孕产妇胃幽门螺杆菌感染常见检测方法的比较

Comparison of common detection measures for helicobacter pylori infection in pregnant women

目的探讨几种不同检测方法对胃幽门螺杆菌(Hp)感染诊断的价值,从而寻求最适合孕产妇的检测方法。方法以13C尿素呼气试验(13C UBT)作为"金标准",对由于消化系统症状就诊的309例孕产妇分别采用Hp免疫球蛋白G(Ig G)抗体检测、酶联免疫试验(ELISA)、免疫印迹法(IBT)进行检测,观察各种检测方法诊断Hp感染的效果。结果 13C UBT与Hp Ig G抗体检测Hp检出率比较,差异具有统计学意义(χ~2=15.541,P<0.05)、13C UBT与ELISA检出率比较,差异具有统计学意义(χ~2=8.870,P<0.05),13C UBT与IBT检出率比较,差异无统计学意义(χ~2=0.428,P>0.05)。准确度方面,Ig G抗体检测为76.70%,ELISA为76.38%,IBT为85.11%。敏感度由高到低分别为Hp Ig G抗体检测、ELISA、IBT,特异度由高到低分别为IBT、ELISA、Hp Ig G抗体检测。Hp Ig G抗体检测Kappa值为0.424,ELISA为0.537,IBT为0.759。结论 Hp Ig G抗体检测可以作为Hp感染大批量的流行病学调查,但不适合胃Hp的筛查。ELISA操作简单,近乎无放射性污染,敏感度也相对较高,经常用于流行病学的调研及大批体检患者的检测。IBT诊断真实性中等,特异性相比较而言略高,检测结果可以对胃Hp的感染分型,对进一步深入了解病情变化做可靠的依据,可作为辅助诊断。

Objective To investigate diagnostic value of different detection measures for helicobacter pylori（Hp） infection, so as to select the most suitable method in detection. Methods 13 C urea breath test（^13C UBT） was taken as gold standard for 309 pregnant women with gastrointestinal symptoms detected by Hp immune globulin G（Ig G） antibody test, enzyme-linked immuno sorbent assay（ELISA） and immunoblotting（IBT）. Observation was made on effects by various measures in diagnosis of Hp infection. Results The difference of Hp detection rate had statistical significance between 13 C UBT and Ig G antibody test（χ^2=15.541, P〈0.05）, and the difference of detection rate between 13 C UBT and ELISA also had statistical significance（χ^2=8.870, P〈0.05）. There was no statistically significant difference of detection rate between 13 C UBT and IBT（χ^2=0.428, P〉0.05）. Ig G antibody test had accuracy as 76.70%, ELISA as 76.38% and IBT as 85.11%. Hp Ig G antibody test, ELISA, and IBT respectively showed their sensitivity from high to low, while IBT, ELISA and Hp Ig G antibody test showed specificity from high to low. Hp Ig G antibody test had Kappa value as 0.424, ELISA as 0.537, IBT as 0.759. Conclusion As a common method for epidemiological investigation of massive Hp infection, Hp Ig G antibody test is not suitable for Hp screening. Due to its easy operation, non radioactive pollution and high sensitivity, ELISA is usually applied in epidemiological research and massive detection. IBT shows moderate accuracy in diagnosis and slightly high specificity, and its test outcome can classify Hp infection. Due to its creditable reference for further disease changes, it can be taken as assistant diagnosis.