An optimized ^(13)C-urea breath test for the diagnosis of H pylori infection

AIM： To validate an optimized ^13C-urea breath test （^13C-UBT） protocol for the diagnosis of H pylori infection that is cost-efficient and maintains excellent diagnostic accuracy. METHODS： 70 healthy volunteers were tested with two simplified ^13C-UBT protocols, with test meal （Protocol 2） and without test meal （Protocol 1）. Breath samples were collected at 10, 20 and 30 rain after ingestion of 50 mg ^13C-urea dissolved in 10 mL of water, taken as a single swallow, followed by 200 mL of water （pH 6.0） and a circular motion around the waistline to homogenize the urea solution. Performance of both protocols was analyzed at various cut-off values. Results were validated against the European protocol. RESULTS： According to the reference protocol, 65.7% individuals were positive for H pylori infection and 34.3% were negative. There were no significant differences in the ability of both protocols to correctly identify positive and negative H pylori individuals. However, only Protocol 1 with no test meal achieved accuracy, sensitivity, specificity, positive and negative predictive values of 100%. The highest values achieved by Protocol 2 were 98.57%, 97.83%, 100%, 100% and 100%, respectively.CONCLUSION： A 10 min, 50 mg ^13C-UBT with no test meal using a cut-off value of 2-2.5 is a highly accurate test for the diagnosis of H pylori infection at a reduced cost.

Effect of posture on ^(13)C-urea breath test in partial gastrectomy patients

AIM: To investigate whether posture affects the accuracy of 13C-urea breath test(13C-UBT) for Helicobacter pylori(H. pylori) detection in partial gastrectomy patients. METHODS: We studied 156 consecutive residual stomach patients, including 76 with H. pylori infection(infection group) and 80 without H. pylori infection(control group). H. pylori infection was confirmed if both the rapid urease test and histology were positive during gastroscopy. The two groups were divided into four subgroups according to patients' posture during the 13C-UBT: subgroup A, sitting position; subgroup B, supine position; subgroup C, right lateral recumbent position; and subgroup D, left lateral recumbent position. Each subject underwent the following modified 13C-UBT: 75 mg of 13C-urea(powder) in 100 m L of citric acid solution was administered, and a mouth wash was performed immediately; breath samples were then collected at baseline and at 5-min intervals up to 30 min while the position was maintained. Seven breathsamples were collected for each subject. The cutoff value was 2.0‰.RESULTS: The mean delta over baseline(DOB) values in the subgroups of the infection group were similar at 5 min(P > 0.05) and significantly higher than those in the corresponding control subgroups at all time points(P < 0.01). In the infection group, the mean DOB values in subgroup A were higher than those in other subgroups within 10 min and peaked at the 10-min point(12.4‰± 2.4‰). The values in subgroups B and C both reached their peaks at 15 min(B, 13.9‰± 1.5‰; C, 12.2‰± 1.7‰) and then decreased gradually until the 30-min point. In subgroup D, the value peaked at 20 min(14.7‰± 1.7‰). Significant differences were found between the values in subgroups D and B at both 25 min(t = 2.093, P = 0.043) and 30 min(t = 2.141, P = 0.039). At 30 min, the value in subgroup D was also significantly different from those in subgroups A and C(D vs C: t = 6.325, P = 0.000; D vs A: t = 5.912, P = 0.000). The mean DOB values of subjects with Billroth Ⅰ anastomosis were higher than those of subjects with Billroth Ⅱ anastomosis irrespectively of the detection time and posture(P > 0.05).CONCLUSION: Utilization of the left lateral recumbent position during the procedure and when collecting the last breath sample may improve the diagnostic accuracy of the 13C-UBT in partial gastrectomy patients.

