4种检测方法在幽门螺杆菌感染中的临床诊断价值分析

doi:10.19871/j.cnki.xfcrbzz.2023.05.009

新发传染病电子杂志 ›› 2023, Vol. 8 ›› Issue (5): 46-51.doi: 10.19871/j.cnki.xfcrbzz.2023.05.009

4种检测方法在幽门螺杆菌感染中的临床诊断价值分析

陈海婷^1,2, 张淑贞², 李雪宏², 刘爱军³, 杨维青¹

1.广东医科大学医学技术学院,广东省医学分子诊断重点实验室,东莞市活性分子重点实验室,广东东莞 523808;
2.深圳市大鹏新区葵涌人民医院检验科,广东深圳 518119;
3.深圳市大鹏新区葵涌人民医院消化内科,广东深圳 518119

收稿日期:2023-05-06 出版日期:2023-10-31 发布日期:2023-12-05
通讯作者: 杨维青,Email：310660622@qq.com

Analysis of clinical diagnostic value of four detection methods in Helicobacter pylori infection

Chen Haiting^1,2, Zhang Shuzhen², Li Xuehong², Liu Aijun³, Yang Weiqing¹

1. Dongguan Key Laboratory of Medical Bioactive Molecular, Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, College of Medical Technology,Guangdong Medical University, Guangdong Dongguan 523808, China;
2. Clinical Laboratory Department of Shenzhen Dapeng New District Kuichong People's Hospital, Guangdong Shenzhen 518119, China;
3. Gastroenterology Department of Shenzhen Dapeng New District Kuichong People's Hospital, Guangdong Shenzhen 518119, China

Received:2023-05-06 Online:2023-10-31 Published:2023-12-05

摘要/Abstract

摘要： 目的评价幽门螺杆菌（H.pylori）感染常用检测方法的临床性能及应用价值,为临床诊断的选择提供参考依据。方法选取2020年1月至2022年1月期间深圳市大鹏新区葵涌人民医院消化内科收治的有上消化道症状的患者276例,对患者进行¹³C尿素呼气试验(¹³C-UBT)和胃镜检查,采集其胃黏膜标本分别进行快速尿素酶试验（RUT）、细菌培养及病理组织学检查,以病理组织学检测结果作为“金标准”,对上述各种检测方法的结果进行比对及统计学处理。结果 ¹³C-UBT、胃镜、RUT、细菌培养、组织学检查结果阳性检出率分别为91.30%(252/276)、65.58%(181/276)、79.71%（220/276）、73.19%（223/276）、90.22%（249/276）;各种检测方法效能从高到低排序,敏感度¹³C-UBT>RUT>细菌培养>胃镜检查、特异度细菌培养>¹³C-UBT>胃镜检查>RUT;一致性检验¹³C-UBT（Kappa=0.935）较好,细菌培养和RUT分别为(Kappa=0.624)、(Kappa=0.431)一般,胃镜(Kappa=0.246) 较差。通过ROC曲线比较分析各种检测方法诊断效果依次为联合试验（¹³C-UBT+组织学）>¹³C-UBT>细菌培养>RUT>胃镜检查。结论 ¹³C-UBT是非侵入性检测H.pylori感染的最佳方法;电子胃镜诊断H.pylori感染的敏感度、准确性较差;而细菌培养H.pylori虽特异性高,但敏感度相对较低、时间长、技术要求高;RUT临床诊断效能明显不及病理组织学检查。目前,胃镜异常加病理组织学检查已成为临床常规,对于行胃镜检查的患者,¹³C-UBT联合病理组织学是H.pylori感染临床诊断最佳检查模式。

关键词: 幽门螺杆菌, 检测方法, 临床诊断, 价值分析

Abstract: Objective To evaluate the clinical performance and application values of common detection tools for Helicobacter pylori (H.pylori) infection, and provide guidance for the clinical diagnosis of H.pylori. Method From January 2020 to January 2022, a total of 276 patients who had upper gastrointestinal symptoms were selected to undertake the electronic gastroscopy and ¹³C-urea breath examination (¹³C-UBT) in the Gastroenterology Department of Shenzhen Dapeng New District Kuichong People's Hospital. Their gastric mucosa samples were collected for rapid urease test (RUT), bacterial culture and histopathological tests. In this study, the results of histopathological tests were taken as the "gold standard", other detection methods were compared and statistically analyzed. Result The positive rates of ¹³C-UBT, electronic gastroscopy, RUT, bacterial culture and histology were 91.30% (252/276), 65.58% (181/276), 79.71% (220/276), 73.19% (223/276) and 90.22% (249/276) respectively. The efficiency of various detection methods was ranked from high to low. Sensitivity：¹³C-UBT>RUT>bacterial culture >gastroscopy; Specificity：bacterial culture >¹³C-UBT> gastroscopy >RUT. The consistency test of ¹³C-UBT (Kappa=0.935) was the best. The Kappa value of bacterial culture and RUT were 0.624 and 0.431 respectively. But the Kappa value of (Kappa=0.246) gastroscopy was poor. ROC curve was used to compare and analyze the diagnostic effect of various detection methods: combination test (¹³C-UBT+ histology) >¹³C-UBT >bacterial culture >RUT >gastroscopy. Conclusion¹³C-UBT is the best non-invasive method to detect H.pylori infection. The sensitivity and accuracy of electronic gastroscopy of H.pylori infection diagnosis are poor. Although the specificity of bacterial culture is high, its sensitivity is relatively low. It costs long time and requires complex techniques. The performance of RUT is obviously inferior to that of histopathological examination. At present, gastroscopy plus histopathological examination has become a clinical routine. For patients requiring gastroscopy, ¹³C-UBT combined with histopathological examination is the optimal detection mode for the clinical diagnosis of H.pylori infection.

Key words: Helicobacter pylori, Detection method, Clinical diagnosis, Value analysis

中图分类号:

R372
R446

陈海婷, 张淑贞, 李雪宏, 刘爱军, 杨维青. 4种检测方法在幽门螺杆菌感染中的临床诊断价值分析[J]. 新发传染病电子杂志, 2023, 8(5): 46-51.

Chen Haiting, Zhang Shuzhen, Li Xuehong, Liu Aijun, Yang Weiqing. Analysis of clinical diagnostic value of four detection methods in Helicobacter pylori infection[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(5): 46-51.

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4种检测方法在幽门螺杆菌感染中的临床诊断价值分析

Analysis of clinical diagnostic value of four detection methods in Helicobacter pylori infection

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