多部位胃黏膜联合取样在幽门螺杆菌培养中的应用价值

The value of combined sampling at multiple sites of gastric mucosa for Helicobacter pylori culture

目的评价胃镜下多部位联合取样对幽门螺杆菌（HP）培养鉴定的价值。方法2014年8月至2015年5月间，258例有上消化道症状的患者，经13C尿素呼气试验后，分别在胃镜下进行胃窦小弯（A）、胃窦大弯（B）、胃角（C）和胃体（D）这4个部位的胃黏膜组织取样，通过体外HP培养鉴定试验，采用Nemenyi检验对比分析多部位联合取样与单部位取样两种模式下对刖，阳性率的影响。结果13C尿素呼气试验与HP分离培养的结果一致性达82．56％。除胃体外，其他单部位取样在HP阳性率上与两部位联合取样差异均存在统计学意义（P〈0．05）。单部位与3个部位联合取样在刎，阳性率上差异均有统计学意义（P〈0．05）。两部位联合取样胃窦小弯和胃体，胃角和胃体，胃窦大弯和胃体的联合取样与任意3部位联合取样差异无统计学意义（P〉0．05）。结论相比单部位取样和3部位取样，胃镜下胃窦小弯和胃体胃黏膜的联合取样在HP培养中的性价比最高。

Objective To evaluate combined sampling at muhiple sites of gastric mucosa for Helicobacter pylori （HP） culture. Methods A total of 258 patients with upper gastrointestinal symptoms received 13C-urea breath test between August 2014 and May 2015. During endoscopy, gastric mucosa biopsy samples from the lesser curvature of the antrum （A）, the greater curvature of the antrum （B）, gastric angle （C） and the body of the stomach （D） were collected to isolate HP strains. The positive rates of HP based on combined sampling and single site sampling were compared with a Nemenyi test. Results Consistency between 13C-urea breath test and HP culture was 82. 56%. There was significant difference between the single site sampling and two-site sampling in the positive rate of HP, except for the body of the stomach（ P〈0. 05 ）. There was significant difference in the positive rate of HP between the single site sampling and three-site sampling （P 〈 0. 05 ）. There was no significant difference between any two-site sampling in the lesser curvature of the antrum and the body of the stomach, gastric angle and the body of the stomach, the greater curvature of the antrum and the body of the stomach, and any three-site sampling （P〉0. 05）. Conclusion The combined sampling of the lesser curvature of the antrum and the body of the stomach have the highest cost-effectiveness in HP culture compared with the single site sampling and three-site sampling.