^(13)碳尿素呼吸试验在诊断儿童幽门螺杆菌感染及评价疗效中的应用

Usefulness of ^(13)C-urea breath test in the diagnosis of Helicobacter pylori infection and evaluation of Helicobacter pylori eradication in children

目的 探讨13 碳尿素呼吸试验 (13 C UBT)在诊断儿童幽门螺杆菌 (Hp)感染及评价疗效中的应用。方法 应用13 C UBT及血清Hp IgG检测 193例无症状儿童及 34 0例反复腹痛患儿Hp感染状况 ,将两项检测均为阳性的反复腹痛患儿 88例随机分为治疗组 (5 7例 )和安慰剂组 (31例 ) ,接受奥美拉唑、克拉霉素、羟氨苄青霉素 (阿莫西林 )三联治疗 ,疗程 1周。停药后 4周随访。结果 腹痛患儿13 C UBT及Hp IgG阳性率分别为 2 9.1%、5 2 .1% ,显著高于无症状儿 (11.4%、39.4% )。 2～、5～、10～ 14岁三组无症状患儿13 C UBT及Hp IgG阳性率随年龄增加 ,但差异无显著性 ,P >0 .0 5。三组患儿13 C UBT阳性率分别为 2 9%、2 9.1%、30 % ,与年龄无关 ,χ2 =0 .0 4,P >0 .0 5 ;而Hp IgG阳性率随年龄增加 (36 %、5 3.7%、70 % ) ,差异有显著性 ,χ2 =13.16 ,P <0 .0 0 5。 2～、5～ 10岁组 13 C UBT及5～、10～ 14组Hp IgG阳性率 ,腹痛患儿较无症状儿明显增高。治疗后治疗组及安慰剂组腹痛消失或好转的总有效率分别为 97%和 2 6 % ;Hp根除率分别为 88% ,10 % ,两组差异有显著性。结论 (1)部分患儿反复腹痛与Hp感染密切相关 ,Hp感染随年龄增加 ,但症状性感染与年龄无关。 (2 ) 13 C UBT检测具有方法简单 ,准确性高 。

Objective To determine the usefulness of 13 C urea breath test ( 13 C UBT) in the diagnosis of Helicobacter pylori (Hp) infection and evaluation of Hp eradication in children. Methods By using the 13 C UBT and serum Hp IgG antibody test, the authors detected the status of Hp infection in 193 asymptomatic children and 340 patients with recurrent abdominal pain (RAP). The patients who were identified to have Hp infection by both methods were divided into treatment group (57 cases) and placebo group (31) randomly. The treatment group were given a triple therapy composed of omeprazole, clarithromycin, and amoxicillin for 1 week. They were followed up and 13 C UBT was repeated 4 weeks after the treatment was completed. Results The positive rates of 13 C UBT and Hp IgG antibody detection in children with RAP were 29.1 % and 52.1 %, respectively, which were much higher than those of asymptomatic children (11.4 % and 39.4 %). The positive rates of 13 C UBT and Hp IgG of asymptomatic children increased with the age, but the differences were not statistically significant ( P >0.05). The positive rates of 13 C UBT of patients 2 , 5 , and 10 14 years of age were 29 %, 29.1 % and 30 %, respectively, which had no correlation with age (χ 2=0.04, P >0.05); but the positive rates of Hp IgG increased with age, which were 36 %, 53.7 % and 70 %, respectively, and the differences were statistically significant (χ 2=13.16, P <0.005). The positive rates of 13 C UBT of patients 2 , 5 10 years of age and of Hp IgG of 5 , 10 14 were much higher than those of asymptomatic children. The therapeutic regimens were effective in 97 % of treatment group and 26 % of placebo group. Hp eradication rates were 88% and 10%, respectively. The differences in both clinical efficacy and Hp eradication rates were statistically significant ( P < 0.001). Conclusions (1) RAP of some children may have a close relation to Hp infection; (2) 13 C UBT is a simple, safe and accurate non invasive method suitable for diagnosing Hp infection and evaluating the Hp eradication in children. (3) Omeprazole triple therapy was effective in eradicating Hp infection in children with a high Hp eradication rate and few side effects.