^13C-尿素呼气试验诊断残胃幽门螺杆菌感染的应用价值

Applying value of ^13 C-urea breath test in the diagnosis of Helicobacter pylori infection in gastric remnant

【摘要】目的研究^13C-尿素呼气试验（^13C—UBT）在残胃患者中诊断Hp感染的准确性。方法选取94例残胃患者（残胃组）和100例非残胃患者（对照组）进行^13C-UBT检测，残胃组根据病程再分为残胃1组（≤5年）29例、2组（6～10年）33例和3组（〉10年）32例。对照组和残胃组手术前诊断Hp感染均依据^13C—UBT或胃黏膜组织切片染色镜检，手术后诊断依据胃黏膜组织切片染色镜检，评价^13C—UBT在残胃患者中的应用价值。^13C—UBT检测与胃黏膜组织切片染色镜检结果一致性检验采用Kappa检验。结果残胃组术后Hp感染率（37．2％）明显低于术前（79．8％；X^2=35．058，P〈0．01）和对照组（77．0％），毕Ⅱ式术后Hp感染率（24．4％）低于毕I式术后（47．2oA；X^2=5．133，P=0．023）。各残胃亚组术前Hp感染率相似（P〉0．05），随着术后病程的延长，残胃各亚组间Hp感染率逐渐降低（残胃1组58．6％，2组36．4％，3组18．8％；X^2=7．839，P=0．021）。评判时残胃组和对照组的分界点分别设置在2．0‰和3．5‰时，诊断准确率最高（92．6％和96．0％），^13C-UBT与胃黏膜组织切片染色检查相比一致性较好（Kappa=0．84，P〈0．01）。结论^13C—UBT若检测方法得当、评判标准合适，在残胃患者中应用仍是一种简单、安全、有效的方法。

Objective To investigate the diagnostic accuracy of ^13C-urea breath test （^13C-UBT） in the diagnosis of Helicobacter pyLori （Hp） infection in patients with gastric remnant. Methods A total of 94 gastric remnant patients （gastric remnant group） and 100 non-gastric remnant patients （control group） received ^13C--UBT. According to the course of the disease, the gastric remnant group were divided into group 1 （29 cases, 45 years）, group 2 （33 cases, 6 to 10 years） and group 3 （32 cases, 〉10 years）. Before surgery, the diagnosis of Hp infection was according to ^13C-UBT and gastric mucosa tissue staining. After surgery, the diagnosis was according to gastric mueosa tissue staining. The applying value of ^13C-UBT in gastric remnant patients was evaluated. The consistency of results between ^13C-UBT and gastric mucosa tissue staining were evaluated by the Kappa test. Results In gastric remnant group, the Hp infection rate after surgery （37.2%） was obviously lower than that before operation （79.8%;X^2 = 35. 058, P〈0. 01） and that of control group （77.0%）. After surgery, the Hp infection rate of patients with Billroth Ⅱ gastrectomy （24.4%） was lower than that of patients with Billroth I gastrectomy （47.2% ; X^2 =5. 133, P=0. 023）. Before surgery, the Hp infection rate of gastric remnant subgroups were similar （P 〉 0. 05）. With the extension of the postoperative course, the Hp infection rate gradually decreased in gastric remnant subgroups （group 1 ： 58.6 %, group 2 ： 36.4 %, group 3：18.8 % ; X^2 = 7. 839, P = 0. 021）. Setting the cut-off point at 2.0‰ in the gastric remnant group and 3.5‰ in the control group,the accuracy rate of diagnosis was the highest （92.6% and 96.0%）. There was good consistency between the results of 13C-UBT and gastric mucosa tissue staining （Kappa=0. 84, P〈0.01）. Conclusion With suitable operation and standard, ^13C-UBT may be a easy, safe and effective assay applied in the gastric remnant patients.