提高短期应用质子泵抑制剂后幽门螺杆菌检测水平的研究

Effects of Short- term Usage of proton pump inhibitors on the detection of Helicobacter pylori

目的:通过对短期应用质子泵抑制剂后的慢性胃炎及消化性溃疡患者,以不同方法检测幽门螺旋杆菌(Hp)感染情况,通过对比阳性率及敏感性,发现短期应用质子泵抑制剂后Hp检测敏感方法。方法:以服用质子泵抑制剂但不超过1周(用药组)及未服用质子泵抑制剂(对照组)患者为入组条件,将两组各60例,分别取胃窦、胃体大弯侧黏膜,采用快速尿素酶法、病理组织切片染色检测,另行粪便Hp抗原检测,统计阳性率及敏感性,并进行两组间对比分析。结果:用药组60例患者中Hp阳性52例,阳性率86.7%,对照组60例患者中Hp阳性50例,阳性率为83.3%,两组间差异无统计学意义(P>0.05)。用药组胃体部尿素酶试验阳性率大于胃窦部(P﹤0.05),两组间胃窦部尿素酶试验阳性率低于对照组(P﹤0.01),胃窦、胃体病理组织学检测阳性率与对照组间差异无统计学意义(P﹥0.05)。而用药组中联合检测(胃窦+胃体)病理切片染色、胃窦病理+粪便Hp抗原、(胃体病理+粪便Hp抗原)阳性率均为80%,敏感性92.3%,阴性预测值较高,与胃窦病理、胃体病理、粪便Hp抗原检测相比差异无统计学意义(P﹥0.05),与尿素酶试验相比差异有统计学意义(P﹤0.01)。结论:短期应用质子泵抑制剂后对Hp尿素酶试验检测有明显影响,进行胃窦、胃体黏膜病理切片染色、粪便抗原检测或两者联合检测可以提高检测阳性率及敏感性。

Objective The purpose of the study was to find a more sensitive method to detect Helicobacter pylori infection in patients taking proton pump inhibitors for a short period. Method 120 patients,who had either been on no medication or were already taking proton pump inhibitors for less than a week,were divided into two groups with 60 in each group. Biopsies taken from the gastric antrum and greater curvature of the stomach（ body） were used for rapid urease testing and for histological examination. Stool samples were also tested for H. pylori stool antigen as an alternative indicator of infection. Results H. pylori organisms were detected in 52 of 60 patients taking proton pump inhibitors（ 86. 7%） and in 50 of 60 controls（ 83. 3%）. The positive rate of the antral urease test was significantly lower in patients taking proton pump inhibitors than in controls（ P〈0. 01）. Body urease test gave more H. pylori- positive results than that of antrum（ P〈0. 05）. There was no significant difference between two groups in histology（ P〉0. 05）. Joint detection（ sinus ＋ body） pathology（ antral pathology ＋ stool antigen）,（ gastric pathology ＋ stool antigen） showed positive rate of 80 % and sensitivity rate of 92. 3%. Negative predictive value was higher,there was no significant rate difference compared between group. No significant difference when compared with antrum pathology,gastric pathology,and HpSA stool（ P〉0. 05）; however,compared with gastric antrum and urease test,the result showed a significant difference（ P〈0. 01）. Conclusion Short- term Usage of proton pump inhibitors on the detection of Helicobacter pylori. Conducting gastric biopsy,stained stool antigen test,or both combined detection can increase the level of detection.