免疫组化染色与^(14)C尿素呼气试验在幽门螺杆菌相关胃炎诊断中的比较

Comparison of immunohistochemical stain and ^(14)C urea breath test in the diagnosis of helicobacter pylori associated gastritis

目的探讨免疫组化染色技术在诊断胃活检组织中幽门螺杆菌(helicobacter pylori,HP)的价值。方法收集行^(14)C尿素呼气试验(UBT)的239例胃活检组织,采用免疫组化染色检测HP感染,其结果分别与金标准进行对比分析,金标准的设定参考第四次全国幽门螺杆菌感染处理共识报告并适当修改,以^(14)C UBT、免疫组化和HE三个条件中至少有两个阳性者定为HP阳性。结果筛选出符合条件的胃活检组织239例,与金标准相比免疫组化染色的敏感性和特异性最高,分别为97. 3%和100. 0%;而^(14)C UBT和HE染色的敏感性和特异性分别为91. 1%、81. 9%和80. 4%、92. 9%。^(14)C UBT的假阳性率为9. 6%,假阴性率为4. 2%。结论免疫组化检测HP有高度的敏感性和特异性,染色结果判断清晰直观,准确可靠,推荐其用于HP胃炎的综合诊断。

Purpose To evaluate the value of immunohistochemical stain(IHC)in the diagnosis of helicobacter pylori(HP)-associated gastritis with gastric biopsy tissue.Method 239 cases of gastric biopsy were selected.All patients had 14C urea breath test(UBT)at the time of gastric biopsy.IHC for HP was performed with the biopsy tissues.The results were compared with gold standard results.Gold standard was established according to the Chinese Fourth National Consensus report on HP infection with modification.It was considered positive if two or more of the three test results were positive,including IHC,UBT,and HE.Results 239 gastric biopsy specimens fit the criteria.Compared with the gold standard,the sensitivity and specificity value of IHC stains were 97.3%and 100.0%respectively,higher than 91.1%,81.9%of 14 C UBT,and 80.4%,92.9%of HE stain respectively.The 14 C UBT showed 9.6%false positive rate,and 4.2%false negative rate.Conclusion IHC is a valuable test in the diagnosis of HP-associated gastritis,and it should be recommended for routine histopathologic diagnostic workup if HP gastritis is clinically suspected or chronic active gastritis is identified in the biopsy tissue.