Validity and cost comparison of ^(14)carbon urea breath test for diagnosis of H Pylori in dyspeptic patients

AIM： To validate and compare the cost of microdose ^14C urea breath test （UBT） with histology and rapid urease test for the diagnosis of H Py/ori. METHODS： Ninety-four consecutive patients with dyspeptic symptoms undergoing gastroscopy were enrolled. Gastric biopsies were taken for histology and rapid urease test. UBT was performed after gastroscopy by microdose ^14 urea capsules. Sensitivity, specificity and accuracy of UBT were calculated and compared with histology and rapid urease test. Cost comparison of these tests was also performed. RESULTS： H pylori was diagnosed by histology and rapid urease test in 66 （70%） and 61 （65%） patients, while ^14C UBT detected infection in 63 （67%）. Accuracy of UBT was 93% in comparison with histology while its positive and negative predictive values were 97% and 84%, respectively. Comparison of ^14C UBT with rapid urease test gives an accuracy of 96%, with positive and negative predictive values of 95% and 97%, respectively. These results were highly reproducible with a Kappa test （P value 〈 0.001）. Cost of histology or rapid urease test with gastroscopy was 110 USD or 95 USD respectively while the cost of UBT was 15 USD.CONCLUSION： Microdose ^14C UBT was comparable to histology and rapid urease test. ^14C UBT is an economical, self sufficient and suitable test to diagnose active Hpylori infection in less developed countries.

Prognostic value of ^(13)C-phenylalanine breath test on predicting survival in patients with chronic liver failure

AIM: To evaluate the prognostic value of percentage of 13C-phenylalanine oxidation (13C-PheOx) obtained by 13C-phenylalanine breath test (13C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of 13C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of 13C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of 13C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival.CONCLUSION: Percentage of 13C-PheOx obtained by 13C-PheBT is a strong predictor of survival in patients with chronic liver disease.

样本采集时间对老年慢性胃炎患者^(13)C-尿素呼气试验结果的影响

目的:分析样本采集时间对老年慢性胃炎患者^(13)C-尿素呼气试验结果的影响。方法:选取2019年6月—2021年6月山东省荣军总医院收治的150例老年慢性胃炎患者作为研究对象。所有患者于空腹及餐后3 h进行^(13)C-尿素呼气试验,并以快速尿素酶检测结果作为“金标准”,比较两个样本采集时间^(13)C-尿素呼气试验结果的准确率、特异度及灵敏度。结果:空腹时采集样本的^(13)C-尿素呼气试验准确率、灵敏度高于餐后3 h,差异有统计学意义(P<0.05)。结论:老年慢性胃炎患者空腹时进行^(13)C-尿素呼气试验的诊断效能较高。

^(13)C尿素呼气试验检测幽门螺杆菌感染的临床应用

目的探讨^(13)C尿素呼气试验检测幽门螺杆菌感染的临床诊断价值。方法选择2022年1月至2023年7月100例上海未凡医学检验实验室接受检查的上腹部不适患者100例作为研究对象。所有患者均行快速脲酶试验(RUT)和^(13)C尿素呼气试验。以组织学检查作为诊断金标准,比较2种方法对患者各种疾病诊断的准确性、阳性率。对2种方法的诊断性能(灵敏度、特异度、准确性、阴性预测值、阳性预测值)进行评估。结果100例上腹部不适患者中,90例经病理检查确诊。^(13)C尿素呼气试验对十二指肠炎和消化性溃疡的诊断阳性率高于RUT(P<0.05)。2种方法对胃息肉、慢性胃炎、胃癌的诊断阳性率比较,差异无统计学意义(P>0.05)。与RUT相比,^(13)C尿素呼气试验具有更高的灵敏度、特异度、准确性、阳性预测值和阴性预测值。2种方法的特异度、准确性差异有统计学意义(P<0.05),而敏感性、阴性预测值、阳性预测值差异无统计学意义(P>0.05)。结论^(13)C尿素呼气试验和RUT均是检测幽门螺杆菌感染的有效诊断方法,但^(13)C尿素呼气试验具有更高的诊断阳性率和整体诊断效能。

Delayed Gastric Emptying in Anorexic Adolescents Measured with the ¹³C Octanoic Acid Breath Test

