伴肠上皮化生病变逆转率15．56％（7,45）,未根治组10．53％（4／38）,组间比较无明显差异。结论根除Hp1年后慢性胃炎病变有明显好转,对萎缩性胃炎伴肠上皮化生病变无明显影响。     

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。     

Evaluation of a commercial enzyme-linked immunosorbent assay (ELISA) kit for serological diagnosis of Helicobacter pylori infection in a group of non-ulcer dyspepsia sufferers.

Helicobacter pylori infection of the stomach is associated with gastritis and peptic ulceration and may be causative. A noninvasive test for this organism might be useful in managing some patients with dyspepsia without the need for further investigation. We have evaluated a new commercially available serological test (Helico-G ELISA, Porton Cambridge, UK) for this infection to assess its diagnostic accuracy in a retrospective study of 115 patients with non-ulcer dyspepsia. Sixty-three of these patients (55%) were found to have H. pylori infection and gastritis on histology. A sensitivity of 81% and specificity of 90% were obtained. No significant fall in the antibody titres was found in a subgroup of 15 patients who were selected to complete a course of triple therapy despite significant improvement in their dyspepsia score and confirmed eradication of H. pylori organism in 80% of these patients. We conclude that the test has limited value in aiding clinical decision of managing patients with dyspepsia.     

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.     

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.     

免疫快检卡-幽门螺杆菌粪便抗原检测的临床评价

目的评估免疫快检卡试验诊断幽门螺杆菌(Hp)感染的准确性.方法108例因上消化道症状接受胃镜检查的患者行免疫快检卡试验和快速尿素酶试验、组织学方法检测Hp.两项试验阳性定为Hp感染.结果免疫快检卡的敏感性为96.67%,特异性为85.29%,准确性为92.55%,阳性预测值为92.06%,阴性预测值为93.55%..结论免疫快检卡是一种准确、快速、方便、无创的检测方法.