儿童粪便幽门螺杆菌抗原检测的临床应用

目的　评价幽门螺杆菌粪便抗原 (HpSA)检测在诊断儿童幽门螺杆菌 (H· pylori)感染及治疗后复查的价值。方法　采用酶联免疫分析法检测 84例患儿的粪便幽门螺杆菌抗原 ,以胃黏膜活检标本快速尿素酶试验、组织切片染色联合检测作为H·pylori感染的诊断标准 ,两项阳性确定为阳性病例 ,两项阴性确定为阴性病例。对其中 12例 H·pylori感染病例行 H·pylori根治治疗结束后 4周同时复查HpSA和13 C尿素呼气试验 (13 C UBT)。结果　相对于胃镜检查结果 ,HpSA的敏感性、特异性、阳性预测价值、阴性预测价值、准确性分别为91 4 % ,92 3% ,96 4 % ,82 8% ,91 7%。抗H· pylori 治疗结束后 4周复查HpSA ,和13 C UBT诊断符合率为83 3%。结论　HpSA具有简便、经济的特点 ,可用于儿童 H·pylori感染的诊断及治疗后复查。     

儿童幽门螺杆菌粪便抗原检测临床应用价值的评价

目的　评估幽门螺杆菌粪便抗原 (HpSA)试验诊断儿童幽门螺杆菌 (Hp)感染的准确性。 方法　收集31例接受13 C 尿素呼气试验 (13 C UBT)检查 2日内患儿的粪便标本 ,应用酶免疫反应原理进行HpSA试验 ;以13 C UBT作为诊断标准。结果　以光密度值≥ 0 12 1为阳性 ,HpSA检测诊断Hp感染的敏感性 86 6 7%、特异性93 78%、阳性预测值为 92 86 %、阴性预测值 88 2 4 %和准确性 90 32 %。结论　HpSA检查是一种简便、非侵入性的诊断儿童Hp感染的一种方法。     

过敏性紫癜伴幽门螺杆菌感染患儿肠道菌群变化的研究

目的 研究过敏性紫癜(HSP)伴有幽门螺杆菌(H.pylori)感染患儿肠道菌群的变化.方法 随机收集40例HSP患儿及40例正常儿童的粪便标本,先用快速免疫检测卡进行粪便幽门螺杆菌抗原(HpSA)检测,判定有无H.pylori感染.然后提取两组粪便标本目标细菌DNA,采用16SrRNA荧光定量PCR技术对两组粪便标本中的双歧杆菌和大肠杆菌进行定量分析和比较.并计算双歧杆菌/大肠杆菌(B/E)比值.结果 HSP患儿H.priori检出率为50.0%,正常儿童为27.5%(x2=4.266.P<0.05).双歧杆菌在HSP伴H.Pylori感染组和HSP非H.pylori感染组分别与正常儿童H.pylori感染组和非H.pylori感染组相比,数鼍明显减少(P<0.008 3);大肠杆菌在正常儿童H.pylori感染组和非H.pylori感染组分别与HSP非H.pylori感染组相比,数量明显升高(P<0.008 3),在HSP伴H.pylorii感染组与HSP非H.pylori感染组相比,数量明显升高(P<0.008 3).B/E值在HSP伴H.pylori感染组分别与HSP非H.pylori感染组、正常儿童H.priori感染组和正常儿童非H.pylon感染组相比,数值明显降低(P<0.008 3).结论 HSP患儿H.pylori检出率较正常儿童明显增多,HSP发病可能与H.pylori感染有关.HSP伴H.pylori感染和HSP非H.pylori感染患儿肠道双歧杆菌均较正常儿童减少,HSP伴H.pylori感染患儿肠道大肠杆菌较HSP非H.pylori感染息儿升高,HSP伴H.pylori感染患儿B/E值明显降低,提示HSP患儿肠道菌群失调明显.     

