血清HP-IgG抗体分析对不同年龄HP感染者的诊断价值以及与根除治疗的关系

发布时间：2018-12-14 13:52

【摘要】：目的探讨HP-IgG抗体水平在诊断不同疾病类型及不同年龄HP感染中的临床价值,研究HP-IgG抗体水平在幽门螺杆菌根除后的变化趋势,寻找HP-IgG抗体水平分析在判断根除疗效中的价值。方法选择2013年7月份至2014年1月份期间就诊于我科行胃镜诊断为慢性胃炎及消化性溃疡的门诊及住院患者共计615人。所有患者均行13C-UBT及HP-IgG抗体水平检测,对比HP-IgG抗体水平诊断不同疾病及不同年龄HP感染的敏感性、特异性,对13C-UBT及HP-IgG抗体水平均阳性患者给予标准四联疗法根除治疗14天,在根除治疗结束后1个月、3个月、6个月时进行HP-IgG抗体水平检测及13C-UBT,分析根除治疗后HP-IgG抗体水平变化趋势并寻找HP-IgG抗体水平分析在判断根除疗效中的价值。全部的统计学分析均应用SPSS19.0软件完成。我们用比来表示率,用x2检验或Fisher确切概率法来进行率的比较;用(?x±s)表示样本均数,采用t检验来进行样本均数的比较,P0.05(P值取双向)为差异有统计学意义。结果1.同一慢性胃病不同年龄以及相同年龄不同慢性胃病类型之间HP-IgG抗体水平检测HP感染的敏感性两两对比无明显差异。但是相同年龄组之间比较,HP-IgG抗体水平在诊断萎缩性胃炎患者HP感染时的特异性要低于非萎缩性胃炎及消化性溃疡患者,在同一慢性胃病类型之间比较,HP-IgG抗体水平在诊断66-75岁患者HP感染时的特异性要低于18-45岁及46-65岁的患者。2.根除治疗前同一慢性胃病不同年龄及相同年龄不同慢性胃病之间的HP-IgG抗体水平对比无明显差异。在疗程结束后1个月、3个月时相同年龄组萎缩性胃炎的HP-IgG抗体水平均低于非萎缩性胃炎及消化性溃疡患者,差异有统计学意义,而在6个月时相同年龄组不同慢性胃病类型的HP-IgG抗体水平两两比较无明显差异。各个随访节点同一慢性胃病类型不同年龄组之间HP-IgG抗体水平均值之间两两对比无明显差异。3.在根除疗程结束后3个月时HP-IgG抗体抗体水平下降比的ROC曲线下面积达到了0.942,当HP-IgG抗体水平较前下降30%时灵敏度及特异性均较高,分别达到了90%及84%。结论:1.血清HP-IgG抗体水平分析在诊断老年及萎缩性胃炎患者HP感染时特异性较低,因此联合检测血清HP-IgG和13C-UBT可避免遗漏老年及萎缩性胃炎患者HP感染的诊断。2.成功根除HP后,非萎缩性胃炎及消化性溃疡患者血清HP-IgG抗体较萎缩性胃炎患者下降缓慢,不同年龄的Hp-IgG抗体水平下降趋势之间无明显异常。3.血清HP-IgG水平在根除疗程结束3个月时下降30%时,对HP根除疗效的判定有较高的诊断价值。
[Abstract]:Objective to investigate the clinical value of HP-IgG antibody level in the diagnosis of HP infection in different disease types and ages, and to study the trend of HP-IgG antibody level after the eradication of Helicobacter pylori. To find out the value of HP-IgG antibody level analysis in the evaluation of eradication efficacy. Methods A total of 615 outpatients and inpatients with chronic gastritis and peptic ulcer diagnosed by gastroscopy from July 2013 to January 2014 were selected. 13C-UBT and HP-IgG antibody levels were detected in all patients. The sensitivity and specificity of HP-IgG antibody levels in the diagnosis of different diseases and different ages of HP infection were compared. Patients with positive levels of 13C-UBT and HP-IgG antibodies were treated with standard quadruple therapy for 14 days. The levels of HP-IgG antibody and 13C-UBT were detected at 1 month, 3 months and 6 months after eradication therapy. To analyze the trend of HP-IgG antibody level after eradication therapy and to find out the value of HP-IgG antibody level analysis in the evaluation of eradication effect. All statistical analysis was completed by SPSS19.0 software. We use ratio to express the rate, use x2 test or Fisher exact probability method to compare the rate, (? X 卤s) denote the sample mean, use t test to compare the sample mean, P0.05 (P value is bidirectional) as the difference has statistical significance. Result 1. There was no significant difference in the sensitivity of HP-IgG antibody to HP infection between different ages and different types of chronic gastropathy of the same age. But in the same age group, the specificity of HP-IgG antibody in diagnosing HP infection in patients with atrophic gastritis was lower than that in patients with non-atrophic gastritis and peptic ulcer. The specificity of HP-IgG antibody in diagnosis of HP infection in patients aged 66-75 years was lower than that in patients aged 18-45 and 46-65 years. There was no significant difference in HP-IgG antibody levels between different ages and different ages before eradication treatment. The levels of HP-IgG antibody in patients with atrophic gastritis were significantly lower than those in patients with non-atrophic gastritis and peptic ulcer at 1 month and 3 months after treatment. At 6 months, there was no significant difference in HP-IgG antibody levels among different chronic gastric disease types in the same age group. There was no significant difference in the mean HP-IgG antibody level between different age groups with the same type of chronic gastropathy at each follow-up node. 3. The area under the ROC curve was 0.942 at 3 months after the end of the eradication course, and the sensitivity and specificity of the HP-IgG antibody level decreased by 30% to 90% and 84% respectively. Conclusion: 1. The specificity of serum HP-IgG antibody analysis in the diagnosis of HP infection in the elderly and atrophic gastritis patients was low. Therefore, the combined detection of serum HP-IgG and 13C-UBT could avoid omitting the diagnosis of HP infection in the elderly and atrophic gastritis patients. 2. After successful eradication of HP, serum HP-IgG antibody levels in patients with non-atrophic gastritis and peptic ulcer decreased more slowly than those in patients with atrophic gastritis. The level of serum HP-IgG decreased 30% at the end of 3 months of eradication therapy, which was valuable for the diagnosis of the curative effect of HP eradication.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573

【相似文献】