孕产妇胃幽门螺杆菌感染常见检测方法的比较
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摘要
目的探讨几种不同检测方法对胃幽门螺杆菌(Hp)感染诊断的价值,从而寻求最适合孕产妇的检测方法。方法以13C尿素呼气试验(13C UBT)作为"金标准",对由于消化系统症状就诊的309例孕产妇分别采用Hp免疫球蛋白G(Ig G)抗体检测、酶联免疫试验(ELISA)、免疫印迹法(IBT)进行检测,观察各种检测方法诊断Hp感染的效果。结果 13C UBT与Hp Ig G抗体检测Hp检出率比较,差异具有统计学意义(χ~2=15.541,P<0.05)、13C UBT与ELISA检出率比较,差异具有统计学意义(χ~2=8.870,P<0.05),13C UBT与IBT检出率比较,差异无统计学意义(χ~2=0.428,P>0.05)。准确度方面,Ig G抗体检测为76.70%,ELISA为76.38%,IBT为85.11%。敏感度由高到低分别为Hp Ig G抗体检测、ELISA、IBT,特异度由高到低分别为IBT、ELISA、Hp Ig G抗体检测。Hp Ig G抗体检测Kappa值为0.424,ELISA为0.537,IBT为0.759。结论 Hp Ig G抗体检测可以作为Hp感染大批量的流行病学调查,但不适合胃Hp的筛查。ELISA操作简单,近乎无放射性污染,敏感度也相对较高,经常用于流行病学的调研及大批体检患者的检测。IBT诊断真实性中等,特异性相比较而言略高,检测结果可以对胃Hp的感染分型,对进一步深入了解病情变化做可靠的依据,可作为辅助诊断。
Objective To investigate diagnostic value of different detection measures for helicobacter pylori(Hp) infection, so as to select the most suitable method in detection. Methods 13 C urea breath test(13C UBT) was taken as gold standard for 309 pregnant women with gastrointestinal symptoms detected by Hp immune globulin G(Ig G) antibody test, enzyme-linked immuno sorbent assay(ELISA) and immunoblotting(IBT). Observation was made on effects by various measures in diagnosis of Hp infection. Results The difference of Hp detection rate had statistical significance between 13 C UBT and Ig G antibody test(χ2=15.541, P<0.05), and the difference of detection rate between 13 C UBT and ELISA also had statistical significance(χ2=8.870, P<0.05). There was no statistically significant difference of detection rate between 13 C UBT and IBT(χ2=0.428, P>0.05). Ig G antibody test had accuracy as 76.70%, ELISA as 76.38% and IBT as 85.11%. Hp Ig G antibody test, ELISA, and IBT respectively showed their sensitivity from high to low, while IBT, ELISA and Hp Ig G antibody test showed specificity from high to low. Hp Ig G antibody test had Kappa value as 0.424, ELISA as 0.537, IBT as 0.759. Conclusion As a common method for epidemiological investigation of massive Hp infection, Hp Ig G antibody test is not suitable for Hp screening. Due to its easy operation, non radioactive pollution and high sensitivity, ELISA is usually applied in epidemiological research and massive detection. IBT shows moderate accuracy in diagnosis and slightly high specificity, and its test outcome can classify Hp infection. Due to its creditable reference for further disease changes, it can be taken as assistant diagnosis.
Objective To investigate diagnostic value of different detection measures for helicobacter pylori(Hp) infection, so as to select the most suitable method in detection. Methods 13 C urea breath test(13C UBT) was taken as gold standard for 309 pregnant women with gastrointestinal symptoms detected by Hp immune globulin G(Ig G) antibody test, enzyme-linked immuno sorbent assay(ELISA) and immunoblotting(IBT). Observation was made on effects by various measures in diagnosis of Hp infection. Results The difference of Hp detection rate had statistical significance between 13 C UBT and Ig G antibody test(χ2=15.541, P<0.05), and the difference of detection rate between 13 C UBT and ELISA also had statistical significance(χ2=8.870, P<0.05). There was no statistically significant difference of detection rate between 13 C UBT and IBT(χ2=0.428, P>0.05). Ig G antibody test had accuracy as 76.70%, ELISA as 76.38% and IBT as 85.11%. Hp Ig G antibody test, ELISA, and IBT respectively showed their sensitivity from high to low, while IBT, ELISA and Hp Ig G antibody test showed specificity from high to low. Hp Ig G antibody test had Kappa value as 0.424, ELISA as 0.537, IBT as 0.759. Conclusion As a common method for epidemiological investigation of massive Hp infection, Hp Ig G antibody test is not suitable for Hp screening. Due to its easy operation, non radioactive pollution and high sensitivity, ELISA is usually applied in epidemiological research and massive detection. IBT shows moderate accuracy in diagnosis and slightly high specificity, and its test outcome can classify Hp infection. Due to its creditable reference for further disease changes, it can be taken as assistant diagnosis.
引文
[1]殷正进,李桂梅,曹晓卉.幽门螺杆菌三种检测方法的比较.诊断病理学杂志,2015,22(10):647-648.
[2]方汝花,周倩.幽门螺杆菌感染的常见临床实验室检测.医学信息(旬刊),2011,24(14):4631.
[3]刘莉,刘都礼,李佽,等.检测胃幽门螺旋杆菌三种染色方法比较.华西医学,2010(1):80-81.