两种非侵入性诊断方法在儿童幽门螺杆菌感染中的应用

目的 比较幽门螺杆菌粪便抗原(HpSA)检测和^13C-尿素呼气试验(^13C-UBT)在诊断儿童幽门螺杆菌(Hp)感染中的价值。方法 采用酶联免疫分析法检测84例因上消化道症状接受胃镜检查儿童粪便HpSA，其中56例行^13C-UBT检测，以胃黏膜活检标本快速尿素酶试验、组织切片染色联合检测作为Hp感染的诊断标准，两项阳性确定为阳性病例，两项阴性确定为阴性病例。结果 相对于胃镜检查结果，HpSA和^13C-UBT敏感性、特异性、阳性预测价值、阴性预测价值、准确性分别为91．4％、95．7％，92．3％、100％，96．4％、100％，82．8％、83．3％，91．7％、96．4％。HpSA和^13C-CUT诊断符合率为94．6％，相关系数r=0．847P：0．000。结论 HpSA检测具有简便、经济的特点，与^13C-UBT一样，是诊断儿童Hp感染准确性高的非侵入性方法。     

幽门螺杆菌粪便抗原检测在幽门螺杆菌感染的应用

目的　评估幽门螺杆菌粪便抗原 (HpSA)试验在幽门螺杆菌 (Hp)感染治疗前后的准确性。方法　收集 62例 4～ 1 7岁因上消化道症状就诊而接受1 3C 尿素呼气试验 (1 3C UBT)、胃镜检查和 31例根除Hp后停药至少 4周 ,接受1 3C 尿素呼气试验 2d内患儿粪便标本 ,应用酶免疫反应原理进行HpSA试验 ;以1 3C UBT检测和胃镜活检作为诊断标准。结果　以光密度值 (A)≥0 .1 2 1为阳性 ,HpSA检测治疗前诊断Hp感染敏感性为 92 .30 %、特异性 91 .30 %、阳性预测值为 92 .30 %、阴性预测值 87.50 %、准确性 91 .94% ;治疗后诊断Hp感染敏感性为 83 .33 %、特异性 88.0 0 %、阳性预测值为 62 .50 %、阴性预测值 95 .65 %、准确性 87.1 0 %。结论　HpSA检查对治疗前诊断儿童Hp感染准确率较高 ;对治疗后的诊断敏感性和特异性较治疗前低。     

非侵入性试验诊断儿童幽门螺杆菌感染的评价

常用的幽门螺杆菌(HP)感染诊断方法包括侵入性检查和非侵入性检查。非侵入性方法避免了内窥镜检查,从而更易被患儿和家属接受。各种非侵入性试验的敏感性和特异性不一,在临床应用中有着各自的适用范围和特点。尿素呼气试验精确性高,可用于HP感染的诊断和治疗后评估,但费用比较昂贵;血清学试验操作简便,但在儿童中应用其可靠性较小;HP粪便抗原检测取样方便,在诊断HP感染方面具有较高的准确性,然而在监测HP根除与否方面存在着争议;PCR检测是一项精确的检查方法,但需特殊设备,操作复杂,多用于科研;唾液和尿液抗体检测准确性较高,但目前研究不多。临床应根据当地HP感染率、经济状况及患儿年龄等具体情况选用合适的方法。     

粪便幽门螺旋杆菌抗原的检测在筛查儿童幽门螺杆菌感染的应用研究

目的 评价粪便幽门螺杆菌抗原(HpSA)试验在诊断儿童幽门螺杆菌感染中的应用价值。方法 用HpSA试验检测有消化道症状的58例患儿HpSA，并同时进行HC标记的尿素呼气试验(^14C-UBT)，以^14C-UBT作为金标准，对HpSA试验进行方法学评价。结果 HpSA试验对Hp感染诊断的敏感性为94．6％、特异性为95．2％、准确性为94．8％、阳性预期值为97-2％、阴性预期值为90.0％。应用HpSA试验检测了1015名健康学生HpSA，阳性率为20．0％。结论 HpSA试验是一种诊断儿童幽门螺杆菌感染的简便、易行、准确性高的非侵入性方法。     