Many gastrointestinal complaints and motility disorders are described in patients suffering from different eating disorders. These have a negative impact on refeeding. This report evaluated–on admission-gastric emptying of a standardized solid meal with 13C octanoic acid breath test in anorexic adolescents. The results were compared with age and gender matched controls. Gastric emptying data were related to a subjective symptom score. 21 Anorexic girls and 3 boys (mean age: 15.6 y ± 1.3 y), body mass index (mean 15.6 kg/m2 ± 1.6 kg/m2), weight loss (mean: 22.2% ± 10.7%) were studied. T? of the gastric emptying time exceeded the P95 in 14/24 (58%) patients, classified as having delayed gastric emptying (DGE). One patient (4%) had a T? exceeding P75 and was classified as slow (SGE), whereas 9/24 (38%) patients had normal gastric emptying (NGE). In comparison to NGE, subjects with DGE had significantly higher symptom scores (p = 0.01) and more weight loss. The DGE and SGE patients lost 25.29% and 21.38% of weight respectively, whereas a weight loss of 17.64% was found in anorexics with NGE. In conclusion, gastric emptying is delayed in patients with anorexia. This is associated with more significant gastrointestinal symptoms and higher weight loss.

Microdose (14)~C-urea breath test to diagnose Helicobacter pylori infection

A capsulated microdose 14C-urea breath test (14C-UBT) was developed to detect Helicobacter pylori (HP) infection in 137 patients (54 HP negative and 83 HP positive individuals)to whom a single dose of 3. 7ｘ 104 Bq of 14C-urea in a capsule was given. Samples of exhaled gas were collected at the sib, 10th, 15th. 20th, 25th, 30th, 45th and 60th minute after the administration and the peak value of exhaled 14CO2 was found in the samples collected at the 25th minute. This peak value was taken as the measuring point and directly expressed as Bq/mmol CO2 to develop a new detecting method. Then its results were compared with those of HP culture and histological examination. It was found that the samples collected on the 25th minute showed a sensitivity of 97. 06%, specificity of 95. 12%, positive predictive value of 97. 06% and negative predictive value of 95. 12% respectively when the mean value of 14CO2 in HP negative subjects ±3s on the 25th minute was taken as the critical value. This suggests that the capsule-based microdose 14C-UBT may replace conventional 14C-UBT using a larger dose of (1. 85-3. 7)ｘ 105 Bq for it is non-invasive, safe, rapid, accurate, simple and economic.

^(13)C-尿素呼气试验诊断儿童幽门螺杆菌感染的探讨

为探讨^(13)C-尿素呼气试验(^(13)C-UBT)对儿童幽门螺杆菌(HP)感染检测的可靠性,对52例4～13岁有消化道症状的儿童作^(13)C-UBT检测,并与HP的尿素酶试验、细菌培养和病理学检查比较。结果:^(13)C-UBT检测HP阳性39例,阴性10例,敏感性100％,特异性76.92％。其中^(13)C-UBT诊断HP感染与胃粘膜3种检测HP方法完全符合33例(63.46％),与胃粘膜两种方法完全符合44例(84.61％),胃粘膜一种方法完全符合49例(94.23％)。结论提示:^(13)C-UBT有高度敏感性及特异性,对确诊儿童胃内HP感染状态是一种可靠、无创伤性的诊断方法,值得推广应用。

^(13)C-尿素呼气试验诊断儿童幽门螺杆菌感染的临床评估

目的 评估13C 尿素呼气试验(13C UBT)诊断幽门螺杆菌(HP)感染的准确性。方法 对23例有消化 道症状的患儿进行病理组织学、快速尿素酶试验,以决定是否感染HP。结果 以内镜检查结果作为诊断HP感 染的金标准。13C UBT的敏感性是92.85%,特异性100%,阳性预测值100%,阴性预测值90%,诊断准确率 95.56%。结论 13C UBT有较高的敏感性和特异性,是一种测定小儿HP感染可靠易行的非侵入性诊断方法。

