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.

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.

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.

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.

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.

^(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.

三种方案治疗小儿幽门螺杆菌相关胃病中焦积热证前后C^(13)-呼吸试验DOB值变化

目的:观察三种方案治疗小儿幽门螺旋杆菌(H.Pylori)相关胃病中焦积热证前后的C13-呼吸试验DOB值变化,寻找最佳治疗方案。方法:108例H.Pylori胃病患儿按1∶1∶1对照原则随机分为3组:中药组、西药组和中西药组,每组各36例。中药组口服安幽颗粒(大黄、槟榔、黄连、丹参、香附、白芍);西药组口服克拉霉素、洛赛克;中西药组口服同疗程安幽颗粒加克拉霉素、洛赛克。结果:H.Pylor临床转阴率,中药组、西药组和中西药组分别为38.24%、15.63%、66.67%,中药组与中西药组相比,存在统计学差异;西药组与中药组、中西药组相比,存在显著统计学意义(P<0.05);呼气试验DOB值指标变化方面,西药组与中西药组间存在显著的统计学差异(P<0.01);西药组与中药组间存在显著的统计学差异(P<0.05);中药组与中西药组间存在统计学差异(P<0.05)。结论:中西药结合治疗能使H.Pylori相关胃病中焦积热证小儿C13-呼吸试验DOB值明显下降,并能提高H.Pylori临床转阴率。

南京地区体检人群幽门螺杆菌^(13)C呼气试验与免疫分型结果分析

目的回顾分析南京地区体检人群幽门螺杆菌(Helicobacter pylori,Hp)^(13)C呼气试验与免疫分型结果,探讨本地区Hp感染的特征。方法对2022年度在南京市第一医院进行体检人群进行回顾性分析,采用^(13)C呼气试验和免疫印迹法进行Hp抗体分型检测,比较两种方法检测的感染率,以及不同性别、年龄分型结果的情况。结果^(13)C呼气试验与Hp抗体免疫分型阳性率分别为30.52%、54.29%,差异有统计学意义(χ^(2)=635.24,P<0.001)。按性别分析:^(13)C呼气试验男性阳性率为32.95%,女性阳性率为27.62%,差异有统计学意义(χ^(2)=50.456,P<0.001);Hp抗体免疫分型男性阳性率为56.59%,女性阳性率为51.88%,差异有统计学意义(χ^(2)=5.799,P=0.009)。男性感染率高于女性。按年龄分析显示^(13)C呼气试验<45岁组阳性率为29.71%,45~59岁组阳性率为32.17%,≥60岁组阳性率为30.14%,各组差异有统计学意义(χ^(2)=8.731,P=0.013)。Hp分型结果<45岁组阳性率为50.00%,45~59岁组阳性率为57.83%,≥60岁组阳性率为60.05%,组间差异有统计学意义(χ^(2)=22.386,P<0.001),45岁以上年龄组感染率高于45岁以下年龄组。Hp分型结果显示Ⅰ型、Ⅱ型感染率按性别和年龄分组,两者差异无统计学意义(χ^(2)=2.605,P=0.107)、(χ^(2)=3.833,P=0.147)。^(13)C呼气试验与Hp抗体免疫分型联合检测灵敏度为75.24%,特异性为75.39%,总符合率为75.32%。结论南京地区体检人群幽门螺杆菌男性感染率高于女性,45岁以上人群感染率偏高,免疫分型结果在不同分组间差别无统计学意义。