非侵入性试验诊断儿童幽门螺杆菌感染的评价

常用的幽门螺杆菌(HP)感染诊断方法包括侵入性检查和非侵入性检查。非侵入性方法避免了内窥镜检查，从而更易被患儿和家属接受。各种非侵入性试验的敏感性和特异性不一，在临床应用中有着各自的适用范围和特点。尿素呼气试验精确性高，可用于HP感染的诊断和治疗后评估，但费用比较昂贵；血清学试验操作简便，但在儿童中应用其可靠性较小；HP粪便抗原检测取样方便，在诊断HP感染方面具有较高的准确性，然而在监测HP根除与否方面存在着争议；PCR检测是一项精确的检查方法，但需特殊设备，操作复杂，多用于科研；唾液和尿液抗体检测准确性较高，但目前研究不多。临床应根据当地HP感染率、经济状况及患儿年龄等具体情况选用合适的方法。     

有消化道症状儿童幽门螺旋杆菌现症感染的调查

目的：了解有消化道症状的儿童幽门螺杆菌（H. pylori）现症感染状态,并调查H. pylori感染的危险因素。方法：选择有上消化道症状的376例患儿进行胃镜检查,同时取3块胃黏膜分别作快速尿素酶及病理组织学检查。部分患儿行13C-尿素呼气试验。上述3种方法中2项或2项以上阳性者诊断为H. pylori感染。同时对患儿居住环境、家庭经济状况、父母文化程度、消化道疾病家族史进行问卷调查。结果：376例患儿中,H. pylori现症感染率为44.9%（169例）。男女H. pylori感染率差异无统计学意义（P>0.05）。3岁~、8岁~、13~16岁年龄组H. pylori阳性率分别为39.5%（47/119）、41.0%（55/134）、54.5% (67/123）,不同年龄组间患儿H. pylori感染率差异有统计学意义（χ2=6.76,P<0.05）。儿童全托及中小学生寄宿、集体居住及用餐者H. pylori阳性率高于非集体居住及用餐者（53.6% vs 40.6%, P<0.05）。家庭经济收入高者H. pylori阳性率低于中低收入者（36.9% vs 48.3%,P<0.05）。父母文化程度高者H. pylori阳性率低于父母文化程度较低者（39.5% vs 50.8%,P<0.05）。有胃炎或消化性溃疡病家族史者H. pylori感染率高于无家族史者（52.9% vs 41.2%,P<0.05）。结论：随着年龄的增长,H. pylori感染率逐渐增加。集体居住、共同用餐、家庭低收入、父母受教育程度低以及有上消化道疾病家族史的患儿有较高的H. pylori感染率,因此以上因素是儿童感染H. pylori的危险因素。     

幽门螺杆菌感染与儿童胃炎关系探讨

为进一步研究幽门螺杆菌（Helicobacter pylori,H.pylori)感染与儿童胃炎的关系，对我科1998年至2000年间500例3岁－15岁儿童胃镜活检组织进行组织学和H.pylori观察，按Sydney胃炎标准对病变分级，分析和探讨H.pylori感染与儿童胃炎发展变化的关系。结果表明：40.4%的儿童胃炎与H.pylori感染有关；而且炎症的程度、淋巴滤泡的形成、嗜酸细胞增多及幽门腺萎缩明显高于无H.pylori感染的儿童胃炎。提示上海地区儿童胃炎有很高的H.pylori感染率，H.pylori感染与儿童胃炎关系密切，儿童H.pylori胃炎的胃粘膜病理变化比非H.pylori感染者严重。     

Accurate diagnosis of Helicobacter pylori infection by stool antigen test and 6 other currently available tests in children

