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:,Email:xiexianhe_2006@yahoo.com.cn5何周桃,谢贤和,韦红,蓝程(,570311):通过对5种幽门螺旋杆菌(Hp)检测方法的比较,寻求敏感性及特异性高快速简便的Hp检测方法,促进Hp感染的早期诊断及治疗对最近1个月内未使用过抗生素质子泵抑制剂H2受体阻滞剂等可能影响Hp检测结果的95例患者同步完成快速尿素酶试验(RUT)细菌培养13C尿素呼气试验(13CUBT)血清学(幽门螺杆菌抗体HpIgG)检查Hp病理组织学检测等检查,以细菌培养病理组织学检测中任何1项阳性为Hp感染阳性为诊断标准,比较RUT细菌培养13CUBTHpIgG检查Hp病理组织学检测5种检测方法检出的敏感度及特异度敏感度以RUT最高(95.7%),其次为病理组织学(87.5%)细菌培养(82.9%)13CUBT(78.1%),最低为HpIgG(43.9%)特异度由高及低依次为细菌培养(96.3%)13CUBT(91.4%)病理组织学(89.7%)HpIgG(70.4%)RUT(65.7%)RUT检测13CUBT病理组织学检测细菌培养的敏感度与HpIgG检测的敏感度比较差异有统计学意义(P0.01),而RUT病理组织学细菌培养13CUBT检测的敏感度4者间差异无统计学意义(P0.05)RUT检测的特异度与13CUBT检测病理组织学检测细菌培养的特异度比较差异有统计学意义(P0.01),13CUBT检测的特异度与HpIgG检测的特异度相比差异有统计学意义(P0.01),而病理组织学细菌培养13CUBT检测的特异度组间差异无统计学意义(P0.05)13CUBT检测的敏感度及特异度均较高,更能反映Hp感染的变化状况,可作为临床诊断Hp的首选方法:螺杆菌,幽门;诊断技术和方法;敏感性与特异性:R573.9:A:1004583X(2011)07057007ComparisonoffivemethodsforHelicobacterpylorusdetectionHEZhoutao,XIEXianhe,WEIHong,LANGChengDepartmentofDigestion,HainanProvincialPeoplesHospital,Haikou570311,ChinaCorrespondingauthor:XIEXianhe,Email:xiexianhe_2006@yahoo.com.cnABSTRACT:ObjectiveWiththecomparisonoffivemethodsforHelicobacterpylorus(Hp)detection,tryingtoseekhigh,fastandsimplewaysintestingthesensitivityandspecificity,thustoimprovetheearlydiagnosisandtreatment.MethodsThecomparisonwasmadewith95patientswhowithinonemonthhadneverappliedantibiotics,protonpumpinhibitors,H2receptorblockersreceptorwhichmightaffecttheresultsofHpdetection.Thesepatientsfinishedsimultaneouslythedetectionofrapidureasetest,bacteriaculture,13Cureasebreathtest,HpIgGantibodytest(HpIgG),histopathologyexamination.AnypositiveresulteitherfrombacteriacultureorhistopathologyexaminationwouldbetakenasthecriteriainthediagnosisofHpinfection.Thecomparisondatainthesensitivityandspecificityfromthefivedetectingmethodswereevaluated.ResultsThehighestsensitivitywasrapidureasetest95.7%,histopathologyexaminationwasrankedthesecond87.5%,bacteriaculturewas82.9%,13Cureasebreathtestwas78.1%,thelowestwasHpIgGantibodytest43.9%.Thecomparisonresultofspecificityfromhightolowwasasfollows:bacteriaculture96.3%,13Cureasebreath91.4%,histopathologyexamination89.7%,HpIgGantibodytest70.4%,rapidureasetest65.7%.Thesensitivityofrapidureasetest,13Cureasebreathtest,histologyexamination,bacteriacultureweresignificantlydifferentfromthatofHpIgGantibodytest(P0.01),whilethesensitivitiesinrapidureasetest,histopathologyexamination,bacteriaculture,13Cureasebreathtestwerenosignificantdifference(P0.05).Thespecificityofrapidureasetestwassignificantlydifferentfromthatof13Cureasebreathtest,histopathologyexamination,bacteriaculture(P0.01).Thespecificityof13CureasebreathtestwasalsodifferentfromthatofHpIgGantibodytest(P0.01),whilethespecificitiesofthehistopathologyexamination,bacteriaculture,13Cureasebreathtestshowednosignificantdifference(P0.05).ConclusionThesensitivityandspecificityof13Cureasebreathtestarerelativelyhigher,whichshowsclearlythechangingstatusofHpinfection,and13CureasebreathtesthasbeenregardedasthepriorapproachofclinicaldiagnosisforHpinfection.KEYWORDS:Helicobacterpylorus;diagnostictechniquesandprocedures;sensitivityandspecificity570201145267ClinicalFocus,April5,2011,Vol26,No.71982WarrenMarshall(Helicobacterpylori,Hp),Hp,2005/Hp,1994(WHO),2006(NCCN)Hp(MALT)Hp,(RUT)Hp,(PCR),13C14C(UreaBreathingTest,UBT)HpHpHpRUT13C(13CUBT)HpIgGHp5,Hp,Hp11.120097~91H2Hp95,65,30,24~79,(54.01.6)RUT13CUBT(HpIgG)Hp47,19,9,9,3,1,2,51.21.2.1,2~3cml,10%,37(5%O2,15%CO2,85%N2),4~5,Hp1.2.211~3,HpPYLORITEST1.2.314%,,,4m,;1%5~8(:1g100ml,2ml,602,);;95%;,),1.2.4(ELISA)HpIgG,,1.2.513C,,1,4~5,,080~100ml13C1,,13C30,030,13CO2(,HGIRIS20013C)Hp:1Hp1.3V1.612V1.61PP0.0522.155,95Hp40,55,42.1%5Hp,115Hp()+-+-(%)RUT4424623264948.413CUBT329413515443.2HpIgG18234116385443.2355404515542.1347412525443.2571201145267ClinicalFocus,April5,2011,Vol26,No.72.2595,RUT,13CUBT,HpIgG13CUBTHpIgGRUTRUTHpIgG(P0.01),13CUBTHpIgG(P0.01),HpIgG(P0.01),HpIgG(P0.01),RUT13CUBT(P0.05)RUT13CUBT(P0.01),RUT(P0.01),RUT(P0.01),13CUBTHpIgG(P0.01),13CUBT(P0.05),2~425Hp()(%)(%)RUT444695.7234953.113CUBT324178.135494.4HpIgG185143.9165470.4354087.545592.7344182.925496.33HpIgG4HpHpIgG2PRUT28.3230.0113CUBT10.0540.0117.0120.0113.4600.014RUT4HpRUT2P13CUBT23.3110.01HpIgG21.2120.0126.1340.0110.7920.012.3Hp95,Hp,31.9%(15/47),73.7%(14/19),66.7%(6/9),11.1%(1/9),40.0%(2/5),33.3%(1/3),50.0%(1/2),1~4Hp,53,Hp,Hp,[1]Hp,CagA+VacA+Hp[2]40Hp(P0.05),Hp11.1%[3]143HpHpIgG,42.57%,69.05%,HpHpIgG,Hp,Hp,Hp,Hp,,[4][5]Hp[6]Hp(ITP),ITP[7]34ITPHp58.8%,Hp55.0%,HpHpITPAppelmelk[8]80%HpBLewisy,Hp,,,B12,Annibale[9],18%Hp[10]Hp,Hp[11]Hp(88.2%)(51.2%)(P0.01),()(46.7%)(11.1%),(P0.01)Hp572201145267ClinicalFocus,April5,2011,Vol26,No.7[1213][14]5037HpIgG,74.0%,11/50(22.0%)(P0.01),Hp4002,Hp78.7%,46.7%,46.3%,[15],HpHp,,,Hp[1617],,Hp,,;,Hp,HpHp,,,,[18]HpHp,,,,,,,,3Hp100%[19]13CUBTHp,Hp,CO2,,CO2,Hp,13CUBT,13CUBTHp,,13C,,HpHpHp[20][21]90613CUBT,Hp548,385,42.5%[22]50HpHp,HpCagA48(96%),13CUBT8(16%),13CUBTHp13CUBT13C,13CUBTHpRUT,,Hp[23],Hp,Hp[24]:,pH2.5~6.5HppH,HppHpH4.0~5.5,HppH,[25],pHRUTHp400Hp[26],RUT,RUT[26],RUT,,13CUBT,RUTHp,Hp,,[27]Hp,13CUBT
本文标题:幽门螺旋杆菌5种检测方法比较
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