^(13)C-尿素呼气试验DOB值与幽门螺杆菌根除率关系的研究

目的探讨^(13)C-尿素呼气试验超基准值(delta over baseline,DOB)对幽门螺杆菌(Helicobacter pylori,H.pylori)根除率的影响,为临床根除H.pylori提供一定指导。方法回顾性分析2008年3月-2015年7月在南京市第一医院门诊首次行^(13)C-尿素呼气试验证实为H.pylori感染的18岁以上,并停药后4周至半年内复查^(13)C-尿素呼气试验患者的临床资料。以首次^(13)C-尿素呼气试验DOB值为标准分为3组,患者共1 104例,A组DOB<16者共302例,男162例,女140例,年龄(50.33±14.26)岁,B组16≤DOB≤35者共514例,男251例,女263例,年龄(49.51±13.91)岁,C组DOB>35者共288例,男135例,女153例,年龄(49.50±13.58)岁,所有患者采用标准三联(奥美拉唑+阿莫西林+克拉霉素)7 d根除方案,分析首次^(13)C-尿素呼气试验不同DOB值对H.pylori根除率是否有影响。结果 A组根除率75.5%(228/302),B组根除率74.9%(385/514),C组根除率71.9%(207/288),差异无统计学意义(χ2=1.120,P>0.05)。结论采用标准三联(奥美拉唑+阿莫西林+克拉霉素)7 d方案根除H.pylori治疗前DOB值不能预测H.pylori根除效果。

半量^(13)C-UBT对幽门螺杆菌感染的诊断价值

目的评价半量13C-UBT诊断幽门螺杆菌感染的临床价值。方法选择32780例消化内科因消化道症状就诊的门诊患者为研究对象,部分行全量13C-尿素呼气试验或14C-尿素呼气试验检测,部分行半量13C-尿素呼气试验。比较三种试验的阳性率。结果全量13C-UBT阳性率较同期14C-UBT低(P<0.05),半量13C-UBT与同期14C-UBT比较差异无统计学意义(P>0.05),半量13C-UBT阳性率比全量13C-UBT高(P<0.05)。结论半量13C-UBT可作为诊断幽门螺杆菌感染的首选检测方法并减少患者在检查中辐射的暴露。

^(13)C-尿素呼气试验定量值与胃黏膜病变程度的相关性

目的:探讨13C-尿素呼气试验定量检测值与胃黏膜病变程度的关系.方法:74例患者于1wk内分别测定13C-尿素呼气试验定量检测和行胃镜检查取胃黏膜,进行组织病理学检查,黏膜按标准予以评分.将13C-尿素呼气试验定量值和胃黏膜病理病变评分做相关性分析.结果:13C-尿素呼气试验定量值与胃窦黏膜慢性炎症(r=0.9958,P=0.0001)、萎缩(r=0.2498,P=0.0318)、肠化(r=0.2784,P=0.02)病变程度呈正相关,与其活动性炎症(r=0.1979,P=0.09)病变程度不相关;13C-尿素呼气试验定量值与胃角黏膜活动性炎症(r=0.6223,P=0.0001)、慢性炎症(r=0.5480,P=0.0001)、萎缩(r=0.6014,P=0.0001)病变程度呈正相关,与其肠化(r=0.1308,P=0.27)病变程度不相关;13C-尿素呼气试验定量值与胃体黏膜活动性炎症(r=0.2039,P=0.08)、慢性炎症(r=0.0966,P=0.41)、萎缩(r=0.1369,P=0.24)、肠化(r=0.1837,P=0.12)程度均不相关;13C-尿素呼气试验定量值与全胃黏膜活动性炎症(r=0.9958,P=0.0001)、慢性炎症(r=0.9843,P=0.0001)、萎缩(r=0.9921,P=0.0001)、肠化(r=0.9934,P=0.0001)病变程度均呈正相关.结论:13C-尿素呼气试验定量值与胃黏膜病理病变程度呈正相关,临床上可以根据13C-尿素呼气试验定量值高低考虑黏膜病理病变程度,进而更好地指导临床诊断、用药及预后.

