华西医学

华西医学

抗菌药物使用对儿童幽门螺杆菌检测方法的干扰

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目的 了解儿童抗菌药物使用对不同幽门螺杆菌(Helicobacter pylori,Hp)检测方法的敏感性干扰。 方法 2015 年 6 月—2017 年 12 月,收集四川大学华西第二医院高度疑诊 Hp 感染且需行胃镜检查的患儿,根据近期抗菌药物使用情况,分为抗菌药物组及对照组,每组 200 例。统计抗菌药物组患儿抗菌药物使用情况。两组患儿分别完成 5 种方法的 Hp 检测:快速尿素酶试验(rapid urease test,RUT)、碳 13 尿素呼气试验(13C-urea breath test,13C-UBT)、病理 Warthin-Starry 染色、胶体金法测 Hp 免疫球蛋白 M(immunoglobulin M,IgM)抗体及酶联免疫吸附分析法测粪便 Hp 抗原(Hp stool antigen,HpSA)。对两组数据进行对比分析。 结果 抗菌药物组与对照组 RUT 阳性率分别为 36.5%、75.0%(P<0.05);13C-UBT 阳性率分别为 59.0%、78.0%,测定值分别为 13.6±4.7、41.7±6.6,差异有统计学意义(P<0.05);病理活检阳性率分别为 48.0%、68.0%(P<0.05),抗菌药物组 Hp 的 L 型改变率为 80.9%;IgM 抗体阳性率分别为 54.5%、65.5%(P<0.05);HpSA 阳性率分别为 38.0%、69.0%(P<0.05)。抗菌药物组患儿中,仅 12.5% 用药目的是为行 Hp 根除,87.5% 为非 Hp 根除性用药。 结论 在抗菌药物使用干扰下,5 种 Hp 检测方法中,13C-UBT 敏感性最高,RUT 及 HpSA 敏感性均极低。对不能配合 13C-UBT 的患儿,IgM 检测敏感性较高。胃镜检查患儿建议 RUT 显色延时并配合多点病理检查,可减少漏诊。

Objective To explore the interference of recent use of antibiotics in the sensitivities of different methods for the detection of Helicobacter pylori (Hp) in children. Methods From June 2015 to December 2017, children who were highly suspected of Hp infection and required gastroscopy were divided into the antibiotic group and the control group according to the recent use of antibiotics, with 200 cases in each group. The use of antibiotics of children in the antibiotic group was analyzed. The children in the two groups completed five methods of Hp detection, including rapid urease test (RUT), 13C-urea breath test (13C-UBT), pathological Warthin-Starry staining, colloidal gold method for measuring Hp immunoglobulin M (IgM) antibody, and enzyme linked immunosorbent assay method for measuring Hp stool antigen (HpSA). Comparative analyses of data were done. Results The positive rate of RUT was 36.5% in the antibiotic group and 75.0% in the control group (P<0.05). The positive rate and value of13C-UBT were 59.0% and 13.6±4.7 in the antibiotic group, and 78.0% and 41.7±6.6 in the control group (P<0.05). The positive rate of pathological biopsy was 48.0% in the antibiotic group and 68.0% in the control group (P<0.05), and L-forms were found in 80.9% of the Hp-positive specimens in the antibiotic group. The positive rate of IgM antibody was 54.5% in the antibiotic group and 65.5% in the control group (P<0.05). The positive rate of HpSA was 38.0% in the antibiotic group and 69.0% in the control group (P<0.05). In the antibiotic group, only 12.5% of the children used antibiotics for eradication of Hp and 87.5% for non Hp eradication. Conclusions Under the interference of antibiotics use, the sensitivity of 13C-UBT is the highest among the five methods for Hp detection, and the sensitivities of RUT and HpSA are very low. For children who could not cooperate with 13C-UBT, the sensitivity of IgM detection is relatively high. For children who need gastroscopy, prolonged chromogenic time for RUT and multi-point pathological biopsy can reduce misdiagnosis.

关键词: 幽门螺杆菌; 抗菌药物; 儿科学

Key words: Helicobacter pylori; Antibiotic; Pediatrics

引用本文: 谢咏梅, 汪志凌, 王丽媛, 蔡晓唐, 高珊. 抗菌药物使用对儿童幽门螺杆菌检测方法的干扰. 华西医学, 2018, 33(12): 1513-1518. doi: 10.7507/1002-0179.201806126 复制

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