^(13)C-尿素呼气试验对幽门螺杆菌密度及胃黏膜炎症的判断价值

The diagnostic value of ^(13) C urea breath test in Helicobacter pylori colonization density and the severity of gastritis

目的 探讨１３Ｃ尿素呼气试验（ＵＢＴ） 对幽门螺杆菌（Ｈｐ） 感染密度及胃黏膜炎症程度的判断价值。方法 以病理组织学为对照，分析ＵＢＴ对Ｈｐ 诊断的准确性并比较不同细菌感染密度以及不同炎症细胞浸润程度时ＵＢＴ结果（ＤＯＢ值） 的差异。结果 ＵＢＴ对Ｈｐ 诊断的敏感性为９３．２％ ，特异性为８９．１ ％ 。Ｈｐ 感染密度重度组的ＤＯＢ值显著高于轻中度组（Ｐ＜０ ．０５） ，ＷＳ染色分级与ＤＯＢ值之间具有弱相关性（ｒｓ＝０ ．５９９ ０ ， Ｐ＜ ０．０００ １，ｎ ＝ １３７）。Ｈｐ 阳性的病例中，不同程度慢性胃炎组、不同程度活动性胃炎组之间的ＤＯＢ值差异无显著性。黏膜炎症程度的分级与ＤＯＢ值无相关性。结论 ＵＢＴ对Ｈｐ 诊断具有高度敏感性和特异性，其结果显示ＤＯＢ值虽能间接反映胃内细菌感染的密度，但两者之间缺乏精确的定量关系。ＤＯＢ值的高低难以反映胃黏膜内中性粒细胞和慢性炎症细胞的浸润程度。

Objective To evaluate the diagnostic value of 13 C urea breath test (UBT) in Helicobacter pylori (Hp) colonization density and the severity of gastritis. Methods The diagnostic accuracy of UBT in the diagnosis of Hp infection with reference to histology (HE and Warthin Starry stain) was analyzed and the UBT results (DOB values) among the groups of gastritis with different degrees of severity were compared. Results By using UBT, 96 of 103 patients with Hp positive histology were detected (sensitivity, 93.2%), the specificity was 89 1%. DOB value in the Hp colonization dense group was significantly higher than in the other groups (low and moderately dense) ( P <0 05). A significant but weak, correlation was found between the DOB values and the colonization density either with ( rs =0.599 0, P <0.000 1) or without ( r s =0.245 7, P =0.015 8) inclusion of histologically negative patients. In Hp positive patients, DOB values neither in the groups of active gastritis (0～3 grade) nor in the groups of chronic gastritis (1～3 grade) had no significant difference. There was no correlation between DOB values and severity of inflammatory infiltration. Conclusion 13 C UBT has high sensitivity and specificity in the detection of Hp infection. There is significant but weak, correlation between DOB values and the colonization density of Hp. DOB values could not reflect the density of neutrophil and lymphocyte infiltration.