幽门螺杆菌感染的诊断--13C-尿素呼气试验

应用13C-尿素呼气试验诊断幽门螺杆菌已经十余年,临床实践证明该试验是一种快速、准确、无痛苦的检测方法,本文就13G尿素呼气试验的原理、适应症、与其他几种检测方法的比较及影响因素作一综述.     

~(13)C-尿素呼气试验诊断幽门螺杆菌感染的研究

本研究旨在评估~(13)C,尿素呼气试验检测幽门螺杆菌感染的可靠性。方法:我们在82例因胃病而行胃镜检查的患者胃窦和胃体取多个活检标本,作组织学、牯膜涂片和快速尿素酶试验,以决定是否感染幽门螺杆菌,并作~(13)C-尿素呼气试验。~(13)C-尿素呼气试验的敏感性、特异性、阳性预测值、阴性预测值是与组织学和尿素酶方法检测幽门螺杆菌的结果比较而计算得到。结果:~(13)C-尿素呼气试验的敏感性97.92％,特异性100％,阳性预测值100％,阴性预测值97.14％,准确性98.78％。结论:~(13)C-尿素呼气试验有高度敏感性和特异性,对确定患者的幽门螺杆菌感染状态是一可靠的无创伤的诊断方法。     

~(13)C-尿素呼气试验诊断幽门螺杆菌感染的临床意义

对 6 5例胃、十二指肠疾病患者和 36例健康人行 1 3 C-尿素呼气试验 (C- UBT)、病理组织学和快速尿素酶(RUT)三种方法检测幽门螺杆菌 (HP) ,其中任两项阳性者认为有 HP感染。结果显示 ,C- U BT、病理组织学和 RUT检测的阳性率分别为 81.5 4%、83.1%、84.6 2 % ;敏感性分别为 96 .2 3%、86 .8%、84.91% ;特异性分别为 10 0 %、91.6 7%、83.33%。认为 C- UBT和病理组织学是检测 HP感染较准确的方法 ,RU T的敏感性与特异性较前两种方法低 ,其操作方便 ,费用低 ,仍是临床常用的检测手段 ,但不能单独作为诊断 HP感染指标。病理组织学和 RU T均为侵入性检查 ,取材也受“灶性”分布的影响 ,而 C- UBT是非侵入性操作 ,更能反映“全胃”HP感染状况 ,临床应用时无任何禁忌和限制 ,如果仅为了检测 HP状态或抗 HP药物疗效监测 ,C- UBT可替代病理组织学及 RUT检查。     

13C-尿素呼气试验诊断胃幽门螺杆菌感染

1材料和方法 1.1材料受试者共98例,选自海军总医院1997-11/1999-04因出现各种消化系统症状而就诊的患者,记录患者一般资料,临床症状、体检结果和病史,年龄5岁～78岁,平均45岁,女26例,男72例13C-尿素(丰度大于99%,纯度大于99%)系协和医院江骥教授惠赠.     

13C-尿素呼气试验在蒙古沙鼠幽门螺杆菌感染检测中的应用

目的　应用13 C -尿素呼气试验检测蒙古沙鼠幽门螺杆菌感染 ,从而建立一长期监控小型试验动物幽门螺杆菌感染无创检测技术。方法　分别在蒙古沙鼠感染幽门螺杆菌后第 2 0 ,5 0 ,10 0及 2 0 0d用13 C -尿素呼气试验进行检测 ,并对检测后沙鼠以细菌分离培养、ELISA、PCR、快速尿素酶试验、病理切片等五种常规方法检测幽门螺杆菌。结果　在上述不同检测时期 ,用13 C -尿素呼气试验所得蒙古沙鼠幽门螺杆菌感染阳性率分别为 77 78% ,83 33% ,84 2 1%和 80 0 0 % ,而应用常规方法检测结果阳性率为 83 33% ,88 88% ,94 2 1%和 85 0 0 %。比较两组试验结果发现 ,13 C -尿素呼气试验比常规检测方法检出阳性率相对偏低 ,但统计学分析发现其具有一致性。结论　13 C -尿素呼气试验用于幽门螺杆菌感染蒙古沙鼠模型检测是一种可行的无创检测方法 ,可作为评价Hp感染的重要参考指标之一     

幽门螺杆菌感染的诊断——^13C—尿素呼气试验

应用^13C—尿素呼气试验诊断幽门螺杆菌已经十余年，临床实践征明该试验是一种快速、准确、无痛苦的检测方法，本就^13C-—尿素呼气试验的原理、适应症、与其他几种检到方法的比较及影响因素作一综述。     

