幽门螺杆菌粪便抗原检测PPT课件.ppt

幽门螺杆菌粪便抗原检测 幽门螺杆菌或幽门螺旋杆菌 幽门螺旋菌 学名 Helicobacterpylori 是革兰氏阴性 微需氧的细菌 生存于胃部及十二指肠的各区域内 它会引起胃黏膜轻微的慢性发炎 甚或导致胃及十二指肠溃疡与胃癌 超过80 的带原者并不会表露病征 世界超过50 人口在消化系统上部带原有幽门螺杆菌 感染较盛行于发展中国家 而西方国家的影响范围也逐渐缩小 幽门螺杆菌的传染途径不明 但个体通常是于幼时被感染 美国国立卫生研究院 NIH 提出大多数常见的胃炎疾病均由幽门螺杆菌所造成 在治疗过程应加入抗生素 在正确认识该细菌以前 胃溃疡病人通常会以中和胃酸及减少分泌的药物来治疗 但经此方法治疗后大多会复发 而胃炎患者则会服用碱式柳酸铋 这方法通常会见效 当时人们仍不知道其机制 后来才发现药物中的柳酸盐会杀死胃部的杆菌 可作为抗生素 现时 这类疾病会以抗生素来杀灭病菌 幽门螺杆菌是人类至今唯一一种已知的胃部细菌 HP感染是世界上最常见的人类细菌感染之一 被认为是慢性胃炎 消化性溃疡的主要原因 世界卫生组织 WHO 将HP列为第1类致病因子 长期的溃疡 会导致癌症 因此WHO宣布胃幽门杆菌为微生物型的致癌物质 也是第一个被确认可对人类致癌的原核生物 幽门螺杆菌简介 第四次全国幽门螺杆菌感染处理共识报告 对于无示警症状者的testandtreat策略 TestsforHelicobacterpyloriinfection 常用检测Hp方法对比总结 Title Evaluationofenzyme linkedimmunosorbentassayforthediagnosisofHelicobacterpyloriinfectioninchildrenfromdifferentagegroupswithandwithoutduodenalulcer Author deOliveira A M Rocha G A Queiroz D M Source JPediatrGastroenterolNutr 1999 28 2 157 161Abstract BACKGROUND METHODS Asecond generationELISAwasusedtoevaluatetheIgGresponsetoH pyloriintheserumof130consecutivechildrenwhounderwentuppergastrointestinalendoscopy ThepresenceofH pyloriwasdeterminedinantralbiopsyspecimensbyculture ureasetest andhistologicanalysis RESULTS Sixty eightchildren allofthe20whohadduodenalulcer wereH pyloripositivebymicrobiologictest ImmunoglobulinGantibodiestoH pyloriweredetectedin79 4 oftheinfectedchildrenandin8 1 ofthenoninfectedones Thesensitivityofthetestwashigherinpatientswithduodenalulcer 100 thaninthosewithout 70 8 Whenusedinchildrenofdifferentagesthetestalsopresenteddifferencesinsensitivity 44 4 inchildren2to6yearsold 76 7 inchildren7to11yearsold and93 1 inchildren12to16yearsold p 0 006 TheserumimmunoglobulinGconcentrationwassignificantlyhigher p 0 0003 inchildrenwithduodenalulcerthaninthosewithoutandwashigherinolderchildrenthaninyoungeroneswithoutduodenalulcer p 0 05 CONCLUSIONS Theaccuracyofthetestinchildrenwithduodenalulcerandinchildrenmorethan12yearsoldwasgood however inchildrenupto12yearsofagewithoutduodenalulcer thesensitivityofthetestwastoolowtobeusedforscreeningpurposesortoruleoutthepresenceofinfection 幽门螺杆菌血清学检测在儿童和青少年的灵敏度分析 1 Non invasiveserologicaltestshavebeenwidelyusedforthediagnosisofH pyloriinfection Inadults thismethodhasprovedtobehighlyaccuratetodiagnosetheinfection butinchildren especiallyyoungerones ELISAappearedtoshowlowsensitivityforthediagnosisofH pyloriinfectioninchildrenaged2to12years especiallyinthosewithoutduodenalulcer 2 幽门螺杆菌清除术后 血液中抗体仍长期存在 起不到监测评估疗效的作用 适合流行病学调查 3 多省暂无收费标准 幽门螺杆菌血清学检测评价 RESULTS Twenty twostudies including2 499patients evaluatedthemonoclonalSAT stoolantigentest beforeeradicationtherapy Pooledsensitivity specificity LR andLR were 0 94 95 CI0 93 0 95 0 97 0 96 0 98 24 15 41 and0 07 0 04 0 12 TheaccuracyofbothmonoclonalandpolyclonalSATwasevaluatedtogetherin13pretreatmentstudies andhigherpooledsensitivitywasdemonstratedwiththemonoclonaltechnique 0 95vs0 83 Twelvestudies including957patients assessedthemonoclonalSATtoconfirmeradicationaftertherapy Pooledsensitivity specificity LR andLR were0 93 0 89 0 96 0 96 0 94 0 97 17 12 23 and0 1 0 07 0 15 Bothtestswereevaluatedtogetherineightpost treatmentstudiesand again themonoclonaltechniqueshowedhighersensitivity 0 91vs0 76 Heterogeneityamongstudiesdisappearedwhenasingleoutlierstudywasexcluded Subanalysisdependingonthereferencemethod thestudypopulation orthestudyqualityshowedsimilarresults CONCLUSION MonoclonalSATisanaccuratenoninvasivemethodbothfortheinitialdiagnosisofH pyloriinfectionandfortheconfirmationofitseradicationaftertreatment Themonoclonaltechniquehashighersensitivitythanthepolyclonalone especiallyinthepost treatmentsetting AccuracyofmonoclonalstoolantigentestforthediagnosisofH pyloriinfection asystematicreviewandmeta analysis AmJGastroenterol2006 101 1921 1930 幽门螺杆菌粪便抗原检查 HpSA