作者：王小群，王春飞，方素芬

单位：中山大学附属第七医院 消化医学中心， 广东 深圳 518000

Authors: Wang Xiaoqun, Wang Chunfei, Fang Sufen

Unit: Center of Digestive Disease, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518000, Guangdong, China

摘要：

目的 通过比较幽门螺杆菌(Hp)感染的多种检测方法探讨其在诊断Hp感染中的价值及临床意义。方法 142例胃病患者先行13C-尿素呼气试验(13C-UBT)，再行胃镜检查及快速尿素酶试验(RUT)，同时活检标本送病理进行聚合酶链反应(PCR)检测及免疫组织化学(IHC)检测。以IHC为金标准，对于RUT、13C-UBT和PCR方法的敏感度、特异度、准确度等方面进行分析比较。结果 RUT的敏感度、特异度、准确度分别是93.5%、63.3%、77.4%,13C-UBT的敏感度、特异度、准确度分别是91.1%、90.5%、92.3%,PCR的敏感度、特异度、准确度分别是88.7%、94.3%、91.1%。PCR诊断Hp感染的特异度最高，敏感度与准确度均稍低于13C-UBT。RUT的敏感度最高，但是特异度及准确度均明显低于13C-UBT及PCR。结论 13C-UBT与PCR诊断Hp的敏感度、特异度及准确度均较高。13C-UBT为无创操作，是判断Hp是否根除的首选，适应于所有年龄和类型的受检者，可在短期内反复应用，而且可以对全胃的感染状况进行观察。但13C-UBT无法对Hp的分子毒力进行分型与评估，无法进行耐药相关检测，并受近期服用过抗生素、质子泵抑制剂及铋剂等黏膜保护剂的影响。因此，对于行胃镜检测的患者，PCR检测的敏感度、特异度及准确度更优，且可以对于克拉霉素、左氧氟沙星耐药突变基因型进行检测，对抗生素的选择有重要指导意义。 

关键词：幽门螺杆菌； 快速尿素酶试验； 13C-尿素呼气试验； 聚合酶链反应

Abstract：

Objective By comparing various examination methods of Helicobacter pylori (Hp) infection to explore their value in the diagnosis of Helicobacter pylori infection. Method 142 patients with gastric diseases were detected by 13C-urea breath test (13C-UBT), followed by endoscopic biopsy for rapid urease test (RUT) and sent to pathology department for polymerase chain reaction (PCR) and immunohistochemical (IHC) detection. IHC was used as the gold standard to compare the sensitivity, specificity and accuracy of RUT, 13C -UBT and PCR. Result The sensitivity, specificity and accuracy of RUT were 93.5%, 63.3% and 77.4%, respectively. The sensitivity, specificity and accuracy of 13C-UBT were 91.1%, 90.5% and 92.3%, respectively. The sensitivity, specificity and accuracy of PCR were 88.7%, 94.3% and 91.1%, respectively. PCR had the highest specificity in the diagnosis of Hp, though its sensitivity and accuracy were slightly lower than 13C-UBT. RUT had the highest sensitivity, but its specificity and accuracy were significantly lower than 13C-UBT and molecular PCR. Conclusion 13C-UBT and PCR have higher sensitivity, specificity and accuracy in the diagnosis of Hp. 13C-UBT is a non-invasive operation, which is preferred for the judgment after the eradication of Hp. It is suitable for all ages and types of subjects, and can be repeatedly applied in a short period of time and used to observe the infection status of the whole stomach. However, it could not type the molecular virulence of Hp, could not effectively evaluate its virulence factors, and could not conduct drug-resistance related detection, and was affected by the recent use of antibiotics, PPI, bismuth and other mucosal protective agents. Therefore, in patients requiring gastroscopy, PCR had the better sensitivity, specificity and accuracy. Moreover, PCR can be used to detect clarithromycin and levofloxacin resistant mutant genotypes, which has important guiding significance for the selection of antibiotics.

Key Words:  Helicobacter pylori; Rapid urease test; 13C -urea breath test; Immunohistochemical; Polymerase chain reaction