摘要
目的 应用胃镜检查及血清抗幽门螺杆菌抗体 (HP IgG)的检测结果对比13 C尿素呼吸试验 (13 C UBT) ,评价13 C UBT对儿童幽门螺杆菌 (HP)感染的诊断可靠性。方法 1997年 10月～ 1999年 12月我院消化门诊具有反复中上腹痛、脐周痛等上消化道症状的患儿 5 89例 ,年龄 4～ 14岁、平均9岁 ;其中 435例进行13 C UBT检查 ,检测当日早晨空腹口服一杯麦片饮食延缓胃排空 ,接着口服 5 0mg13 C 尿素试剂 ,于服药前及服药后半小时取气样 ,应用同位素比值质谱仪检测 ,以DOB表示。检查前停服抗生素 2周者 2 47例 ,停服 4周者 188例。 41例症状严重的患儿同时做胃镜 ,取胃窦粘膜行嗜银染色检查及快速尿素酶试验 ,两者均阳性者确定为HP感染。对比计算13 C UBT检测结果与胃镜检查的符合率、敏感性、特异性、阳性预测值、阴性预测值。同期有 30 0例患儿行血清HP IgG测定 ,其中146例测定了13 C UBT ,观察与HP IgG的符合率。结果 13 C UBT阳性率 2 7 5 8%,随年龄增长感染率上升 ,7岁以后上升明显 ,儿童期感染率剧增 ,符合发展中国家的类型。检查前停服抗生素 2周与 4周者阳性率分别为 2 7 12 %、2 8 19%。血清抗HP IgG阳性率 5 6 7%。胃镜检查阳性率 39%,阳性染色切片中HP菌数量较少。13 C UBT与胃镜检查的符合率为
Objective To evaluate the reliability of 13C-urea breath test ( 13C-UBT) in the diagnosis of Helicobacter Pylori (HP) infection in children by using gastroscopy and serum HP antibody study.Methods Totally 589 children with repeatedly occurred epigastric or periumbilical pain were studied from October 1997 to December 1999 in outpatients clinic of gastroenterology of our hospital.The patients′ ages ranged from 4 to 14 years, the average age was 9 years. Of the 589 patients, 435 were examined with 13C-UBT. After overnight fasting, in the morning each child received a cup of oat meal to delay gastric emptying and 50 mg of 13C-urea was administrated, and before and 30 minute after the dose, expired gases were collected for analysis with isotope ratio mess spectrometry. The result were expressed as DOB (Delta over baseline). Two hundred and forty-seven and 188 cases have stopped using antibiotics 2 and 4 weeks before examination, respectively. At the same time 41 of 435 cases with serious symptoms were examined with gastroscopy and antral biopsies were obtained for Warthin-Starry staining (W-S stain) and rapid urease test (RUT). Diagnosis of HP infection was made when both examinations were positive. The rate of consistency betwenn 13C-UBT and gastroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. At the same time HP-IgG antibody was examined in 300 of 589 cases, while 13C-UBT was performed in 146 of 300 cases. The consistency between 13C-UBT and serum HP-IgG antibody was also calculated. Results Positive results of 13C-UBT were seen in 27.58% of the patients, the rate of infection rose with increase of patients′ age, which was remarkable after 7 years of age. The rate of infection increased very fast during childhood. The patterns of infection were similar to that in the other developing countries. In patients who had not received antibiotics for 2 weeks and 4 weeks, the rates of HP infection were 27.12% and 28.17%, respectively. The positive rate of serum HP-IgG antibody was 56.7%. The HP like microorganism was seen in histologic study after gastroscopy in 39% of the cases. The consistency rate between gastroscopy and 13C-UBT was 90.24%. The sensitivity, specificity, PPV and NPV were 75%, 100%, 100%, and 86.2%, respectively. The rate of consistency between 13C-BUT and serum HP-IgG antibody were 63.1%. Conclusions 13C-UBT is a method with higher sensitivity and high specificity. As a noninvasive method, it is reliable for detection of HP infection in children. There was no significant difference in positive rate of 13C-UBT between inpatients without antibiotics use for 2 weeks and 4 weeks before examination.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2001年第12期743-745,共3页
Chinese Journal of Pediatrics
