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- The Accuracy of the Rapid Urease Test and丨C-Urea Breath Test in the Diagnosis of Helicobacter Pylori Infection
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題名 | The Accuracy of the Rapid Urease Test and丨C-Urea Breath Test in the Diagnosis of Helicobacter Pylori Infection=快速尿素酶測試法及碳-13尿素呼吸測試法在診斷幽門螺旋桿菌感染之準確性 |
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作 者 | 何愛生; 楊東和; 徐榮源; 葉淳; 曾暉華; 李瑞成; 李美旋; 許重得; | 書刊名 | 中華醫學雜誌 |
卷期 | 58:6 1996.12[民85.12] |
頁次 | 頁400-406 |
分類號 | 415.526 |
關鍵詞 | 丨C-urea breath test; 碳-13尿素呼吸測試法; 血清學診斷法; 幽門螺旋桿菌; 快速尿素酶測試法; ELISA; Helicobacter pylori; Rapid urease test; |
語文 | 英文(English) |
中文摘要 | 背景 幽門螺旋桿菌是形成消化性潰瘍的重要致病因子。檢測的方法 雖多,卻無一致的標準作法。本研究之目的即是比較臨床上常用來診斷該菌各 方法間的準確度及實用性。 方法 113位納入研究的病患,皆接受胃鏡合併胃黏膜組織學、快速尿素(脢) 測試法、血清學診斷法及碳-13尿素呼吸測試法的檢測。以尿素呼吸測試法中碳 -13濃度差的千分之五當作正常值的上限。並將進入本研究的前60位病患,以 多次呼吸取樣的方法分別在碳-13尿素溶液服下後的第15、30及60分鐘分別收 集檢體。依照Whitehead學者的分類將胃炎分成4級;並將4種檢驗幽門螺旋桿 菌方法中具有3種以上方法為陽性的病例當作診斷陽性的金標準。 結果 依照本研究的診斷金標準,十二指腸潰瘍、胃潰瘍、胃炎及無症狀者之 幽門螺旋桿菌陽性率分別為97.9%、81.8%、47.6%及13.6%,快速尿素(脢)測試 法及尿素呼吸測試法均具較高的敏感性 (93.6%及96.2%) 及準確度 (93.8%及 93.8%)。快速尿素(脢)測試法比尿素呼吸測試法的特異性及陽性預期值稍高,分 別為94.3%及88.6%,97.3%及94.9%。四種測試方法中,敏感性最低者為Giemsa 染色法 (87.2%),特異性最低者則為血清學診斷法 (71.4%)。胃炎程度和呼吸測 試法中碳-13的濃度差呈正相關性 (r值為0.576,p < 0.001)。 結論 快速尿素(脢)測試法及碳-13尿素呼吸測試法皆具極高的診斷準確性, 操作亦十分容易。故建議當前者的測試結果呈陽性時,不需再加作其他檢測法。 然而當病患不願作胃鏡時,碳-13尿素呼吸測試法將成為診斷或療效追蹤的最佳 選擇。 |
英文摘要 | Background. Helicobacter pylori (H. pylori) is an important predisposing factor in peptic ulcer disease. Many tests have been proposed, but there is no generally accepted single method for the detection of H. pylori. This study compared the four available methods in the detection of H. pylori. Methods. One hundred and thirteen patients were studied with endoscopic biopsy. Biopsy specimens were examined with modified Giemsa stain and rapid urease (CLO) test. Serology (ELISA) and l3C-urea breath test (l3C-UBT) were also performed. The l3C-UBT results were expressed at an excess delta l3CO2 excretion of 5 per mil as the upper limit. Multiple breath samples were collected 15, 30 and 60 minutes following l3C-urea ingestion (t=15, 30, 60) in the first 60 patients. Gastric inflammatory changes were graded according to the Whitehead classification. The diagnostic gold standard was defined when three or more of the four test parameters showed positive. Results. According to this diagnostic gold standard, the positive rates of H. pylori were 97.9% for duodenal ulcer, 81.8% for gastric ulcer, 47.6% for symptomatic gastritis and 13.6% for asymptomatics. Rapid urease test and the l3C-UBT had better sensitivity (93.6% and 96.2%) and accuracy (93.8% and 93.8%). The specificity and positive predictive value for rapid urease test was better than l3C- UBT (94.3% vs 88.6%, 97.3% vs 94.9% respectively). Modified Giemsa stain had the lowest sensitivity (87.2%), and the ELISA test had the lowest specificity (71.4%). Severity of the gastric inflammatory processes was directly correlated with the excess delta l3CO2 (r = 0.576). Conclusions. Both the CLO and l3C-UBT had higher accuracy in the detection of H. pylori. When the CLO test result is positive, there is little additional diagnostic benefit from performing other tests. If patients refuse endoscopic examination, l3C-UBT is a good alternative for the detection of H. pylori, either during diagnosis or follow-up after therapy. |
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