幽门螺杆菌粪便抗原检测在幽门螺杆菌感染诊断及随访中的价值

目的 对幽门螺杆菌粪便抗原（HpSA）检测诊断hp感染、hp根除治疗后的随访及在儿童中的应用价值，进行临床评价。方法 以快速尿素酶试验=、组织学和细菌培养中的二项阳性或细菌培养一项阳性作为诊断HP的金标准，采用ELISA法检测128例因上消化道症状接受胃镜检查患者HPSA，评价HPSA诊断HP感染的敏感性、特异性；其中79例同时进行^13C-UBT作为对照，评价HPSA诊断HP感染的准确性。结果 在128例中，HPSA检测的敏感性、特异性和准确性分别为95.16%，98.41%和96.80%。根除治疗前HPSA检测和^13C-UBT诊断HP的敏感性为97.96%和95.92%，特异性为96.67%和100.00%，准确性均为97.46%；根除治疗后4周随访HPSA检测和^13C-UBT的敏感性均为100.00%，特异性为91.43%和94.29%，准确性 93.18%和95.45%。以^13C-UBT作标准，HPSA检测29例患儿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检测是一种简便、准确、非侵入性的诊断HP感染的方法，适用于HP感染的诊断、根除治疗后随访及儿童患者。     

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。     

幽门螺杆菌根除治疗前后快速尿素酶试验诊断的准确性

目的 评价快速尿素酶试验(RUT)在根除治疗前后诊断幽门螺杆菌(Hp)感染的准确性。方法 选择250例接受胃镜检查的患者，123例无Hp根除治疗史，127例为Hp根除治疗后复查患者。每例患者取胃窦和胃体活检标本各3块，分别用于RUT、细菌培养和病理组织学检查。以细菌培养及病理组织学检查结果作为“金标准”，即培养和(或)组织学检查结果阳性者为Hp阳性，而培养和组织学检查结果同时阴性者为HP阴性或HP根除。结果 末行Hp根除治疗的患者RUT正确的诊断了86例Hp阳性中的84例和37例Hp阴性中的34例，其敏感性和特异性分别为97．7％和91.9％。根除治疗后RUT敏感性和特异性分别为64.3％和99.0％。然而，根除治疗后6个月以上复查胃镜，RUT敏感性和特异性均达100％。结论 根除治疗前和根除治疗后6个月以上复查，RUT诊断Hp感染准确性高。     

老年人幽门螺杆菌粪便抗原检测的价值

目的 评价一种新的酶联免疫法检测老年人粪便中幽门螺杆菌（helicobacter pylori,Hp）特异抗原的可靠性和临床应用价值。方法 因上消化道症状行胃镜检查的老年患者共199例，其中既往无胃手术史者151例，胃大部切除术后者48例。均行胃粘膜活检，作快速尿素酶试验（RUT）和组织学检查（W－S染色），以RUT和W－S染色为金标准，两项均阳性（或阴性）诊断为Hp阳性（或阴性）。所有患者均检查幽门螺杆菌粪便抗原（HpSA）和^13C－尿素呼气试验（^13C-UBT），分别与金标准比较，计算其敏感性和特异性。结果 经金标准诊断，无胃手术史患者中Hp阳性81例，阴性70例。HpSA检测的敏感性和特异性分别为96.3%和90.0%，^13C-UBT为92.6%和92.9%，两种方法的敏感性和特异性差异无显著性。胃大部切除术后患者中Hp阳性23例，阴性25例，HpSA检测的敏感性和特异性分别为91.3%和88.0%，^13C-UBT为65.2%和92.0%，两种方法敏感性差异有显著性（P＜0.05）。结论 HpSA在诊断老年人Hp感染方面准确、快速、简便，值得推广。对于胃大部切除术后的老年患者，其诊断Hp的敏感性明显优于^13C-UBT。     

