Helicobacter pylori 진단법 중 조직학적 검출법, Urease 검사, Immunoblotting의 연령에 따른 양성 일치율에 관한 연구
Concordance rate of the helicobacter pylori detection between histology, urease test and immunoblotting test in children
헬리코박터 파일로리 UREASE검사 IMMUNOBLOTTING;
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Helicobacter pylori infection can be diagnosed by invasive and non-invasive techniques. Invasive tests need an endoscopic gastric mucosal biopsy for either urease test, histology or culture. Non-invasive tests include serology, ^(13)C urea breath test and stool antigen test. But there is no "gold standard" for the disgnosis of H. pylori, so the choice of a diagnostic test should depend on the clinical circumstances, sensitivity and specificity of the tests, and the cost effectiveness of the testing strategy. In this study, we evaluated the percentage of positive cases and concordance rate of the Hematoxylin-Eosin stain, urease test and immunoblotting test in children and young adults. Seven hundred three consecutive pediatric patients who underwent upper gastrointestinal tract endoscopy from 1990 to 1995 at the Gyeongsang National University Hospital because of recurrent abdominal pain and one hundred thirty four healthy first year-medical students of Gyeongsang National University College of Medicine were enrolled. Three endoscopic biopsy specimens (two for histologic examination and one for urease testing) were taken from the antral floor. Venous blood was also drawn after the endoscopy for immunoblotting. Histologic analysis was performed, using the Sydney system and histologic H. pylori-lke organism(HPLO) was considered present if H. pyloril like organisms were noted on the histologic samples. An antral biopsy specimen for urease testing was inoculated into phenol red buffered 2% urea broth and incubated for 48 hours at 37℃ to detect color changes. The reading was considered positive if red coloring was detected within 48 hours. Immunoblotting was performed using the H. pylori strain #51. Among three distinct immunoblot patterns, patternⅠ was considered to be a specific marker of H. pylori infection in this study. In children under 5 years of age, the percentage of positive cases detected was 3.2% by HPLO, 39.2% by urease test and 40% by immunoblotting test; in children of 5 to 10 years of ages, 17.9% by HPLO, 43.5% by urease test and 54.4 % by immunoblotting test;. in children of 10 to 15, 42.6% by HPLO, 52.9% by urease test and 73.4% by immunoblotting test; in young adults, 52.2% by HPLO, 64.9% by urase test, 87.3% by immunoblotting test. The both positive percentage of urease test and immunoblotting test were 23.1% in under 5 years of ages, 43.1% in 5-10 years of ages, 60.9% in 10-15 years of ages and 67.3% in 20-30 years of ages. Whenever the histological diagnostic test was positive, the other two tests were also positive. However, it gave a least positive result compared with the others. Therefore, the histolgical test needs an improvement in detecting the H. pylori. In the age group of 1 to 5, a positive concordance rate between urease and immunoblotting test was low. In young children. urease test using one antral biopsy specimen gave a less positive result than immunoblotting. Therefore, the urease test also needs a improving measures to get an increased positive result in this age group.