^(13)C-尿素呼吸试验对儿童幽门螺杆菌感染根除后1年的随访

目的 探讨洛赛克、克拉霉素、阿莫西林三联根除儿童幽门螺杆菌 (Hp)感染的远近期疗效。 方法 经1 3C尿素呼吸试验 (1 3C UBT)及血清Hp IgG测定 2项阳性的反复腹痛儿 95例 ,随机分为治疗组 (60例 )与安慰剂组 (35例 ) ,治疗组接受洛赛克 0 .8mg/ (kg·d) ,每天一次 ,克拉霉素 1 5mg/ (kg·d) ,每天 2次 ,阿莫西林 30mg/ (kg·d) ,每天 3次 ,三联口服治疗 ;疗程 1周。停药后 1 ,3 ,6 ,1 2个月门诊随访 ,复查1 3C UBT及Hp IgG。 结果 1 .治疗组停药后 4周腹痛的总有效率 96 .7% ,而安慰剂组仅 34 .6 % ;治疗组Hp根除率为 90 % ,明显高于安慰剂组 1 4 .3 %。 2 .治疗组Hp根除后 3 ,6 ,1 2个月复查Hp再感染率分别为 1 .85 %、1 .85 %、3 .57%。 结论 1 .洛赛克等三联根除反复腹痛儿Hp感染临床效果显著 ,Hp根除率高 ,远近期疗效均好 ,1年再感染率低。2 .1 3C UBT监测Hp根除情况快捷准确。

幽门螺旋菌检测试剂［^（13）C］尿素的合成

报道了由［１３Ｃ］碳酸钡制成［１３Ｃ］尿素的方法，其产率为７５％。产品经高效液相色谱（ＨＰＬＣ）等分析，纯度优于国外同类产品，质量符合药典规定，并经临床应用于［１３Ｃ］尿素呼气实验检测幽门螺旋菌，获得满意的效果．

应用^(13)C-尿素呼气试验检测成都市健康体检者胃幽门螺杆菌感染情况分析

目的通过应用13C-尿素呼气试验(13C-urea breath test,C-UBT)对成都市健康体检者开展幽门螺杆菌(Helico-bacter pylori,Hp)检测,比较不同年龄、性别和季节之间Hp阳性感染率的差异,探讨Hp感染分布规律。方法采用13C-UBT检测2400例健康体检人群的Hp感染情况,并按年龄、性别和季节分组,进行统计分析。结果 Hp感染率为44.08%,但性别和季节差异均无统计学意义(P>0.05),而不同年龄组的Hp感染率差异有统计学意义(P<0.05)。结论呼气试验适用于体检人群中Hp感染的检测。应通过健康教育提高人们相关知识水平,从而自觉预防和控制胃部疾病的发生。

^(13)C-美沙西丁呼气试验对亚临床肝性脑病的临床价值分析

目的 探讨13C-美沙西丁呼气试验对亚临床肝性脑病(SHE)发病率和预后判断等方面的临床应用价值。方法 随机选择72例肝硬化患者和31例正常人作为研究对象,对所有受试者进行数字连接试验和智商(IQ)检测,以明确有无SHE,并同步进行13C-美沙西丁呼气试验、血氨等检测。比较13C-美沙西丁呼气试验的肝功能分级与临床Child Pugh分级的关系;采用多因素相关分析,比较13C-美沙西丁呼气试验的分级指标、血氨指标对并发SHE的关系;随访所有肝硬化患者的13C-美沙西丁呼气试验分级结果与SHE的关系。结果 肝硬化患者13C-美沙西丁呼气试验的肝功能分级与临床Child Pugh分级的差别无统计学意义(P>0.05)。13C-美沙西丁呼气试验分级为病理性肝损害、Child Pugh A级的两组肝硬化患者中无SHE,SHE患者均出现在13C-美沙西丁呼气试验分级为Child B级或Child C级且血氨值为(90.56±13.66)μmol/L或更高的患者中。在肝硬化患者13C-美沙西丁呼气试验的肝功能分级中,Child C级中SHE的发病率高于Child B级(P<0.05)。随访发现,13C-美沙西丁呼气试验为Child B级和Child C级患者存在并发SHE的危险。结论 13C-美沙西丁呼气试验可作为SHE发病的重要评判因素之一并有助于对肝硬化并发SHE的预后判断。

