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.

Cost effectiveness analysis of population-based serology screening and ^(13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer:A markov model

AIM:To compare the costs and effectiveness of no screening and no eradication therapy, the population- based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy. METHODS:A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses. RESULTS:Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost- effectiveness of serology screening over the UBT was robust to most parameters in the model. CONCLUSION:The population-based serologyscreening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

Capsule ^(13)C-urea breath test for the diagnosis of Helicobacter pylori infection

AIM: To compare the accuracy of capsule 13C-urea breath test (UBT) with conventional invasive methods for the diagnosis of Helicobacter pylori infection.METHODS: One hundred patients received CLO test,histological examination, culture and 100- or 50-mg capsule UBT for the diagnosis of Hpyloriinfection. Hpylori infection was defined as those with positive culture or positive results from both histology and CLO test.RESULTS: Both the sensitivity and specificity of the 100-mg capsule UBT (n = 50) were 100%. The sensitivity and specificity of the 50-mg capsule UBT (n = 50) were 96.4and 100%, respectively. Taken together, the accuracy of capsule UBT (n=100) was higher than that of CLO test,histology and culture (100% vs 92%, 91% and 89%,respectively; P= 0.035, 0.018 and 0.005, respectively). Our data showed that the optimal timing of sampling for 100-and 50-mg capsule UBT was 15-30 and 6-15 min, respectively.CONCLUSION: Capsule UBT has a higher accuracy compared with biopsy-based tests. It is an ideal method for the diagnosis of Hpyloriinfection.

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.

Role of the^(13)C-methacetin breath test in the assessment of acute liver injury in a rat model

AIM: To evaluate the role of the 13C-methacetin breath test(13C-MBT) in the assessment of acute liver injury in a rat model.METHODS: Acute liver injury in rats was induced by a single intraperitoneal injection of D-galactosamine(D-GalN). Forty-eight male Sprague-Dawley rats were randomly assigned to a control group(n = 8) and five model groups(each n = 8), and acute liver injury was assessed at different time points(6, 12, 24, 48 and 72 h) after D-GalN injection. The 13C-MBT, biochemical tests, 15-min retention rate of indocyanine green(ICGR15), and liver biopsy were performed and compared between the control and model groups. Correlations between parameters of the 13C-MBT(Tmax, MVmax, CUM120 and DOBmax), biochemical tests, ICGR15 and liver necrosis score were also analyzed using Spearman'scorrelation analysis.RESULTS: Tmax, MVmax, CUM120 and DOBmax, as well as most of the traditional methods, correlated with the liver necrosis score(r = 0.493, P < 0.05; r =-0.731, P < 0.01; r =-0.618, P < 0.01; r =-0.592, P < 0.01, respectively). MVmax, CUM120 and DOBmax rapidly decreased and were lower than those in the controls as early as 6 h after D-GalN injection(3.84 ± 0.84 vs 5.06 ± 0.78, P < 0.01; 3.35 ± 0.72 vs 4.21 ± 1.44, P < 0.05; 52.3 ± 20.58 vs 75.1 ± 9.57, P < 0.05, respectively) and reached the lowest point 24 h after D-GalN injection. MVmax, CUM120 and DOBmax returned to normal levels 72 h after D-GalN injection and preceded most of the traditional methods, including liver biopsy.CONCLUSION: The 13C-MBT is a sensitive tool for the timely detection of acute liver injury and early prediction of recovery in a rat model. Further clinical studies are warranted to validate its role in patients with acute liver injury.

^(13)C-methacetin breath test reproducibility study reveals persistent CYP1A2 stimulation on repeat examinations

AIM: To find the most reproducible quantitative parameter of a standard 13C-methacetin breath test (13C-MBT). METHODS: Twenty healthy volunteers (10 female, 10 male) underwent the 13C-MBT after intake of 75 mg 13C-methacetin p.o. on three occasions. Short-and medium-term reproducibility was assessed with paired examinations taken at an interval of 2 and 18 d (medians), respectively. RESULTS: The reproducibility of the 1-h cumulative 13C recovery (AUC0-60), characterized by a coefficient of variation of 10%, appeared to be considerably better than the reproducibility of the maximum momentary 13C recovery or the time of reaching it. Remarkably, as opposed to the short gap between consecutive examinations, the capacity of the liver to handle 13C-methacetin increased slightly but statistically significantly when a repeat dose was administered after two to three weeks.Regarding the AUC0-60, the magnitude of this fixed bias amounted to 7.5%. Neither the time gap between the repeat examinations nor the gender of the subjects affected the 13C-MBT reproducibility. CONCLUSION: 13C-MBT is most reproducibly quantified by the cumulative 13C recovery, but the exactitude thereof may be modestly affected by persistent stimulation of CYP1A2 on repeat examinations.

