幽門螺桿菌糞便抗原檢測ppt課件

幽門螺桿菌糞便抗原檢測 幽門螺桿菌或幽門螺旋桿菌 幽門螺旋菌 學名 Helicobacterpylori 是革蘭氏陰性 微需氧的細菌 生存于胃部及十二指腸的各區(qū)域內 它會引起胃黏膜輕微的慢性發(fā)炎 甚或導致胃及十二指腸潰瘍與胃癌 超過80 的帶原者并不會表露病征 世界超過50 人口在消化系統(tǒng)上部帶原有幽門螺桿菌 感染較盛行于發(fā)展中國家 而西方國家的影響范圍也逐漸縮小 幽門螺桿菌的傳染途徑不明 但個體通常是于幼時被感染 美國國立衛(wèi)生研究院 NIH 提出大多數常見的胃炎疾病均由幽門螺桿菌所造成 在治療過程應加入抗生素 在正確認識該細菌以前 胃潰瘍病人通常會以中和胃酸及減少分泌的藥物來治療 但經此方法治療后大多會復發(fā) 而胃炎患者則會服用堿式柳酸鉍 這方法通常會見效 當時人們仍不知道其機制 后來才發(fā)現藥物中的柳酸鹽會殺死胃部的桿菌 可作為抗生素 現時 這類疾病會以抗生素來殺滅病菌 幽門螺桿菌是人類至今唯一一種已知的胃部細菌 HP感染是世界上最常見的人類細菌感染之一 被認為是慢性胃炎 消化性潰瘍的主要原因 世界衛(wèi)生組織 WHO 將HP列為第1類致病因子 長期的潰瘍 會導致癌癥 因此WHO宣布胃幽門桿菌為微生物型的致癌物質 也是第一個被確認可對人類致癌的原核生物 幽門螺桿菌簡介 第四次全國幽門螺桿菌感染處理共識報告 對于無示警癥狀者的testandtreat策略 TestsforHelicobacterpyloriinfection 常用檢測Hp方法對比總結 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 幽門螺桿菌血清學檢測在兒童和青少年的靈敏度分析 1 Non invasiveserologicaltestshavebeenwidelyusedforthediagnosisofH pyloriinfection Inadults thismethodhasprovedtobehighlyaccuratetodiagnosetheinfection butinchildren especiallyyoungerones ELISAappearedtoshowlowsensitivityforthediagnosisofH pyloriinfectioninchildrenaged2to12years especiallyinthosewithoutduodenalulcer 2 幽門螺桿菌清除術后 血液中抗體仍長期存在 起不到監(jiān)測評估療效的作用 適合流行病學調查 3 多省暫無收費標準 幽門螺桿菌血清學檢測評價 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 幽門螺桿菌糞便抗原檢查 HpSA 和13碳尿素呼氣試驗 UBT 價格舉例比較 幽門螺桿菌糞便抗原檢測 1 無創(chuàng)的