[4]梁丽,石川.尿素14C呼气试验与组织病理学和细菌培养在检测幽门螺旋杆菌感染的比较.北方药学,2012,9(5):50-52.
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[6]李世霞.292例体检者幽门螺杆菌检测结果分析.中国肿瘤临床,2011,38(11):654-655.
[7]杨雁华,刘玉萍,程幼夫,等.应用13C-尿素呼气试验检测成都市健康体检者胃幽门螺杆菌感染情况分析.实用医院临床杂志,2013,10(2):71-73.
[8]杨锴毓,李雨庆,周学东.口腔幽门螺杆菌与胃幽门螺杆菌感染关系的研究进展.华西口腔医学杂志,2014(3):314-318.
[9]张盛洪,陈宏颖.胃幽门螺杆菌染色方法之比较.诊断病理学杂志,2014,21(2):123.
[10]Isobe H,Nishiyama A,Takano T,et al.Reduction of overall Helicobacter pylori colonization levels in the stomach of Mongolian gerbil by Lactobacillus johnsonii La1(LC1)and its in vitro activities against H.pylori motility and adherence.Bioscience Biotechnology&Biochemistry,2012,76(4):850-852.
[11]金明哲.幽门螺杆菌检测方法研究进展.检验医学与临床,2012,9(9):1099-1101.
[12]王凯娟,王润田.中国幽门螺杆菌感染流行病学Meta分析.中华流行病学杂志,2003,24(6):443-446.
[13]杜希英,秦绪记,杜光菊,等.13C呼气试验—一种非侵入的临床检查方法.标记免疫分析与临床,2010,17(3):202-205.
[14]Abrams SA,Griffin IJ,Hawthorne KM,et al.A combination of prebiotic short-and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents.American Journal of Clinical Nutrition,2005,82(2):471-476.
[15]Fujimoto Y,Shimoyama A,Suda Y,et al.Synthesis and immunomodulatory activities of Helicobacter pylori,lipophilic terminus of lipopolysaccharide including lipid A.Chem Inform,2012,356(38):37-43.
[16]沈世恩,毕其华,周欢琴.杭州地区体检人群幽门螺杆菌感染情况调查分析.中国卫生检验杂志,2014(11):1642-1643.
[17]董玲,孙剑勇,王吉耀.幽门螺杆菌感染不同检测方法的评价.中华消化杂志,2004,24(4):235-236.
[2]方汝花,周倩.幽门螺杆菌感染的常见临床实验室检测.医学信息(旬刊),2011,24(14):4631.
[3]刘莉,刘都礼,李佽,等.检测胃幽门螺旋杆菌三种染色方法比较.华西医学,2010(1):80-81.
[4]梁丽,石川.尿素14C呼气试验与组织病理学和细菌培养在检测幽门螺旋杆菌感染的比较.北方药学,2012,9(5):50-52.
[5]戈宏焱,陈博,刘会龙,等.13C尿素呼气实验检测老年人幽门螺杆菌的现症感染.中国老年学,2011,31(6):943-944.
[6]李世霞.292例体检者幽门螺杆菌检测结果分析.中国肿瘤临床,2011,38(11):654-655.
[7]杨雁华,刘玉萍,程幼夫,等.应用13C-尿素呼气试验检测成都市健康体检者胃幽门螺杆菌感染情况分析.实用医院临床杂志,2013,10(2):71-73.
[8]杨锴毓,李雨庆,周学东.口腔幽门螺杆菌与胃幽门螺杆菌感染关系的研究进展.华西口腔医学杂志,2014(3):314-318.
[9]张盛洪,陈宏颖.胃幽门螺杆菌染色方法之比较.诊断病理学杂志,2014,21(2):123.
[10]Isobe H,Nishiyama A,Takano T,et al.Reduction of overall Helicobacter pylori colonization levels in the stomach of Mongolian gerbil by Lactobacillus johnsonii La1(LC1)and its in vitro activities against H.pylori motility and adherence.Bioscience Biotechnology&Biochemistry,2012,76(4):850-852.
[11]金明哲.幽门螺杆菌检测方法研究进展.检验医学与临床,2012,9(9):1099-1101.
[12]王凯娟,王润田.中国幽门螺杆菌感染流行病学Meta分析.中华流行病学杂志,2003,24(6):443-446.
[13]杜希英,秦绪记,杜光菊,等.13C呼气试验—一种非侵入的临床检查方法.标记免疫分析与临床,2010,17(3):202-205.
[14]Abrams SA,Griffin IJ,Hawthorne KM,et al.A combination of prebiotic short-and long-chain inulin-type fructans enhances calcium absorption and bone mineralization in young adolescents.American Journal of Clinical Nutrition,2005,82(2):471-476.
[15]Fujimoto Y,Shimoyama A,Suda Y,et al.Synthesis and immunomodulatory activities of Helicobacter pylori,lipophilic terminus of lipopolysaccharide including lipid A.Chem Inform,2012,356(38):37-43.
[16]沈世恩,毕其华,周欢琴.杭州地区体检人群幽门螺杆菌感染情况调查分析.中国卫生检验杂志,2014(11):1642-1643.
[17]董玲,孙剑勇,王吉耀.幽门螺杆菌感染不同检测方法的评价.中华消化杂志,2004,24(4):235-236.