^13C—尿素呼气试验诊断幽门螺杆菌感染的研究

目的评估13C-尿素呼气试验（13C-UBT）幽门螺杆菌（Hp）感染的可靠性。方法对82例因胃病而行胃镜检查的患者，于胃窦和胃体取多个活检标本作组织学、粘膜涂片和快速尿素酶试验，以决定是否感染Hp，并作13C-UBT。结果13C-UBT的敏感性、特异性、阳性预测值、阴性预测值是与组织学和尿素酶方法检测Hp的检测结果比较而计算得到。13C-尿素呼气试验的敏感性97．92％、特异性100％、阳性预测值100％、阴性预测值97．14％、准确性98．78％。结论13C-尿素呼气试验有高度敏感性和特异性，对确定患者的Hp感染状态是一非常可靠而又无创伤的诊断方法。     

14C-尿素呼气试验对幽门螺杆菌感染的诊断价值

目的：评估^14C-尿素呼气试验（^14C-UBT）对幽门螺杆菌（HP）感染的诊断价值。方法：对2000例1月内未曾使用可能影响HP检测结果的药物者同步完成快速尿酶试验（RUT）、病理、^14C-UBT检测，以病理（HE染色）、RUT均阳性为诊断HP感染的标准，评价^14C-UBT对HP感染的诊断价值。结果：^14C-UBT的敏感性89.7％，特异性98.4％，阳性预测值98.4％，准确性93.4％，阴性预测值88.1％。结论：^14C-UBT是HP感染无创伤、敏感而特异的诊断方法。     

13C—尿素呼气试验诊断幽门螺杆菌感染的临床意义

对６５例胃、十二脂肠疾病患者和３６例健康人行１３Ｃ－尿素呼气试验（Ｃ－ＵＢＴ）、病理组织学和快速尿素酶（ＲＵＴ）三种方法检测幽门螺杆菌（ＨＰ）,其中任两项阳性者认为有ＨＰ感染。结果显示,Ｃ－ＣＢＴ、病理组织学和ＲＵＴ检测的阳性率分别为８１．５４％、８３．１％、８４．６２％;敏感性分别为９６．２３％、８６．８％、８４．９１％;特异性分别为１００％、９１．６７％、８３．３３％。认为Ｃ－ＵＢＴ和病理组织     

^14C-尿素呼气试验检测幽门螺杆菌感染的应用体会

目前诊断幽门螺杆菌(HP)感染的方法较多,在非侵袭方法中尿素呼气试验具有敏感性和特异性高的特点,对确定患者的HP感染状态是一种非常可靠而又无创伤诊断方法。本文通过对临床上具有反复发作的上消化道症状而又不愿接受胃镜检查的患者.行~(14)C-尿素呼气试验(~(14)C-UBT),诊断HP感染。对HP阳性患者给予三联抗HP治疗,并观察临床症状缓解率及HP根除率。现将应用体会报告:     

幽门螺杆菌根除治疗前后组织学检查和13C-尿素呼气试验的准确性分析

背景：幽门螺杆菌（H．pylori）的研究已有20多年的历史，但关于根除治疗前后Hpylori感染与炎症的关系以及评价治疗效果时应用何种方法、在何部位取活检的研究不多，仍存在争议。目的：探讨并比较H．pytori感染根除治疗前后不同活检部位组织学检查和^13C-尿素呼气试验（UBT）检查的准确性。方法：受试者在根除治疗前后于胃窦、胃体和胃角处分别取黏膜活检标本各1块，以Giemsa染色、改良甲苯胺蓝染色和免疫组化法检测H．pytori感染情况。并对部分Hpytori感染的组织学检查和^13C-UBT进行评估。结果：治疗前胃窦、胃体、胃角Hpytori感染率分别为6113％、66．0％和59．6％。对4810例证实有H．pytori感染的患者在根除治疗后随访6周，有22．0％的病例有细菌残留，胃窦、胃体和胃角处Hpytori感染率分别为17．4％、17．3％和18．3％，各组间无显著性差异（P〉0．05）。Hpzlori感染者根除治疗前99．7％有活动性炎症，99．0％有慢性炎症。根除治疗后尽管有细菌残留，但炎症活动性减低。组织学检查H．pytor／感染的患者中，根除治疗前有78．3％^13C-UBT阳性：根除治疗后，仅有49．6％^13C-UBT阳性。结论：根除治疗前^13C-UBT和组织学检查结果的符合度较高，但对抗H．pytori治疗效果的评价，组织学检测优于^13C-UBT。     

