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。

To evaluate the usefulness of detecting Helicobacter pylori stool antigen in the elderly

Objective To assess the reliability of a newly developed enzyme immunoassay for Helicobacter pylori-specific antigen detection in the old patients' stools. Methods The 199 old patients referred to our department for upper gastrointestinal endoscopy were included. Among which, 48 patients suffered from subtotal gastrectomy previously, and 151 patients never had any gastric surgery. All patients underwent gastroscopy with biopsies for rapid urease test (RUT) and histology (Warthin-Starry stain). Used RUT and Warthin-Starry stain as gold standard, Helicobacter pylori (H. pylori) status was defined positive (or negative) if both RUT and Warthin-Starry stain were positive (or negative). A stool specimen was collected for each patient and tested by using a novel enzyme immunoassay for H. pylori detection (HpSA). Every patient was also detected by 13 C-urease breath test ( 13C-UBT). Sensitivity and specificity of these two tests were calculated respectively. Results H. pylori ststus was positive in 81 patients and negative in 70 patients of 151 patients. The sensitivity and specificity of HpSA were 96.3% and 90.0%, and 13 C-UBT were 92.6% and 92.9% respectively; H. pylori infection was confirmed in 23 of 48 patients with gastric surgery, the sensitivity of HpSA test for the diagnosis of H. pylori infection was 91.3% and its specificity 88.0%, and 13 C-UBT were 65.2% and 92.0% respectively, the sensitivity of 13 C-UBT was lower than HpSA in the patients with a history of gastric surgery (P<0.05). Conclusions The HpSA assay is a noninvasive, reliable, rapid, and easy-to-use tool for evaluating H. pylori status in the elderly. When HpSA is employed in patients with subtotal gastrectomy, its sensitivity seems to be more precise than 13 C-UBT.