幽門(mén)螺桿菌糞便抗原檢測(cè)ppt課件

幽門(mén)螺桿菌糞便抗原檢測(cè) 幽門(mén)螺桿菌或幽門(mén)螺旋桿菌 幽門(mén)螺旋菌 學(xué)名 Helicobacterpylori 是革蘭氏陰性 微需氧的細(xì)菌 生存于胃部及十二指腸的各區(qū)域內(nèi) 它會(huì)引起胃黏膜輕微的慢性發(fā)炎 甚或?qū)е挛讣笆改c潰瘍與胃癌 超過(guò)80 的帶原者并不會(huì)表露病征 世界超過(guò)50 人口在消化系統(tǒng)上部帶原有幽門(mén)螺桿菌 感染較盛行于發(fā)展中國(guó)家 而西方國(guó)家的影響范圍也逐漸縮小 幽門(mén)螺桿菌的傳染途徑不明 但個(gè)體通常是于幼時(shí)被感染 美國(guó)國(guó)立衛(wèi)生研究院 NIH 提出大多數(shù)常見(jiàn)的胃炎疾病均由幽門(mén)螺桿菌所造成 在治療過(guò)程應(yīng)加入抗生素 在正確認(rèn)識(shí)該細(xì)菌以前 胃潰瘍病人通常會(huì)以中和胃酸及減少分泌的藥物來(lái)治療 但經(jīng)此方法治療后大多會(huì)復(fù)發(fā) 而胃炎患者則會(huì)服用堿式柳酸鉍 這方法通常會(huì)見(jiàn)效 當(dāng)時(shí)人們?nèi)圆恢榔錂C(jī)制 后來(lái)才發(fā)現(xiàn)藥物中的柳酸鹽會(huì)殺死胃部的桿菌 可作為抗生素 現(xiàn)時(shí) 這類(lèi)疾病會(huì)以抗生素來(lái)殺滅病菌 幽門(mén)螺桿菌是人類(lèi)至今唯一一種已知的胃部細(xì)菌 HP感染是世界上最常見(jiàn)的人類(lèi)細(xì)菌感染之一 被認(rèn)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(lèi)致病因子 長(zhǎng)期的潰瘍 會(huì)導(dǎo)致癌癥 因此WHO宣布胃幽門(mén)桿菌為微生物型的致癌物質(zhì) 也是第一個(gè)被確認(rèn)可對(duì)人類(lèi)致癌的原核生物 幽門(mén)螺桿菌簡(jiǎn)介 第四次全國(guó)幽門(mén)螺桿菌感染處理共識(shí)報(bào)告 對(duì)于無(wú)示警癥狀者的testandtreat策略 TestsforHelicobacterpyloriinfection 常用檢測(cè)Hp方法對(duì)比總結(jié) 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(mén)螺桿菌血清學(xué)檢測(cè)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(mén)螺桿菌清除術(shù)后 血液中抗體仍長(zhǎng)期存在 起不到監(jiān)測(cè)評(píng)估療效的作用 適合流行病學(xué)調(diào)查 3 多省暫無(wú)收費(fèi)標(biāo)準(zhǔn) 幽門(mén)螺桿菌血清學(xué)檢測(cè)評(píng)價(jià) 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(mén)螺桿菌糞便抗原檢查 HpSA 和13碳尿素呼氣試驗(yàn) UBT 價(jià)格舉例比較 幽門(mén)螺桿菌糞便抗原檢測(cè) 1 無(wú)創(chuàng)的