幽门螺杆菌粪便抗原检测

1、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：Helicobacter pylori）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

2、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test an

3、d treat策略Tests for Helicobacter pylori infection常用检测Hp方法对比总结方法方法灵敏度灵敏度特异性特异性点评点评Rapid urease test98%99%快速准确有创伤治疗后检测灵敏度下降Histology95%95%可检测分析相关疾病有创伤技术经验要求高Culture特异性高（可达100%），灵敏度低，培养成功率低培养时间长主要用于药敏分析经验技术要求高PCR敏感特异抗药性基因分析技术要求严，难规范大规模应用ELISA serology85-92%79-83%准确性相对较低，特别对于儿童无创快速不能用于治疗后检测13C/14C urea b

4、reath test95%96%无创快速准确，治疗前后都适用价格较贵，13C更贵，14C具有放射性指导儿童等规范操作有难度HpSA95%94%无创快速准确最便宜对于儿童也有较好准确性不如血液和尿液检测流行Title: Evaluation of enzyme-linked immunosorbent assay for the diagnosis of Helicobacter pylori infection in children from different age groups with and without duodenal ulcer.Author: de Oliveira, A

5、. M.; Rocha, G. A.; Queiroz, D. M. (.)Source: J Pediatr Gastroenterol Nutr, 1999, 28(2): 157-161Abstract:BACKGROUND: . METHODS: A second-generation ELISA was used to evaluate the IgG response to H. pylori in the serum of 130 consecutive children who underwent upper gastrointestinal endoscopy. The pr

6、esence of H. pylori was determined in antral biopsy specimens by culture, urease test, and histologic analysis. RESULTS: Sixty-eight children (all of the 20 who had duodenal ulcer) were H. pylori positive by microbiologic test. Immunoglobulin G antibodies to H. pylori were detected in 79.4% of the i

7、nfected children and in 8.1% of the noninfected ones. The sensitivity of the test was higher in patients with duodenal ulcer (100%) than in those without (70.8%). When used in children of different ages the test also presented differences in sensitivity: 44.4% in children 2 to 6 years old; 76.7% in

8、children 7 to 11 years old, and 93.1% in children 12 to 16 years old (p = 0.006). The serum immunoglobulin G concentration was significantly higher (p = 0.0003) in children with duodenal ulcer than in those without and was higher in older children than in younger ones without duodenal ulcer (p = 0.0

9、5). CONCLUSIONS: The accuracy of the test in children with duodenal ulcer and in children more than 12 years old was good; however, in children up to 12 years of age without duodenal ulcer, the sensitivity of the test was too low to be used for screening purposes or to rule out the presence of infec

10、tion.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-invasive serological tests have been widely used for the diagnosis of H. pylori infection. In adults, this method has proved to be highly accurate to diagnose the infection, but in children, especially younger ones, ELISA appeared to show low sensitivity for the dia

11、gnosis of H. pylori infection in children aged 2 to 12 years, especially in those without duodenal ulcer.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-two studies, including 2,499 patients, evaluated the monoclonal SAT（stool antigen test） before eradication thera

12、py. Pooled sensitivity, specificity, LR+, and LR were: 0.94 (95% CI 0.930.95), 0.97(0.960.98), 24 (1541), and 0.07 (0.040.12). The accuracy of both monoclonal and polyclonal SAT was evaluated together in 13 pretreatment studies, and higher pooled sensitivity was demonstrated with the monoclonal tech

13、nique (0.95 vs 0.83). Twelve studies, including 957 patients, assessed the monoclonal SAT to confirm eradication after therapy. Pooled sensitivity, specificity, LR+, and LR were 0.93 (0.890.96), 0.96 (0.940.97), 17 (1223), and 0.1 (0.070.15). Both tests were evaluated together in eight post-treatmen

14、t studies and, again, the monoclonal technique showed higher sensitivity (0.91 vs 0.76). Heterogeneity among studies disappeared when a single outlier study was excluded. Subanalysis depending on the reference method, the study population, or the study quality showed similar results.CONCLUSION: Mono

15、clonal SAT is an accurate noninvasive method both for the initial diagnosis of H. pylori infection and for the confirmation of its eradication after treatment. The monoclonal technique has higher sensitivity than the polyclonal one, especially in the post-treatment setting.Accuracy of monoclonal sto

16、ol antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis(Am J Gastroenterol 2006;101:19211930)省份/地区项目编号项目名称项目内涵除外内容单位价格（元）说明文号广东省25040307913碳尿素呼气试验项230粤价2008127号广东省23050001414碳呼气试验包括各类呼气试验次92粤价2006131号广东省250403080幽门螺杆菌粪便抗原检查项55粤价2008127号河北省25040307913碳尿素呼气试验项200翼价管字200910号河北省23050001414碳呼气试验包括各类呼气试验次80冀价行费字200267号河北省250403080新开展项目：幽门螺杆菌粪便抗原检查