Comparison of Three Different Non-Invasive Methods for Detecting Helicobacter Pylori Infection in Children

三種非侵襲性幽門桿菌檢測法在孩童之比較

郭昭宏(Chao-Hung Kuo) ； 盧建宇(Chien-Yu Lu) ； 蘇育正(Yu-Chung Su) ； 余方榮(Fang-Jung Yu) ； 李易諶(Yi-Chen Lee) ； 楊淵傑(Yuan-Chieh Yang) ； 吳宜珍(I-Chen Wu) ； 王聖雯(Sheng-Wen Wang) ； 黃玉燕(Yu-Yen Huang) ； 楊曉芳(Shao-Fang Yang) ； 張玲麗(Lin-Li Chang)

《臺灣消化醫學雜誌》 22卷3期 (2005/09) Pp. 213-220

https://doi.org/10.6557/GJT.200509_22(3).0001

摘要

背景：幽門螺旋桿菌(H.pylori)的感染多發生在孩童時期，此外針對孩童亦有人報告幽門螺旋桿菌與蛋白質流失腸病變、缺鐵性貧血等疾病有關，所以幽門螺旋桿菌的診斷及確認就相當重要。然而台灣地區關於幽門螺旋桿菌在孩童時期盛行率的研究仍不多，以往對孩童之研究多以血清抗體測試為主，所以並不能完全反映出真正幽門螺旋桿菌之盛行率。雖然目前各種非侵襲性之幽門螺旋桿菌檢測法進展甚多，但研究報告多以大人為主。
目的：比較三種非侵襲性的檢查法在孩童之幽門螺旋桿菌診斷上的敏感性及專一性、陽性預測值及陰性預測值。
病人及方法：受試者143名（6至12歲，平均9.57±2.04歲，男：女＝46:36)，事先由家長簽署臨床試驗同意書，並填寫一份家庭工作生活問卷表。一個月內未曾接受抗生素治療、鉍鹽治療或質子幫浦抑制劑治療及未曾接受胃腸道手術者，進入本研究。每名小朋友均收取尿液，糞便及血液之檢體，並接受碳－13尿素呼氣法(13C-UBT)之檢驗，在此我們使用之13C劑量為50mg，尿液施行RapidRun test，糞便施行HpSA test，血液則進行Signify test。幽門螺旋桿菌感染之確定：13C-UBT呈陽性反應。統計方法：以Chi-square分析法來分析，p值設定為0.05。
結果：1.在143位孩童中，有12位(8.4%)被檢測出有幽門螺旋桿菌感染，而其餘之131位(91.2%)無幽門螺旋桿菌感染。我們也發現隨著年齡增加幽門螺旋桿菌之陽性率也有升高之趨勢。
2.三種非侵襲性之幽門螺旋桿菌檢測法之比較：在RapidRun法中，有10位孩童呈陽性結果（其中一位是偽陽性）。它的敏感性與專一性分別為75%及99.2%，而正確率為97.2%。在HpSA法中，有10位孩童呈陽性結果（其中4位是偽陽性）。它的敏感性與專一性分別為50%及96.7%，而正確率為93.0%。在Signify法中，有9位孩童呈陽性結果（其中一位是偽陽性）。它的敏感性與專一性分別為66.7%及99.2%，而正確率為96.5%。
結論：依照我們的結果，這三種非侵襲性檢測法均有90%以上之正確率，因此應適合用於篩檢。其中又以尿液之RapidRun法更適用於檢測孩童是否有幽門螺旋桿菌感染。因為尿液檢體之取得不僅容易、便宜、安全且較準確。

關鍵字

幽門螺旋桿菌感染 ； 非侵襲性檢測法 ； 孩童

並列摘要

BACKGROUND/AIMS: There are many kinds of non-invasive tests used for detection of H. pylori infection in children. They are designed for different targets: 13C-UBT for detecting the presence of urease in stomach; HpSA for detecting H. pylori antigen in stool; RapidRun for detecting urinary H. pylori antibody; Signify for detecting H. pylori antibody in whole blood. So we want to access the reliability of these newly developed non-invasive tests.
METHODOLOGY: This study included 143 children (69 boys and 74 girls; mean age: 9.2 years-old.; range, 5-14 years-old.). They were volunteers. All these children did not receive endoscopic examination. They all received 13C-UBT as the golden standard test. We also collected their stool, urine, and serum to perform the following tests: HpSA, RapidRun and Signify H pylon test. Exclusion criteria were the following: antibiotic, bismuth salts, or proton pump inhibitor therapy in the last 2 months, previous anti-H.pylori treatment; chronic use of corticosteroids or immunosuppressant drugs; prior gastric surgery; presence of a bleeding peptic ulcer; severe concomitant disease. The statistical analysis use Chi-square test and P value was defined as 0.05.
RESULTS: In these 143 children, 12 (8.4%) were regarded as H pylon-infected and 131 (91.2%) were regarded as uninfected. We found a trend that the prevalence rate is increased when age is older RapidRun was positive in 10 cases (1 of which was false positive). Its sensitivity and specificity was 75% and 99.2%, respectively. The accuracy rate was 97.2%. HpSA was positive in 10 cases (4 of which were false positives) and its sensitivity and specificity were 50% and 96.7%, respectively. The accuracy rate was 93.0%. Signify was positive in 9 cases (1 of which was false positive) and its sensitivity and specificity were 66.7% and 99.2%, respectively. The accuracy rate was 96.5%.
CONCLUSIONS: In according to our study, these three non-invasive tests all showed acceptable accuracy rate above 90%. 13C-UBT is a most suitable non-invasive screening test for children. And urine-based test may be a better alternative choice for detecting H. pylori infection in children. Not only urine specimen is easier cheaper and safer to obtain it, but also this kind of test is reliable and suitable for children.

並列關鍵字

H. pylori infection ； non-invasive test ； children