Invasive and noninvasive tests have been developed for the diagnosis of Helicobacter pylori infection. Because H pylori infection is acquired in childhood and adolescence, accurate diagnosis of the infection in the pediatric population is important. We conducted a study to compare invasive tests: culture, biopsy urease test, histology, and polymerase chain reaction on gastric biopsy specimens, with noninvasive tests: serology, (13)C-urea breath test, and a new diagnostic modality, stool antigen test to diagnose H pylori infection. A total of 53 children with symptoms were enrolled in this study, and all had completed the 7 diagnostic tests for H pylori. All the diagnostic tests except serology were excellent methods of diagnosing H pylori infection in children; the diagnostic accuracy was as follows: stool antigen test 96.2%, biopsy urease test 96.2%, histology 98.1%, polymerase chain reaction 94.3%, culture 98.1%, (13)C-urea breath test 100%, and serology 84.9%. The stool antigen test, being highly sensitive and specific, will be potentially very helpful in diagnosing H pylori infection in children.     

Helicobacter pylori antigens in stool specimens of gastritis children before and after treatment

BACKGROUND: Various testing methods are successfully applied to the diagnosis of Helicobacter pylori infection, but noninvasive techniques are still needed for therapeutic monitoring, especially in children. In the search for new noninvasive techniques for the diagnosis of H. pylori infection, the authors evaluated an enzyme immunoassay for the detection of H. pylori antigen in stool (HpSA). METHODS: The authors studied 62 H. pylori-positive children with chronic gastritis and 45 control subjects. H. pylori infection was diagnosed using cultures and histology of gastric biopsy specimens and a stool antigen test before treatment (clarithromycin, amoxicillin, omeprazole for 7 days) and 4 weeks to 6 weeks after treatment. RESULTS: Before therapy, antigen in stool was detected in 55 of 62 H. pylori-positive patients, which indicates that the sensitivity of the HpSA test was 88.7%. Of the 45 control subjects (with negative culture and histology results), 43 had negative results for H. pylori in the stool test (specificity, 95.5%). After completion of therapy, eradication was obtained (and confirmed by culture and histology) in 53 of the 62 H. pylori-positive children (85.5%). Four weeks to 6 weeks after eradication therapy, the sensitivity, specificity, positive predictive value, and negative predictive value of the stool antigen (HpSA) test were 88.9%, 96.2%, 80%, and 98%, respectively. CONCLUSIONS: The accuracy of the HpSA test for the detection of H. pylori in human stool 4 weeks to 6 weeks after treatment is comparable with the accuracy of the culture results. The stool antigen (HpSA) test was found to be a useful method for posttreatment eradication testing of infection in children.     

Helicobacter pylori stool antigen test

Objective :Helicobacter pylori (H.pylori) infection is usually acquired in early childhood. Invasive techniques used for diagnosis ofH.pylori infection require endoscopic examination which is expensive and inconvenient and may cause complications. the aim of this study was to evaluate the performance of a new noninvasive diagnostic method, stool antigen test forH.pylori in untreated children with recurrent abdominal pain.Methods: Eighty children (35 female, 45 male) who have undergone upper gastrointestinal endoscopy due to recurrent abdominal pain were included in the study. theH.pylori stool antigen test (HpSA) is based on a sandwich enzyme immunoassay with antigen detection. HpSA sensitivity, specificity, and positive and negative predictive values were determined with reference to the results of both histology and rapid urease test as a gold standard (H. pylori status).Results: While 49 of the 80 children (61%) tested were positive forH.pylori according to the results of both histology and rapid urease test, 28 children had negativeH.pylori status. Among those 49 children, 48 were found to be positive by HpSA. Of 28 patients with negativeH.pylori status, 28 were H.py/ori-negative also in the stool test. the sensitivity, specificity, and positive and negative predictive values of HpSA were found to be 98%, 100%, 100%, and 96.5%, respectively.Conclusion: these findings have demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection ofH.pylori infections in children.     

