摘要
目的探讨^(13)C-尿素呼气试验(^(13)C-UBT)在不同年龄段儿童幽门螺杆菌(Hp)感染中的诊断价值。方法228例疑似Hp感染患儿,将2~5岁患儿作为A组(62例),将6~17岁患儿作为B组(166例)。所有患儿均进行胃镜检查以及^(13)C-UBT、快速尿素酶试验(RUT)、Hp粪便抗原检测。记录所有患儿Hp感染情况;比较A组与B组患儿胃内胆汁反流发生情况,^(13)C-UBT假阴性与真阳性患儿胃内胆汁反流发生情况以及^(13)C-UBT检测Hp阳性的敏感度、特异度和准确度。结果联合检测Hp感染率86.4%(197/228)高于^(13)C-UBT检出阳性率65.4%(149/228),差异有统计学意义(P<0.05)。197例Hp感染患儿中胃内胆汁反流发生率为15.7%(31/197),其中B组胃内胆汁反流发生率为20.1%(28/139),高于A组的5.2%(3/58),差异具有统计学意义(P<0.05)。228例患儿中^(13)C-UBT检测Hp的敏感度为75.6%,特异度为96.8%,准确度为78.5%,阳性预测值为99.3%(149/150),阴性预测值为38.5%(30/78)。A组中^(13)C-UBT检测Hp的敏感度89.7%和准确度90.3%均明显高于B组的69.8%、74.1%,差异均具有统计学意义(P<0.05);两组的特异度比较,差异无统计学意义(P>0.05)。在^(13)C-UBT假阴性患儿中胆汁反流发生率35.4%(17/48)明显高于^(13)C-UBT真阳性患儿的9.4%(14/149),差异有统计学意义(P<0.05)。结论^(13)C-UBT在儿童Hp感染检测中的特异性和阳性预测值均较高,尤其在2~5岁儿童中具有相对较高的敏感度和准确度,对于^(13)C-UBT检测为阴性而临床疑似Hp感染的患儿,应联合其他检测方法进一步检查确诊,避免漏诊发生。
Objective To discuss the diagnostic value of^(13)C-urea breath test(^(13)C-UBT)in Helicobacter pylori infection(Hp)in children of different ages.Methods Of the 228 children with suspected Hp infection,children aged 2-5 years were included as group A(62 cases)and children aged 6-17 years were included as group B(166 cases).All children underwent gastroscopy and^(13)C-UBT,rapid urease test(RUT),and Hp fecal antigen testing.Hp infection was recorded in all the children,and the occurrence of gastric bile reflux was compared between group A and group B.The occurrence of gastric bile reflux in children with false negative and true positive^(13)C-UBT was compared,as well as the sensitivity,specificity and accuracy of^(13)C-UBT in detecting Hp positivity.Results The rate of Hp infection was 86.4%(197/228)by combined testing,which was higher than that of 65.4%(149/228)by^(13)C-UBT,and the difference was statistically significant(P<0.05).The incidence of gastric bile reflux among 197 children with Hp infection was 15.7%(31/197),of which the incidence of gastric bile reflux in group B was 20.1%(28/139),which was higher than that of 5.2%(3/58)in group A,and the difference was statistically significant(P<0.05).The sensitivity of^(13)C-UBT for Hp detection in 228 children was 75.6%,specificity was 96.8%,accuracy was 78.5%,positive predictive value was 99.3%(149/150)and negative predictive value was 38.5%(30/78).The sensitivity of 89.7%and accuracy of 90.3%of Hp detection by^(13)C-UBT in group A were significantly higher than those of 69.8%and 74.1%in group B.The differences were statistically significant(P<0.05),while the differences were not statistically significant(P>0.05)when comparing the specificity of the two groups.The incidence of gastric bile reflux was 35.4%(17/48)in children with false-negative^(13)C-UBT,which was significantly higher than that of 9.4%(14/149)in children with true-positive^(13)C-UBT,and the differences were all statistically significant(P<0.05).Conclusion The specificity and positive predictive value of^(13)C-UBT in the detection of Hp infection in children are both high,especially in children aged 2-5 years with relatively high sensitivity and accuracy.For children with negative^(13)C-UBT test and clinical suspicion of Hp infection,further examination should be combined with other tests to confirm the diagnosis and avoid the occurrence of missed diagnosis.
作者
高利伟
吕金芳
郝彤彤
林健瑶
罗文雄
颜斐斐
GAO Li-wei;LYU Jin-fang;HAO Tong-tong(Ddepartment of paediatrics,Guangdong Women and Children Hospital,Guangzhou 511400,China)
出处
《中国实用医药》
2023年第14期87-89,共3页
China Practical Medicine
基金
广东省中医药局科研项目资助(项目编号:20201034)。
