Evaluation of Topographic Gastric Histology in H. pylori Infection - A Comparative Study with CLO Test and Bacterial Culture

胃內不同解剖位置的組織切片在幽門螺旋菌感染的臨床價值並和尿素酵素反應測試及細菌培養等診斷技術做比較

楊曉白(Hsiao-Bai Yang) ； 許博翔(Bor-Shyang Sheu) ； 簡崇和(Chung-Ho Chien) ； 黃愛惠(Ay-Huey Huang) ； 謝淑珠(Shu-Chu Shiesh) ； 林錫璋(Xi-Zhang Lin) ； 吳俊忠(Jiunn-Jong Wu) ； 蘇益仁(Ih-Jen Su)

《慈濟醫學雜誌》 10卷3期 (1998/09) Pp. 165-173

https://doi.org/10.6440/TZUCMJ.199809.0165

摘要

內視鏡生體檢查可以瞭解幽門螺旋菌感染的情形。本篇的目的是探討取槎的適當個數及位置，並比較各種侵襲檢查（內視鏡生體組織切片檢查、尿素酵素反應測試[CLO test]、細菌培養）的可靠性，試圖澄清之間的差異。47位消化不良且未經藥物治療的病人（25位男性、22位女性）進入本研究，每人經內視鏡在胃內六個不同位置（包括胃竇部的小彎及大彎側、胃角、胃體部、高體部的小彎近賁門處及大彎側）採得標本做組織切片檢查。在胃竇部取一標本做尿素酵素反應測試，另外在胃竇及胃角取了三塊做細菌培養。依據組織切俓檢查結果，34位病人（72.3%）患有幽門螺旋菌感染，而尿素酵素反應測試和細菌培義的敏感性及特異性分別是91.2%&100%，79.4%&100%。尿素酵素反應測試是一個省時又可靠的檢定方法。幽門螺旋菌的分佈大多十分廣泛但不平均，其中有三位細菌量很少且只在胃角及高體部發現，因而尿素酵素反應試測不到。此外菌量太身或污染菌太多都可能導致陰性細菌培養結果。若結合細菌感染及組織發炎的嚴重程度來評估取樣位置，則以胃竇部小彎側最具代素性。由胃各部位組織切片發現最少三個切片，取樣位置包含胃竇部小彎側、胃角及高體部近賁門處最理想。

關鍵字

幽門螺旋菌 ； 內視鏡生體檢查 ； 組織切片 ； 取樣位置 ； 尿素酵素反應測試 ； 細菌培養

並列摘要

Endoscopic biopsy is an effective method for the diagnosis of Helicobacter pylori infection. This study sought to determine suitable biopsy locations and the optimal number of specimens for histology examination and to clarify the discrepancies among various invasive diagnostic tests. Forty-seven dys-peptic patients （25M, 22F） were topographically sampled for histology, mucosal rapid urease （CLO）test and bacterial culture. Based on histology, 34 patients (72.3%) had H. pylori infection. The sensitive-ity and specificity of the CLO test and culture were 91.2% & 100% and 79.4% and 100%, repectively. CLO test is known to be a reliable method for the diagnosis of H. pylori infection. In this study , the distribution of H. pylori varied in the stomach and the uneven distribution of bacteria may be respon-sible for the discrepancy in the diagnostic yield. There were 3 patients with a low bacterial load which was confined to the angle or high body of the stomach and with negative CLO test in the antrum. We recommend that at least three biopsies for histology including the antrum of the lesser curvature side, angle and higher body (near cardia), should be sampled to improve the diagnostic accuracy of H. pylori infection and inflammation activity.

並列關鍵字

Helicobacter pylori ； topographic biopsy ； mucosal rapid urease test (CLO test) ； histology ； culture