Evaluation of stool antigen test for Helicobacter pylori infection in asymptomatic children from a developing country using 13C-urea breath test as a standard

OBJECTIVE: Prevalence of asymptomatic Helicobacter pylori infection is very high in infants and children in developing countries. C urea breath test (UBT) is a reliable non-invasive diagnostic test for H. pylori infection in children that avoids invasive endoscopy. We compared a newly introduced H. pylori stool antigen test (with a high sensitivity and specificity in symptomatic children) with UBT in asymptomatic children mostly 1-5 years old, from a population with a high prevalence of infection. METHOD: Eighty six asymptomatic children (42 boys and 44 girls) were tested for H. pylori infection using the UBT and a stool antigen test (HpSA) based on a sandwich enzyme immunoassay for antigen detection. RESULTS: Forty five of the eighty-six (52.3%) children tested positive for H. pylori using the breath test. In 34 of these forty-five children, H. pylori antigen was detected in stool (sensitivity = 75.6%, 95% CI = 63 to 88%). Of the 50 of 86 (58%) children positive by HpSA test, 34 were positive for breath test. Of the 41 children with negative UBT test 25 were negative for stool antigen test (specificity = 61%, 95% CI = 46 to 76%). CONCLUSION: The sensitivity and specificity of the new stool antigen test are lower in asymptomatic children with high H. pylori prevalence rate compared to those reported for children with gastrointestinal symptoms. Its usefulness is limited for diagnosis in an asymptomatic child with H. pylori infection.     

Diagnostic value of stool antigen and antibody tests for Helicobacter pylori infection in Turkish children with upper gastrointestinal complaints before and after eradication

The aim of this study was to evaluate the diagnostic value of Helicobacter pylori stool antigen (HpSA) and serologic tests before and after eradication therapy for H. pylori in Turkish children in our region with upper gastrointestinal complaints. In this study, 87 children with upper gastrointestinal complaints and 95 children with various symptoms without gastrointestinal complaints were enrolled. H. pylori infection was detected by urea breath test (UBT). HpSA and H. pylori immunoglobulin G (HpIgG) tests were applied to all the children. Eradication treatment was given to the 34 H. pylori-positive children. The UBT was positive in 43 of 87 children (49.4%) with upper gastrointestinal complaints. The sensitivity and specificity of the HpSA in children with upper gastrointestinal complaints were 86% and 84.1%, respectively, and those for the HplgG were 76.7% and 90.9%, respectively. After eradication, the overall HpSA test sensitivity and specificity values were detected as 88.9% and 84%, respectively, and those for the HpIgG were 77.8% and 36%, respectively. The HpSA test is highly sensitive and specific for the diagnosis of H. pylori and for confirming eradication in Turkish children with upper gastrointestinal complaints. However, serology is not a reliable method for the diagnosis of H. pylori infection or for confirming eradication in children.     

幽门螺杆菌粪便抗原与血清学抗体联合检测在儿童幽门螺杆菌感染流行病学调查中的应用

目的 评价幽门螺杆菌粪便抗原(HpSA)检测与传统血清学检测方法联合应用在儿童Hp感染流行病学调查中的可行性。方法 无症状儿童480例行Hp血清学抗体检测。对Hp血清学阳性儿童再行粪便HpSA检测。以HpSA阳性作为Hp现症感染诊断标准;以血清抗Hp-IgG抗体阴性作为未感染的诊断标准。以Hp现症感染儿童作为病例组,未感染儿童作为对照组,探讨儿童Hp感染危险因素。结果 血清抗Hp抗体阳性率为35.8％(172／480)。HpSA阳性率即Hp现症感染率为13.3％(64／480)。儿童Hp感染呈家庭内聚集及口-口传播和粪-口传播途径。结论 HpSA原与血清学检测两种非侵入性方法相结合简便、易行、费用相对低廉、准确性较高,适合在儿童中开展Hp感染流行病学调查。     

Stool antigen test for diagnosis of Helicobacter pylori infection in children with symptomatic disease: a prospective study