^(13)C-尿素呼气试验在不同年龄段儿童幽门螺杆菌感染中的诊断价值分析

目的探讨^(13)C-尿素呼气试验(^(13)C-UBT)在不同年龄段儿童幽门螺杆菌(Hp)感染中的诊断价值。方法228例疑似Hp感染患儿,将2~5岁患儿作为A组(62例),将6~17岁患儿作为B组(166例)。所有患儿均进行胃镜检查以及^(13)C-UBT、快速尿素酶试验(RUT)、Hp粪便抗原检测。记录所有患儿Hp感染情况;比较A组与B组患儿胃内胆汁反流发生情况,^(13)C-UBT假阴性与真阳性患儿胃内胆汁反流发生情况以及^(13)C-UBT检测Hp阳性的敏感度、特异度和准确度。结果联合检测Hp感染率86.4%(197/228)高于^(13)C-UBT检出阳性率65.4%(149/228),差异有统计学意义(P<0.05)。197例Hp感染患儿中胃内胆汁反流发生率为15.7%(31/197),其中B组胃内胆汁反流发生率为20.1%(28/139),高于A组的5.2%(3/58),差异具有统计学意义(P<0.05)。228例患儿中^(13)C-UBT检测Hp的敏感度为75.6%,特异度为96.8%,准确度为78.5%,阳性预测值为99.3%(149/150),阴性预测值为38.5%(30/78)。A组中^(13)C-UBT检测Hp的敏感度89.7%和准确度90.3%均明显高于B组的69.8%、74.1%,差异均具有统计学意义(P<0.05);两组的特异度比较,差异无统计学意义(P>0.05)。在^(13)C-UBT假阴性患儿中胆汁反流发生率35.4%(17/48)明显高于^(13)C-UBT真阳性患儿的9.4%(14/149),差异有统计学意义(P<0.05)。结论^(13)C-UBT在儿童Hp感染检测中的特异性和阳性预测值均较高,尤其在2~5岁儿童中具有相对较高的敏感度和准确度,对于^(13)C-UBT检测为阴性而临床疑似Hp感染的患儿,应联合其他检测方法进一步检查确诊,避免漏诊发生。

四位一体知信行健康教育模式在儿童^(13)C-尿素呼气试验检测中的应用研究

目的探讨四位一体知信行健康教育模式在儿童13C-尿素呼气试验检测中的应用效果。方法选择2021年7月一2022年2月于广西壮族自治区妇幼保健院就诊的300名儿童,以随机数字表法分为2组,各150名,对照组采用常规健康教育指导,试验组采用四位一体知信行行为理论健康教育模式指导。对比分析2组^(13)C一尿素呼气试验检测吹气方法的掌握率、依从性、家属满意度。结果试验组的^(13)C一尿素呼气试验检测吹气方法的掌握率、依从性、家属满意度均高于对照组,差异有统计学意义(P<0.05)。结论将四位一体知信行健康教育模式应用于儿童^(13)C一尿素呼气试验检测可有效提高儿童依从率及家长满意度,值得推广。

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.

血清胃泌素-17及胃蛋白酶原联合C^(13)呼气试验检测在健康体检中的应用研究

目的探讨血清胃泌素-17(G-17)及胃蛋白酶原(PG)联合C^(13)呼气试验检测在健康体检中的应用价值,确立G-17筛查慢性萎缩性胃炎的cut-off。方法随机选择2017年1-12月在该院行胃镜检查的体检人员396例,按病理组织学诊断分为非萎缩性胃炎组(261例)、萎缩性胃炎组(104例)、胃溃疡组(31例),用酶联免疫吸附测定(ELISA)定量测定血清PG-Ⅰ、PG-Ⅱ、G-17水平,按试验盒说明书,以PG-Ⅰ<70μg/L或PGR(PG-Ⅰ/PG-Ⅱ)<7.0为阳性。所有研究对象均行C^(13)呼气试验,以超基准值4.0倍为幽门螺杆菌(HP)阳性。结果非萎缩性胃炎组、萎缩性胃炎组、胃溃疡组的血清PG-Ⅰ、PGR水平差异有统计学意义(P<0.05),血清PG-Ⅱ水平各组间差异无统计学意义(P>0.05);各组间比较,萎缩性胃炎组血清PG-Ⅰ、PGR水平显著低于其他两组。萎缩性胃体炎组、全胃多灶性萎缩性胃炎组血清PG-Ⅰ水平较萎缩性肾窦炎组明显降低(P<0.01),萎缩性胃窦炎组、全胃多灶性萎缩性胃炎组血清G-17水平较萎缩性胃体炎组明显降低(P<0.01)。在血清PG-Ⅰ、PGR及C^(13)呼气试验中,任意一项阳性即判定为血清PG联合C^(13)呼气试验阳性,萎缩性胃炎组阳性率明显高于非萎缩性胃炎组及胃溃疡组,3组间差异有统计学意义(P<0.05),血清PG联合C^(13)呼气试验检测萎缩性胃炎灵敏度为88.46%,特异度为78.68%,阳性预测值为65.74%,阴性预测值为94.41%;其中灵敏度、阳性预测值及阴性预测值均明显高于单独血清PG检测(P<0.05)。根据ROC曲线,判断G-17诊断萎缩性胃炎的曲线下面积为0.78,cut-off值为7.81pmol/L,约登指数为0.46。结论血清G-17及PG联合C^(13)呼气试验检测可以作为一种无创性的大规模筛查胃部疾病的有效手段,适合对健康人群推广。

