糞便檢測可以預測兒童的H. pylori感染


2003年6月27日-根據一項發表於6月號Gut的研究結果顯示,一種單株抗體的糞便檢測對於兒童是否感染Helicobacter pylori具高度的預測性,但是還需要進一步研究以證實這項檢測對於六歲以下兒童的預測性。
  
  德國慕尼黑Ludwig-Maximilians大學的 S.Koletzko和同事表示,可靠的非侵入性[H.]pylori感染檢測法可以用來研究發生率、傳染和是否已免除感染,一種糞便中H. pylori抗原的酵素免疫分析(EIA)可以避免出現問題,採樣糞便的困難點在於兒童無法主動合作。
  
  研究人員從三個研究中心招募302名之前曾出現症狀而未治療的兒童,其中148名為女孩,年齡介於 0.5 到 18.7歲,經過培養、組織學、迅速的尿素酵素檢測,及13C 尿素呼吸檢測顯示92名兒童感染H. pylori,而210名並未受到感染,糞便採樣後進行EIA檢查,使用不同的生產批量和光學密度(OD)0.150作為分界值。
  
  被感染H. pylori的兒童之OD中位數為2.729(第5-第 95 百分比, 0.232-> 4.000)未感染的兒童為0.021(0.009-0.075),有二個偽陽性和二個偽陰性,檢測的敏感性為98%、特異性為99%、陽性預測率為98%,而陰性預測率為99%,年齡和OD值在感染和未感染的兒童間並不具有顯著的交互作用,因為116個兒童中只有18名兒童在六歲以下而感染H. pylori,作者建議還需要進一步研究以證實這項檢測。
  
  《對於兒童的預測性》
  
  研究人員表示,單株EIA糞便檢測易於執行,並且提供極好的陽性和陰性檢測結果之間的區別,如果進一步的兒童研究可以確認我們的結果,這項檢測將可以成為發生率、H.pylori感染的自發性清除、以及預防性方法如接種疫苗的效果等方面極佳的研究工具。
  
  慕尼黑的兒童健康基金會資助這項研究。Connex 股份有限公司提供免費的檢測套組以進行糞便抗原的測定。

Stool Test Predicts H. pylori<

By Laurie Barclay, MD
Medscape Medical News

June 27, 2003 — A monoclonal antibody stool test is highly predictive of the presence or absence of Helicobacter pylori infection in children, according to the results of a study published in the June issue of Gut. Further study is needed to validate the test for children younger than six years.

"Reliable non-invasive methods for detection of [H.] pylori infection are required to investigate the incidence, transmission, and clearance of infection in childhood," write S. Koletzko from Ludwig-Maximilians University in Munich, Germany, and colleagues. "An enzyme immunoassay (EIA) to detect H. pylori antigen in stool would circumvent...difficulties as stool samples can be obtained from children without their active collaboration."

Of 302 symptomatic previously untreated children recruited from three centers, 148 were girls, and age range was 0.5 to 18.7 years. Culture, histology, rapid urease test, and 13C urea breath test showed that 92 children were infected with H. pylori and that 210 were not. Stool samples were tested by EIA using two different production lots and an optical density (OD) of 0.150 as a cut-off value.

Median OD value was 2.729 (5th-95th percentile, 0.232 - >4.000) in the H. pylori infected children and 0.021 (0.009 - 0.075) in the noninfected children. There were two false-positives and two false-negatives, yielding a sensitivity of 98%, specificity of 99%, positive predictive value of 98%, and negative predictive value of 99%. Age and OD values were not significantly correlated in infected or in noninfected children.

Because only 18 of 116 children younger than six years were infected with H. pylori, the authors recommend further validation of this test in young infected children.

"The monoclonal EIA stool test is easy to perform and provides excellent differentiation between positive and negative test results," the authors write. "If further studies in children confirm our results, this test may become an excellent tool to study the incidence, spontaneous clearance of H. pylori infection, and effect of preventive measures such as vaccination."

The Child Health Foundation in Munich supported this study. Connex GmbH provided free test kits for determination of stool antigen.

Gut. 2003;52:804-806

Reviewed by Gary D. Vogin, MD

    
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