OBJECTIVE: Noninvasive tests for the diagnosis of Helicobacter pylori (Hp) infection in children are limited by low accuracy rates and lack of validation. Existing studies indicate that the stool antigen test (HpSA) has an acceptable level of accuracy for the diagnosis of Hp infection in adults but not children. The aim of this study was to evaluate the accuracy of the HpSA test for the detection of Hp infection in U.S. children. METHODS: Children requiring upper endoscopic procedures were prospectively recruited from two pediatric gastroenterology clinics. Stool samples were collected from each participant before endoscopy. The presence of Hp infection was determined by positive histologic findings and positive rapid urease test (RUT). The presence of Hp organisms in stool was determined by an enzyme-linked immunosorbent assay using a commercially available polyclonal antibody kit (Meridian Diagnostics, Cincinnati, OH, U.S.A.). Results of the stool antigen test were compared with histology findings and RUT results. RESULTS: One hundred twenty-one children (mean age, 10.1 +/- 3.7 years) participated, of whom 9 (7.4%) had Hp infection. Histologic findings and RUT results were concordant in 95% of the children. Per study protocol, HpSA had a sensitivity, specificity, positive and negative predictive value, and accuracy rate of 67%, 99%, 86%, 97%, and 96.5%, respectively. CONCLUSION: HpSA, a polyclonal antibody test, had a low sensitivity for infection in children in the United States and at present cannot replace histologic findings as the gold standard for the diagnosis of Hp infection in the pediatric population.     

Comparison of invasive and non-invasive tests diagnosis and monitoring of Helicobacter pylori infection in children

BACKGROUND: There are few reports which the tests used for diagnosing Helicobacter pylori infection and monitoring its eradication in children. STUDY AIMS: Prospective evaluation of invasive (gastric histology, rapid urease test [RUT]) and non-invasive (stool antigen [FemtoLab H. pylori], urea breath test [UBT]) tests in the diagnosis of H. pylori infection and post-treatment eradication in children and adolescents. METHODS: Ninety-two patients (50 male, 42 female) referred for upper gastrointestinal endoscopy were prospectively enrolled. UBT was performed and stool specimens collected for monoclonal enzyme immunoassay for H. pylori antigen (FemtoLab) 1 to 4 days before endoscopy. H. pylori in gastric biopsies was evaluated by RUT and staining with hematoxylin-eosin and giemsa. Eradication therapy was given to children with abdominal pain and H. pylori gastritis. FemtoLab H. pylori and UBT were repeated 6 weeks after the end of triple therapy. RESULTS: Histology identified H. pylori in 49 of 92 (53%) subjects. Concordance between histology and RUT was found in 78 of 92 children. FemtoLab H. pylori was positive in 41 of 78 (52.6%) children with sensitivity, specificity, positive and negative predictive values of 97.5%, 94.7%, 95.1% and 97.3%, respectively. For UBT, these values were 100%, 96.9%, 97.5% and 100%, respectively. Twenty-six of 36 patients who received triple therapy returned for eradication evaluation. Tests for H. pylori antigen in stool were positive in 10 of 26 and for UBT in 11 of 26. CONCLUSION: Stool antigen (FemtoLab) and UBT were equally effective in diagnosing and confirming eradication of H. pylori infection in children.     

Evaluation of invasive and non-invasive diagnostic modalities for Helicobacter pylori infection in children

Invasive and non invasive tests for Helicobacter pylori performed on 31 children were evaluated as diagnostic modalities. Investigations included upper gastrointestinal endoscopy and endoscopic grasp biopsy (EGB) from antrum and corpus (for rapid urease test, impression smear, histology and culture), antral brushings, serum ELISA for IgG antibodies, rapid blood test, and IgG antibodies in unstimulated saliva. Our results suggested that amongst the invasive methods brush cytology was more sensitive than histology and impression smear. Best interpretation of urease test was possible at 4 hours incubation. Culture of EGB sample constitutes the most specific way to establish the diagnosis of infection but is not easy. Hence, non-invasive modalities like serum ELISA, rapid blood test and salivary ELISA can be used in children for the detection of H pylori infection.