胃蛋白酶原、胃泌素17联合^(13)C尿素呼气试验在早期胃癌筛查中的应用

目的探讨胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、胃泌素17(G-17)联合^(13)C-尿素呼气试验(^(13)C-UBT)检测在早期胃癌筛查中的应用价值。方法选取2019年6月—2022年6月因消化道症状在武汉市第一医院接受胃镜和病理学检查的156例患者,根据组织病理学诊断结果分为非萎缩性胃炎组(37例)、萎缩性胃炎组(21例)、早期胃癌组(24例)、进展期胃癌组(37例)和胃溃疡组(37例)。采用酶联免疫吸附法检测各组患者的血清PGⅠ、PGⅡ、G-17水平,采用^(13)C-UBT试验检测幽门螺杆菌(Hp)感染情况。结果5组患者血清PGⅠ、G-17水平和Hp感染率比较,差异均有统计学意义(P<0.05);5组患者血清PGⅡ水平比较,差异无统计学意义(P>0.05)。受试者工作特征(ROC)曲线分析结果显示,血清PGⅡ诊断早期胃癌的曲线下面积(AUC)为0.405(95%CI:0.228~0.582,P>0.05);血清PGⅠ、G-17及Hp感染诊断早期胃癌的AUC分别为0.815、0.709、0.649(95%CI:0.669~0.961、0.538~0.880、0.481~0.817,均P<0.001);血清PGⅠ、G-17及Hp感染联合检测诊断早期胃癌的AUC为0.874(95%CI:0.731~0.982,P<0.001),敏感度为89.5%,特异度为60.31%。结论血清PGⅠ、G-17及^(13)C-UBT检测对早期胃癌筛查具有重要的预警作用,联合检测可提高早期胃癌诊断准确率。

^(13)C尿素呼气试验DOB值与上消化道疾病的相关性

目的探究^(13)C尿素呼气试验超级准值(^(13)C-UBT DOB值)与上消化道疾病类型及慢性萎缩性胃炎(CAG)胃黏膜病理分级的关系。方法回顾性选取^(13)C-UBT阳性(DOB≥4.0‰)同时完善胃镜检查的596例患者,纳入呈阴性(DOB<4.0‰)诊断为CAG患者25例作为对照,分析DOB值与上消化道疾病类型及CAG胃黏膜病理分级的相关性。结果入组患者中女性DOB值显著高于男性,DOB值与上消化道疾病类型的关系有统计学意义,慢性胃炎、消化性溃疡、胃癌的DOB值呈下降趋势。DOB值与胃黏膜萎缩、肠化程度差异具有统计学意义,中度及以上萎缩、肠化患者,DOB值呈下降趋势;与炎症、炎症活动性程度未见相关性,说明DOB值不能预测疾病及胃黏膜损伤的严重程度,对于低DOB值患者同样需要重视。结论DOB值定量对于临床中推测上消化道疾病、胃黏膜损伤程度有一定价值,但不能作为诊断Hp感染相关疾病及判断胃黏膜损伤程度的依据。

^(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-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。

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．