胃大部切除术后患者幽门螺杆菌感染诊断方法的评估  

Assessment on the accuracy of diagnostic methods for Helicobacter pylori infection in patients with partial gastrectomy

作　　者：李晓波[1] 刘文忠[1] 戈之铮[1] 冉志华[1] 陈晓宇[1] 徐蔚文[1] 萧树东[1] 

机构地区：[1]上海第二医科大学仁济医院消化科上海市消化疾病研究所,200001

出　　处：《中华消化杂志》2002年第10期608-610,共3页Chinese Journal of Digestion

摘　　要：目的　评估胃大部切除术后患者中幽门螺杆菌 (Hp)感染状态和两种常用诊断方法 (14 C 尿素呼气试验、快速尿素酶试验 )的准确性。方法　用培养、组织学、14 C 尿素呼气试验 (14 C UBT)和快速尿素酶试验 (RUT)四种方法同时对胃大部切除术后患者进行Hp感染的诊断 ,以培养和组织学联合诊断作为“金标准” ,评估14 C UBT和RUT的准确性。以非手术者作对照 ,评估胃大部切除术后患者的Hp感染率。 结果　 37例胃大部切除术后患者 (BillrothⅠ式 17例和BillrothⅡ式 2 0例 )的Hp总阳性率为 2 9.7% ,BillrothⅠ式 (2 9.4% )和Ⅱ式 (30 .0 % )患者间Hp阳性率差异无显著性 (P >0 .0 5 )。RUT敏感性为 72 .7% ,特异性为 5 7.7% ,准确性为 6 2 .2 % ;14 C UBT敏感性为 6 3.6 % ,特异性为 10 0 .0 % ,阴性预示值 86 .7% ,准确性为 89.2 %。对照组Hp阳性率为 71.4%。 结论　胃大部切除术后患者Hp感染率低 ;RUT特异性低 ,14 C UBT敏感性低 。Objective To investigate the status of Helicobacter pylori(H.pylori) infection and the accuracy of the two commonly used diagnostic methods, the 14 C urease breath test( 14 C UBT) and the rapid urease test(RUT) in patients with partial gastrectomy due to peptic ulcer or gastric cancer. Methods Culture, histology, RUT, combined with 14 C UBT, were carried out to diagnose the H. pylori infection in patients with partial gastrectomy. The Giemsa staining and H.pylori culture served as the ‘golden reference’ in evaluating the diagnostic accuracy of the RUT and 14 C UBT. The prevalence of H.pylori infection of patients with partial gastrectomy was determined with the dyspeptic controls without surgery. Results 37 patients (17 Billroth Ⅰ resection, 20 Billroth Ⅱ resection) were included in the study. The overall prevalence in the Giemsa staining and culture proved as H.pylori infection was 29.7%, and no statistical difference was seen between patients will Billroth Ⅰ(29.4%) and Billroth Ⅱ(30.0%) resections. The sensitivity of the RUT was 72.7%, the specificity was 57.7%, and the overall accuracy was 62.2%. The sensitivity of the 14 C UBT was 63.6%, the specificity was 100.0%. The negative predictive value was 86.7%, and the overall accuracy was 89.2%. The total prevalence of H.pylori infection in the controls was 71.4%. Conclusion Prevalence of H.pylori infection in patients with partial gastric resection is low. The two diagnostic methods, 14 C UBT and RUT, cannot be recommended as accurate diagnostic tools for H.pylori infection in patients after partial gastrectomy due to low specificity and low sensitivity, respectively.

关 键 词：幽门螺杆菌 ^14C-尿素呼气试验 快速尿素酶试验 胃大部切除术 诊断 

分 类 号：R656.61[医药卫生—外科学]