两种^(13)C-尿素呼气试验试剂诊断幽门螺杆菌感染临床可靠性比较

背景:13C鄄尿素呼气试验快捷、无创伤,敏感性和特异性高,在临床上被广泛应用于幽门螺杆菌(H.pylori)感染的检测。从加拿大进口的13C鄄尿素试剂已获得国家食品药品监督管理局许可并应用于临床。目的:与加拿大进口的13C鄄尿素试剂进行比较,评估美国Isotec公司生产的13C鄄尿素试剂用于诊断H.pylori感染的临床可靠性。方法:114例因上消化道症状接受胃镜检查者随机分为A、B两组,取胃窦活检标本分别作快速尿素酶试验、组织学检查和H.pylori培养,三项中有两项或以上阳性,或H.pylori培养单项阳性判为H.pylori感染,否则判为无H.pylori感染,以此作为诊断H.pylori感染的金标准。A组使用加拿大进口的13C鄄尿素试剂,B组使用美国Isotec公司生产的13C鄄尿素试剂,分别进行13C鄄尿素呼气试验。根据金标准分别计算和比较两组13C鄄尿素呼气试验的准确性、敏感性、特异性和阳性预测值、阴性预测值。结果:A组13C鄄尿素呼气试验诊断H.pylori感染的准确性为92.8%,敏感性为94.1%,特异性为90.9%,阳性预测值为94.1%,阴性预测值为90.9%;B组准确性为98.3%,敏感性为96.9%,特异性为100%,阳性预测值为100%,阴性预测值为96.3%。两组上述各项指标均无显著差异。结论:A组和B组13C鄄尿素呼气试验诊断H.pylori感染的准确性、敏感性。

幽门螺杆菌根除治疗前后组织学检查和^(13)C-尿素呼气试验的准确性分析

背景:幽门螺杆菌(H.pylori)的研究已有20多年的历史,但关于根除治疗前后H.pylori感染与炎症的关系以及评价治疗效果时应用何种方法、在何部位取活检的研究不多,仍存在争议。目的:探讨并比较H.pylori感染根除治疗前后不同活检部位组织学检查和13C-尿素呼气试验(UBT)检查的准确性。方法:受试者在根除治疗前后于胃窦、胃体和胃角处分别取黏膜活检标本各1块,以Giemsa染色、改良甲苯胺蓝染色和免疫组化法检测H.pylori感染情况。并对部分H.pylori感染的组织学检查和13C-UBT进行评估。结果:治疗前胃窦、胃体、胃角H.pylori感染率分别为61.3%、66.0%和59.6%。对4810例证实有H.pylori感染的患者在根除治疗后随访6周,有22.0%的病例有细菌残留,胃窦、胃体和胃角处H.pylori感染率分别为17.4%、17.3%和18.3%,各组间无显著性差异(P>0.05)。H.pylori感染者根除治疗前99.7%有活动性炎症,99.0%有慢性炎症。根除治疗后尽管有细菌残留,但炎症活动性减低。组织学检查H.pylori感染的患者中,根除治疗前有78.3%13C-UBT阳性;根除治疗后,仅有49.6%13C-UBT阳性。结论:根除治疗前13C-UBT和组织学检查结果的符合度较高,但对抗H.pylori治疗效果的评价,组织学检测优于13C-UBT。

红外线同位素能谱分析仪^(13)C-美沙西汀呼气试验对肝豆状核变性患儿肝功能评估的价值

目的探讨红外线同位素能谱分析仪(IRIS)13C-美沙西汀呼气试验在肝豆状核变性(WD)患儿肝功能评估的价值。方法确诊为WD9例患儿作为研究对象,进行13C-美沙西汀呼气试验肝功能检测,并与其临床、肝功能及Child-Pugh肝功能分级进行比较。结果临床肝功能正常的肝豆状核变性4例患儿13C-美沙西汀呼气试验MVmax40、CUM40及CUM120值异常;5例临床肝功能异常的WD患儿13C-美沙西汀呼气试验参数程度上与Child-Pugh肝功能分级一致。结论美沙西汀呼气试验作为一种灵敏、定量的肝功能试验对WD患儿的肝功能状况的评估有重要意义。