胃大部切除术后患者幽门螺杆菌感染诊断方法的评估

目的：评估胃大部切除术后患者中幽门螺杆菌(Hp）感染状态和两种常用诊断方法（^14C-尿素呼气试验、快速尿素酶试验）的准确性，方法：用培养、组织学、^14C-尿素呼气试验（^14C-UBT)和 快速尿素酶试验（RUT）四种方法同时对胃大部切除术后患者进行Hp感染的诊断，以培养和组织学联合诊断作为“金标准”，评估^14C-UBT和RUT的准确性，以非手术者作对照，评估胃大部切除术患者的Hp感染率。结果：37例胃大部切除术后患者（Billroth Ⅰ或17例和BillrothⅡ式20例）的Hp总阳性率为29．7％，BillrothⅠ式（29．4％）和Ⅱ式（30．0％）患者间Hp阳性率差异无显著性（P＞0．05）。RUT敏感性为72．7％，特异性为57．7％，准确性为62．2％，^14C-UBT敏感性为63．6％，特异性为100．0％，阴性预示值86．7％，。对照组Hp阳性率为71．4％。结论：胃大部切除术后患者Hp感染率低，RUT特异性低，^14C-UBT敏感性低，因此均不适用于胃大部切除术后患者Hp感染的诊断。     

^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。     

两种13C-尿素呼气试验试剂诊断幽门螺杆菌感染临床可靠性比较

^13C-尿素呼气试验快捷、无创伤，敏感性和特异性高。在临床上被广泛应用于幽门螺杆菌(H.pylori)感染的检测。从加拿大进口的^13C-尿素试剂已获得国家食品药品监督管理局许可并应用于临床。目的：与加拿大进口的^13C-尿素试剂进行比较，评估美国Isotec公司生产的^13C-尿素试剂用于诊断H.pylori感染的临床可靠性。方法：114例因上消化道症状接受胃镜检查者随机分为A、B两组。取胃窦活检标本分别作快速尿素酶试验、组织学检查和H．pylori培养．三项中有两项或以上阳性，或H．pylori培养单项阳性判为H．pylori感染，否则判为无H．pylori感染。以此作为诊断H．pylori感染的金标准。A组使用加拿大进口的^13C尿-素试剂，B组使用美国Isotec公司生产的^13C-尿素试剂，分别进行^13C-尿素呼气试验。根据金标准分别计算和比较两组^13C-尿素呼气试验的准确性、敏感性、特异性和阳性预测值、阴性预测值。结果：A组^13C-尿素呼气试验诊断H．pylori感染的准确性为92．8％，敏感性为94．1％，特异性为90．9％，阳性预测值为94．1％，阴性预测值为90．9％；B组准确性为98．3％。敏感性为96．9％，特异性为100％，阳性预测值为100％，阴性预测值为96.3％。两组上述各项指标均无显著差异。结论：A组和B组^13C-尿素呼气试验诊断H．pylori感染的准确性、敏感性、特异性和阳性预测值、阴性预测值均较高．美国Isotec公司生产的^13C-尿素试剂用于临床诊断H．pylori感染结果可靠。     

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。     

微剂量^14HC-尿素呼气试验诊断幽门螺杆菌感染

本研究旨在评价微剂量(37kBq)^14C-尿素呼气试验(^14C-UBT)对幽仃螺扦菌(Hn感染的诊断教果。106例病人清晨空腹饮下37kBq^14C-尿素水溶液，海胺溶液吸收20分钟呼气CO2；2mm01．液闪仪测定^14C放射性活性．结果以dpm／mmolCO：表达。19例志愿第二日重复试验。以Warthin-Starry组织染色和快速尿素酶试验作为参照标准，ROC分析法确定^14C-UBT最适判别值。结果得出^14C-UBT最适判别值为250dpm／mmol CO2；实验对HP感染诊断的敏感性、特异性和准确性分别为98.3%(58／50)、98．7%(46/47)、和98．7%(104／106)；实验重复性良好；体重校正对诊断效果无影响。研究结果提示散剂量^14C-UBT诊断HP感染具有高度的准确性，且简单和安全；试验无需试餐和加用非标记尿素，结果不需以体重校正。     

