上消化道症状儿童13 C-尿素呼气试验联合胃镜诊断的临床分析

摘要

目的：探讨成都地区因上消化道症状就诊患儿行13 C‐尿素呼气试验（13 C‐UBT ）检测幽门螺杆菌（Hp）感染及行胃镜检查的临床意义。方法对4490例有上消化道症状的患儿行13 C‐UBT 检查，比较不同性别、年龄、症状患儿的13 C‐UBT阳性率。对阳性患者再行胃镜检查，取胃黏膜行快速尿素酶试验。结果有上消化道症状的4490例儿童中，13C‐UBT总阳性率为17．22％，儿童Hp感染无明显下降趋势；男女阳性率差异无统计学意义（P＞0．05）；＞5～11岁组和＞11～17岁组患儿阳性率分别为20．39％和19．97％，以腹痛为主要症状者阳性率为22．18％，差异有统计学意义（P＜0．05）。在13 C‐UBT阳性患儿中有736例（95．21％）接受胃镜检查，快速尿素酶试验与13 C‐UBT阳性符合率为95．24％。13 C‐UBT阳性患儿的胃镜下改变以慢性浅表性胃炎和慢性十二指肠炎最多见，消化性溃疡其次。结论2011～2013年成都地区儿童 Hp感染无明显下降趋势。13 C‐UBT阳性率与性别无关，但与年龄及症状相关，13 C‐UBT对5岁以上以腹痛为主要表现的患儿寻找病因有重要的临床意义；同时可提高患儿及家长对胃镜检查的接受度，对阳性者再行胃镜检查有助于进一步明确诊断。%Objective To investigate the clinical significance of 13C‐urea breath test(UBT) combined with gas‐troscopic examination in detecting Helicobacter pylori (Hp) infection in the children with upper gastrointestinal symptoms .Methods 13C‐UBT was performed in 4 490 children with upper gastrointestinal symptoms .The positive rates of 13C‐UBT were compared among children with different genders ,ages and symptoms .The children with posi‐tive 13 C‐UBT results were performed the gastroscopic examination again and the gastric mucosa was taken for con‐ducting the rapid urease test .Results Among 4 490 children with upper gastrointestinal symptoms ,the total positive rate of 13C‐UBT was 17 .22% ,the Hp infection in children had no declining trend;there was no significant difference in the positive rate between boys and girls(P> 0 .05) .The positive rate of Hp infection in the >5 -11 years old group and >11-17 years old group were 20 .39% and 19 .97% respectively ,which in the children with abdominal pain as the main symptom was 22 .18% .736 children with 13 C‐UBT positive results received the gastroscopic exami‐nation of Hp infection ,and the positive coincidence rate of rapid urease test and 13C‐UBT was 95 .24% .The gastro‐scopic changes in the children with 13C‐UB positive were mainly chronic superficial gastritis and chronic dodecadactyl‐itis ,followed by peptic ulcer .Conclusion Hp infection among children in Chengdu area during 2011 -2013 has no significant declining trend .The 13 C‐UBT positive rate has no relation with gender ,but has relation with age and symptoms .13 C‐UBT has an important clinical significance for searching the etiology in the children patients aged more than 6 years old and with abdominal pain as the main manifestation;meanwhile which can increase the accepta‐bility for the children patients and their parents to gastroscopy ,the performing the gastroscopic examination in chil‐dren with 13 C‐UBT positive is conducive to further clarify the diagnosis .