红外能谱仪检测~(13)C-尿素呼气试验诊断幽门螺杆菌感染

目的：验证红外能谱仪检测１３Ｃ－尿素呼气试验（ＵＢＴ）诊断幽门螺杆菌（Ｈ．ｐｙｌｏｒｉ）感染的可靠性,并与气体质谱仪检测结果作一比较。方法：对７６例患者以红外能谱仪进行１３Ｃ－ＵＢＴ检测Ｈ． ｐｙｌｏｒｉ感染,Ｈ． ｐｙｌｏｒｉ感染状态由快速尿素酶试验、组织学检查以及细菌培养确定。其中１７例患者的呼气样本分别用红外能谱仪与气体质谱仪进行检测。结果：７６例患者中Ｈ． ｐｙｌｏｒｉ阳性者４３例（５６．６％）,红外能谱仪进行１３Ｃ－ＵＢＴ的测定结果为４１例（５３．９％）,其敏感性和特异性分别达到９３．０％和９７．０％。气体质谱仪与红外能谱仪的检测数值相差无几。结论：以红外能谱仪进行１３Ｃ－ＵＢＴ检测可靠、准确地诊断Ｈ．ｐｙｌｏｒｉ感染,并具有简单、实用的特点。红外能谱仪与气体质谱仪一样可被广泛应用于Ｈ．ｐｙｌｏｒｉ检测。     

Nondispersive Isotope-Selective Infrared Spectroscopy: A New Analytical Method for 13C-Urea Breath Tests

Background: Currently, stable isotope techniques in breath tests using ¹³C-labeled substrates are limited to a few centers equipped with expensive and complex isotope ratio mass spectrometry (IRMS). Although breath samples can be mailed to these centers, widespread application of ¹³C breath tests would be more feasible with a cheaper and more practicable analysis system at hand. Methods: We therefore tested the newly developed nondispersive isotope-selective infrared spectrometer (NDIRS) with reference to IRMS in a clinical setting comparing the results of both techniques in 538 consecutive ¹³C-urea breath tests performed for the detection of Helicobacter pylori infection. Results: With NDIRS five false-positive and three false-negative results were observed; that is, the sensitivity of NDIRS was 98.3%, and the specificity was 98.6%. The delta over base-line values of both devices correlated linearly (Y = 0.87 ± 0.01 X + 0.29 ± 0.15; r = 0.95; p < 0.0001; n = 538). Conclusions: When running this large number of breath tests in 3 days, the NDIRS proved to be a reliable, stable, and easy-to-operate analytical tool, which is well qualified for gastroenterologic application in the diagnostic routine. Both the price and the easy handling of NDIRS will facilitate the widespread use of the noninvasive stable isotope technique for ¹³C breath tests.     

商用血清学试剂盒诊断幽门螺杆菌现症感染的应用评估

背景：寻找操作简便的非侵人性检测方法对于幽门螺杆菌（H．pylori）现症感染的诊断非常重要。目的：评估应用胶体金免疫层析技术的商用血清学试剂盒在诊断H．pylori现症感染中的应用价值。方法：167名健康志愿者纳入本研究。采集血标本，以Assure H．pylori快速检测试剂盒行免疫层析。同时行^13C-尿素呼气试验（^13C-UBT）和内镜活检组织病理学检查，两项检查均阳性定义为H．pylori感染，两项检查均阴性定义为H．pylori阴性。结果：根据诊断标准．147例纳入统计分析者的H．pylori感染率为65．3％，Assure H．pylori快速检测的现症感染阳性率为68．7％．其诊断敏感性、特异性、阳性预测值、阴性预测值和准确性分别为96．9％、84．3％、92．1％、93．5％和92．5％。结论：Assure H．pylori快速检测是一种简单、快速、可靠的非侵人性H．pylori现症感染诊断方法，在流行病学调查中有很好的应用前景。     

幽门螺杆菌感染诊断方法的比较

338例病人同时进行了快速尿素酶试验(简称RUT)。Warthin-Starry染色(简称W-S染色)、培养法、~(13)C-尿素呼气试验(~(13)C-UBT)、血清IgG、IgM等6种诊断方法中任意3种检查,以同时2种(或以上)检查方法一致的结果作为诊断幽门螺杆菌(Hp)是否存在的标准。对上述6种方法的敏感性、特异性、符合率、阳性预测值、阴性预测值分别给予评价,结果显示:RUT、W-S染色、~(13)C-UBT三法诊断Hp的敏感性、特异性等较高,均接近或高于90％。     

No Evidence of an Association between Helicobacter pylori Infection and Raynaud Phenomenon