残胃对^14C-尿素呼气试验影响的研究

目的：评估用^14C-尿素呼气试验(^14C-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，作快逮尿素酶试验和常规病理切片5张，Giemsa染色镜检HP)定性．再用^14C-UBT检刊HP．用X^2检验两组结果的准确性．结果一用全标准检测的残胃和对用组的阴性病人(分别为20例和14例)再用^14C-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^14C-UBT检测各出现一例假胡性。两种方法检测的准确性无显性差别，X^2=0.315．P>O．5。结论，残胃对用^14C-UBT检HP的准确性无影响。     

Helicobacter pylori

PURPOSE OF REVIEW: Helicobacter pylori is an important human pathogen, responsible for most peptic ulcer disease, gastritis and gastric malignancies. H. pylori has several unique features: it is highly adapted for gastric colonization, yet it produces clinical consequences in a small minority, its genome is known, and it is the only bacterium strongly associated with cancer. H. pylori is therefore of great interest to clinicians and researchers of many, often disparate, disciplines. We highlight recent advances in this fast changing field from many different areas. RECENT FINDINGS: The major contentious clinical issues relate to the synergistic gastrotoxic interactions of H. pylori with non-steroidal anti-inflammatory drugs, and a possible association of H. pylori with atherosclerotic events. Accumulating evidence implicates genetic variation in the inflammatory response to H. pylori in the etiology of the increased risk of gastric cancer after H. pylori infection. Studies of pathogenesis have been aided by increasingly sophisticated murine models. The effects in gastric epithelial cells of two of the major virulence factors (genes within the cag pathogenicity island and the vacuolating cytotoxin, VacA) of H. pylori illustrate the complex network of cellular reactions activated by H. pylori. The metabolism of H. pylori is dependent on the availability of hydrogen. SUMMARY: Basic science research into H. pylori continues to elucidate the mechanisms by which H. pylori infection causes disease. These findings have implications for the design of novel therapies and for improving clinical strategies to identify at-risk individuals. Many are also worthy of consideration for other epithelial-microbial interactions.     

Helicobacter pylori

The diagnostics and treatment of Helicobacter pylori infections have substantially changed in recent years. Instead of a general test-and-treat strategy, differentiated treatment methods are increasingly being used. Practical problems in many cases were that a useful combination was often not employed after the failure of an initial antibiotic treatment. In 2009 new guidelines on the diagnostics and treatment of Helicobacter pylori infections were published. Various expert groups from gastro-enterology, microbiology and rheumatology provided new general frameworks and concrete treatment suggestions for Helicobacter pylori infections of the stomach. The statements are grouped according to ?should“ and ?can“ recommendations and the consensus opinion is divided into various subgroups. The new S3 guidelines specify the therapy indications with respect to first and second line procedures and now give different durations of therapy (7 days for first line, 10 days for second line after treatment failure) as well as concrete algorithms. Before treatment two positive diagnostic procedures are required because the prevalence in Germany is decreasing. In addition to the rapid test and histological investigations, the 13-C breath test and stool tests with excellent sensitivity and specificity are also now available. Probiotics can improve therapy success especially for long-term antibiotic regimes and in the future bismuth could again play an increasingly more important role because antibiotic resistance to metronidazol and clarithromycin is increasing.     

Helicobacter pylori

Helicobacter pylori is associated with various gastroduodenal diseases such as peptic ulcer, functional dyspepsia, MALT lymphoma and distal gastric cancer. Diagnosis of H. pylori can be established by non-invasive (^13Curea breath test, stool antigen test, serology) and invasive (histology, rapid urease test, culture) tests. In adults, culture and susceptibility testing should or must be performed after failing of first-line therapy in case of a control endoscopy and before third-line therapy, respectively. Peptic ulcer and gastric MALT lymphoma represent obligatory indications for eradication therapy. Other potential indications are functional dyspepsia, prevention of gastric cancer in individuals being at risk, and before starting treatment with traditional non-steroid antiphlogistics. First-line therapy is performed with a 7-days combination of proton pump inhibitor with clarithromycin and amoxicillin or metronidazole. In second-line therapy levofloxacin and rifabutin are good rescue antibiotics.     