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.

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.

Can pH Monitoring Predict Gastric Emptying Measured by ¹³C-Acetate Breath Test in Gastroesophageal Reflux with Neurological Impairment?

Introduction: Delayed gastric emptying (DGE) often occurs in patients with gastroesophageal reflux (GER) due to neurological impairment (NI). 13C has been used as an alternative tool for measuring the gastric emptying rates. The aim of this study was to predict gastric emptying in children with GER using 13C-acetate breath test (ABT) by 24-hour pH monitoring. Methods: Nineteen patients were divided into 2 groups: a DGE group with NI (14 patients), and normal-emptying group without NI (5 patients). The liquid test meal consisted of RacolTM (5 ml/kg) mixed with 13C-acetate (50 mg for infants, 100 mg for children, and 150 mg for adolescents). 13CO2 was measured using a gas chromatograph-isotope ratio mass spectrometer. The results are expressed as the % of 13C expired per hour and cumulative 13C excretion over a 3-hour periods including the parameters of half excretion and lag time. Results: The mean half excretion time was 1.762 hour in the DGE group and 1.095 hour in the normal-emptying group (P = 0.0196). The mean lag time was 0.971 hour in the DGE group and 0.666 hour in the normal-emptying group (P = 0.0196). Therefore, DGE was significantly more prevalent in the DGE compared to the normal-emptying group. The percentage of the time when the pH was less than 4 on 24-hour esophageal pH monitoring was 21.6% ± 9.2% in the DGE group and 28.5% ± 11.6% in the normal-emptying group (P = 0.4634). Conclusion: The percentage of time when the pH is less than 4 on 24-hour pH monitoring cannot predict DGE measured by the 13C-ABT in GER.

Breath and string test: A diagnostic package for the identification of treatment failure and antibiotic resistance of Helicobacter pylori without the necessity of upper gastrointestinal endoscopy

AIM: Helicobacter pylori (H pylori) resistance after failed eradication has a major impact on the outcome of a further treatment regimen. The aim of this study was to assess the validity of a non-invasive strategy using the 13C-urea breath test (UBT) and the gastric string test in identifying post-treatment resistance of H pylori. METHODS: The UBT was routinely performed 4 to 6 wk after H pylori eradication therapy. Forty-two patients (24 females, 18 males, mean age 48 years) with a positive UBT were included in the study. A gastric string test using a capsule containing a 90 cm-long nylon fiber was performed. Before the capsule was swallowed, the free end of the string was taped to the cheek. After one hour in the stomach, the string was withdrawn. The distal 20 cm of the string was inoculated onto an agar plate and processed under micro-aerophilic conditions. Following the string test, upper gastrointestinal endoscopy was performed to obtain gastric biopsies for conventional culture. RESULTS: H pylori was successfully cultured from the gastric string in 34 patients (81%), but not in 5 patients due to contamination with oropharyngeal flora. H py/oriwas cultured from the gastric biopsies obtained at endoscopy in 39 patients (93%). CONCLUSION: The UBT followed by the gastric string test in the case of treatment failure is a valid diagnostic strategy with the aim of determining the post-therapeutic antibiotic resistance of H pylori with little inconvenience to the patient. Upper Gl-endoscopy can be avoided in several cases by applying consequently this diagnostic package.

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。

^(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。

^(13)碳-尿素呼气试验评价尿素酶试验诊断幽门螺杆菌的价值

目的应用13碳-尿素呼气试验(13C-UBT)评估快速尿素酶试验诊断幽门螺杆菌(HP)的价值。方法选择胃镜活检组织快速尿素酶试验HP阴性的胃肠道疾病患者,行13C-UBT检测,并以非胃肠道疾病患者为对照。13C-UBT检查HP阳性病例分三组分别施行质子泵抑制剂(PPI)三联、PPI二联和单纯PPI治疗,治疗后复查13C-UBT,作为评价疗效指标。结果768例快速尿素酶试验HP阴性的患者中,460例13C-UBT结果为HP阳性,阳性率59.9%。对13C-UBT检测HP阳性病例三种治疗后转阴率分别为83.6%,16.4%和3.8%,组间差异显著(P<0.05)。结论对于胃镜胃黏膜组织快速尿素酶试验显示HP阴性的病例,应用13C-UBT有助于提高HP检出率和判断HP根除治疗效果。

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。

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。

^(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.

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。