Background: Raynaud phenomenon (RP) is a vasospastic condition that manifests itself as cold-induced ischemic attacks of the fingers with skin color changes. It may be classified as primary (PRP) or secondary (SRP), if associated to other diseases, mainly connective-tissue diseases. Recently, the association between PRP and Helicobacter pylori infection has been reported. The aims of this study were to evaluate the prevalence of gastric H. pylori infection in a large group of patients affected by PRP and SRP and to assess whether it was more evident in patients with more recent onset of RP. Methods: Ninety-eight consecutive patients (93 F and 5 M), referring to our videocapillaroscopic service for the diagnosis of vascular and connective-tissue diseases, were evaluated. Forty-nine of them were affected by PRP and 49 by SRP. Patients were classified as having PRP on the basis of normal serological and immunological findings, normal videocapillaroscopic examination and exclusion of other conditions inducing RP. H. pylori infection was diagnosed by ¹³C-urea breath test (UBT). Two groups of 49 age-and sex-matched controls, respectively, were also evaluated. Results: Patients with SRP resulted significantly older than those with PRP (P &lt; 0.006). UBT was found positive in 22/49 patients with PRP (45%) and in 29/49 patients with SRP (59%). The positivity of the respective control groups was 36% and 53% (P = NS). There was no higher prevalence of H. pylori infection in patients with RP lasting for less than 4 years. Conclusions: The results do not confirm the previously reported high prevalence of H. pylori infection in patients with PRP. A high association was not even found between the presence of the microorganism and SRP. There was no difference in the prevalence of H. pylori infection among the subgroups with more recent onset of both PRP and SRP.     

Cost effectiveness analysis of population-based serology screening and ^13C-Urea breath test for Helicobacter pylori to prevent gastric cancer： A markov model

AIM：To compare the costs and effectiveness of no screening and no eradication therapy, the populationbased Helicobacter pylori （H pylori） serology screening with eradication therapy and 13C-Urea breath test （UBT） with eradication therapy.
METHODS：A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years （QALYs） gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses.
RESULTS：Compared to no screening, the incremental cost-effectiveness ratio （ICER） was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The costeffectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION：The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.     

13C-Urea Breath Test for Diagnosis of Helicobacter pylori Infection in the Elderly

Helicobacter pylori infection has a high prevalence in the elderly, but its characteristics and treatment in the geriatric population are not well defined. The aims of the study were to characterize geriatric patients according to referral patterns and results of the 13C-urea breath test (13C-UBT) and to investigate the results of treatment combinations for H. pylori eradiction. The 13C-UBT was performed with 75 mg urea labeled with 13C. Physicians who ordered the test completed a questionnaire covering demographic data, indication for the test, chronic use of a proton pump inhibitor, or nonsteroidal anti-inflammatory drug, and type of eradiction therapy. The study sample consisted of 2128 patients, aged 70-102 years, 958 (45%) men, referred for 13C-UBT. The test was positive on 697 (33%). History of peptic disease was the main indication for referral, following by validation of successful eradication, Israeli origin screening for gastric cancer, treatment with regimen containing metronidazole, history of peptic disease, and recurrence of symptoms were predictive factors for a positive 13C-UBT. Multivariate logistic regression analysis revealed a significant influence of eradication therapy on negative results. History of peptic disease and validation of successful eradication are the main indications for referral of the elderly for 13C-UBT. Our results are in accordance with the increase in metronidazole resistance of H. pylori stains and the cohort effect of H. pylori infection on the elderly Israeli-born population.     

Comparison of Diagnostic Methods for Helicobacter pylori Infection in Patients with Upper Gastrointestinal Bleeding

Background: Accuracy of the most frequently used tests for diagnosing Helicobacter pylori infection in patients with upper gastrointestinal bleeding of peptic origin is determined. Methods: Seventy-eight patients with endoscopically-proven upper gastrointestinal bleeding of peptic origin were included. The presence of H. pylori was considered when observed from the histology or, if negative, when serology and breath test were both positive. Accuracy of the rapid urease test was estimated in accordance with results obtained with other diagnostic methods. Results: Lesions causing gastrointestinal bleeding were 56 duodenal ulcers, 13 gastric ulcers, 7 pyloric channel ulcers, 13 acute lesions of the gastric mucosa and 16 erosive duodenitis. H. pylori infection was present in 68 patients (87.2%). Forty-four patients had received non-steroidal anti-inflammatory drugs. The sensitivity/specificity (%) of the diagnostic methods was 48.5/100 for the rapid urease test, 91/77.8 for the breath test, 89.5/80 for serology and 86.3/100 for histology. The prior consumption of proton-pump inhibitors and antibiotics induced false-negative results in the rapid urease test and breath test, with no effect on serology and histology. Conclusions: The prevalence of H. pylori infection in patients with upper gastrointestinal bleeding from peptic lesions is high. Sensitivity of the rapid urease test for diagnosing H. pylori is low in this setting. Cases with negative rapid urease test need the combination of two or more additional tests if diagnosis is to be achieved. Cases with positive rapid urease test do not need further investigation for diagnosis.