Diagnosis of Helicobacter pylori infection and diseases associated with Helicobacter pylori by Helicobacter pylori outer membrane proteins

sAIM: To examine the serological response of patients with upper gastrointestinal diseases and Helicobocter pylon (Hpy/on)infection to two Hpyloriouter membrane proteins (OMPs) (Mr18 000 and Mr26 000) acquired by gene recombinant technique, and to determine the diagnostic significance of serological tests derived from these OMPs.METHODS: Recombinant vectors encoding the two Hpylori OMPs were used to transform and express in BL21 (DE3) E.coli After purification with NP-NTA agarose resin, colloid gold kits were prepared with purified recombinant proteins to detect H pyloH infection and H pylori-associated diseases by the immunity-marker technology. We selected 150 patients with Hpy/on‘infection and digestive symptoms wibhout previous treabnent, including chronic gastritis (n = 60), duodenal ulcer (n = 30), gastric ulcer (n = 30), and gastric cancer (n=30).As controls, 33 Hpylori-negative healthy volunteers were also recruited. Serum samples were collected from all subjects, and the antibodies to specific proteins of Hpylori were tested with the colloid gold test kits. The sensitivity,specificity and accuracy of the colloid gold tests were evaluated, by using the combination of standard diagnostic methods (^13C urea breath test and bacteria culture) and classic enzyme-linked immunosorbent assay (ELISA) as reference.RESULTS: After purification with Ni^2+-NTA agarose resin,the purity of recombinant fusion proteins was about 95%.The recombinant fusion proteins were recognized by the specific monodonal antibodies against bhe two Hpy/oriOMPs,as demonstrated by the ELISA. Of the 150 serum samples from patients infected with Hpy/oH 141 (94.0%) responded positively to the recombinant protein with Mr26 000, while the seropositive rates were 95.0%, 96.7%, 96.7% and 90.0% for patients with H pylori-associated chronic gastritis,duodenal ulcer, gastric ulcer, and gastric cancer respectively.The sensitivity, specificity, and accuracy of the colloid gold kit with Mr26 000 protein were 94.0%, 97.0%, and 94.5%,respe.ctively. Compared with the classic ELISA, bacteria culture and ^13C urea breath test results in detecting Hpyloriinfection, there was no significant difference (P>O.O5). For the colloid gold kit with Mr18 000, the seropositive rates were 52.0%, 40.0%, 40.0%, 53.3% and 86.7%, respectively,in Hpylori-infected palJents, and bhose wibh Hpylori-associated chronic gastritis, duodenal ulcer, gastric ulcer, and gastric cancer. There was a significant difference (P<0.05) in seropositivity between patient with gastric cancer (86.7%) and those with other diseases (43.3%).CONCLUSION: The two colloid gold kits derived from the recombinant OMPs are useful tools either for detecting Hpyloriinfection, or for, predicting Hpylori-associated gastric malignancy.     

Usefulness of the Helicobacter pylori stool antigen test for detection Helicobacter pylori infection

Several diagnostic tests are available for evaluating Helicobacter pylori (H. pylori) infection: histological examination, culture of gastric biopsy specimens, rapid urease test, urea breath test and serology. In this study, we assessed the reliability of a newly developed enzyme immunoassay HpSA (H. pylori Stool Antigen) kit for detecting H. pylori antigen in stool. Eighty-five patients (50 males, 35 females; mean age 41.6 +/- 9.8 years) with dyspeptic symptoms who were examined by upper gastrointestinal endoscopy. The patients with a history of previous treatment with proton pump inhibitors, bismuth compounds or antibiotics were excluded. During the endoscopic examination biopsies were taken from antrum and corpus for rapid urease test and histological examination. Stool specimens were submitted to the laboratory and HpSA test was performed. H. pylori was considered in condition with rapid urease test and histopathological examination for H. pylori positive. Forty-six of 85 patients were positive and remaining 39 patients were negative for H. pylori with the rapid urease test and pathologic evaluation. When 0.160 was adopted as the cut-off value, in accordance with the manufacturer's recommendations; stool antigen has been detected in 45 of the 46 H. pylori positive patients. The sensitivity and specificity of HpSA test were 97.8%, 94.9% respectively. These results indicate that HpSA is a highly reliable diagnostic method for H. pylori infection.