聚合酶链反应方法检测儿童幽门螺杆菌的临床价值  

The clinical value of the polymerase chain reaction technique in detection of pediatric helicobacter pylori infection

作　　者：王文妤 蒋丽蓉[1] 邓朝晖[1] 赵瑞柯 莫茜[2] 曹清 Wang Wenyu;Jiang Lirong;Deng Zhaohui;Zhao Ruike;Mo Qian;Cao Qing(Gastroenterology Department, Shanghai Children＇s Medical Center, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属儿童医学中心消化科,200127 [2]上海交通大学医学院附属儿童医学中心感染科,200127

出　　处：《中国小儿急救医学》2018年第3期212-215,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨聚合酶链反应（polymerase chain reaction，PCR）方法检测幽门螺杆菌（helicobacter pylori，HP）在儿童消化道疾病的临床价值。方法2016年12月至2017年8月因消化道症状就诊且有指征接受上消化道内镜检查的患儿共130例，入组120例，年龄3-17岁。胃镜直视下取胃窦黏膜2块，并吸取胃液。一块组织黏膜行病理学检测，另一块组织黏膜与胃液一同行PCR检测，用UreC、HP-16s、CSTP三对引物同时进行HP检测，用Cag750和Cag595两对引物同时检测细胞毒素相关基因A蛋白（CagA）。结果胃镜检查检出上消化道溃疡28例（23.33%），病理学方法检出HP 26例（21.67%），PCR方法检出41例（34.17%），PCR检查HP检出率明显高于病理学方法HP检出率，差异有统计学意义（χ^2＝4.659，P＝0.031）。通过病理学方法检测HP，有消化性溃疡和无消化性溃疡的患儿标本分别检出14例（50.00%）和12例（13.04%），检出率差异有统计学意义（χ^2＝17.275，P〈0.001）；通过PCR检测HP，有消化性溃疡和无消化性溃疡的患儿标本分别检出16例（57.14%）和25例（27.17%），检出率差异有统计学意义（χ^2＝8.572，P＝0.003）；通过PCR检测CagA，有消化性溃疡和无消化性溃疡的患儿标本均检出7例（25.00%比7.61%），检出率差异有统计学意义（χ^2＝6.300，P＝0.012）。结论PCR法可以快速敏感准确地检测HP及其CagA基因；取胃黏膜及胃液同时行PCR检测，可提高HP检出率，建议PCR法和病理学方法结合作为儿童HP的检测方法。ObjectiveTo investigate the clinical value of the polymerase chain reaction（PCR）technique in detection of pediatric helicobacter pylori（HP）infection.MethodsA total of 130 children with different digestive tract symptoms received esophagogastroduodenoscopy,and 120 children between 3 and 17 years old were enrolled.The gastric antrum mucosa was taken under the gastroscope for 2 blocks,and the gastric juice was absorbed as the specimen.One block of gastric antrum mucosa was examined histopathologically,and the other block of gastric antrum mucosa and gastric juice were examined by PCR.We used the primers UreC,HP-16s,CSTP to detect HP,and then used the primers Cag750 and Cag595 to detect CagA.ResultsA total of 28 cases（23.33%）of upper gastrointestinal ulcer were detected by gastroscopy,and HP was detected by histopathological method in 26 cases（21.67%）,and 41 cases（34.17%）were detected by PCR method.The detection rate of HP by PCR was significantly higher than that of HP in pathological method（χ^2=4.659,P=0.031）.By pathological examination of HP,14 cases（50%）and 12 cases（13.04%）with peptic ulcers and no peptic ulcers were detectd,and the difference in detection rate was statistically significant（χ^2=17.275,P〈0.001）.Samples of children with peptic ulcers and no peptic ulcers were detected in 16 cases（57.14%）and 25 cases（27.17%）by PCR,and the difference in detection rate was statistically significant（χ^2=8.572,P=0.003）.The CagA were detected in 7 cases of peptic ulcers and 7 cases of non peptic ulcers by PCR,and the difference in detection rate was statistically significant（25.00% vs 7.61%,χ^2=6.300,P=0.012）.ConclusionThe PCR method could quickly and sensitively detect the HP and its CagA gene,and the detection of gastric mucosa and gastric juice by PCR could improve the detection rate of HP.A combination of PCR and pathological method is suggested as the detection method for children′s HP infection.

关 键 词：儿童 幽门螺杆菌 病理组织学 聚合酶链反应 细胞毒素相关基因A蛋白 

分 类 号：R725.7[医药卫生—儿科]