| BACKGROUDIn 1983, Australian scholars Warren and Marshall firstly in the word discovered Helicobacter pylori (H.pylori) in patient’s gastric mucosa who suffered from gastritis, which caused widespread concern in the whole academic community. Currently, research on H.pylori have made much remarkable progress. Being a gram-negative micro-aerobic bacteria with flagella, H.pylori appear as a kind of typical slightly bent rod form, which may show an "S" or "C" type and be prone to become spherical in special conditions (antibiotics, environmental factors, etc.). Infection by H.pylori may cause gastric and a sequence of other diseases. In which, the most important one is gastric cancer. In 1994, the World Health Organization(WHO) defined H.pylori infection as Class I (clear) carcinogen. Presently, H.pylori has been identified as a causative factor of chronic gastric and duodenal ulcer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, essential iron deficiency anemia in adults and children, idiopathic thrombocytopenic purpura and some other diseases. In addition, it is reported to be closely related to micronutrient deficiency-related diseases, asthma, hepatitis, pancreatic disease and atherosclerosis.For a long time, gastric mucosa is considered the unique living environment for H.pylori until 1989, Krajden and other scholars firstly isolated and cultured H.pylori from patients with gastritis and plaque successfully. In recent years, the view point that oral as another important environmental factor for H.pylori colonization and growth has gradually been widely recognized. Subsequently, the research on oral H.pylori becomes another hot spot. Some scholars believe that H.pylori might be a kind of opportunistic pathogens, in addition to causing gastric lesions, might also induce oral diseases. The oral H.pylori in the patients with gastrointestinal lesions was homology in the morphology, biology with that in gastric mucosa. The oral H.pylori was widely present in saliva, plaque and other parts which not only caused oral disease, and possibly caused gastric H.pylori infection and relapse with swallowed into the stomach colonization.The route of transmission of H.pylori is still controversial and not fully clear. Mongolian gerbils and other animals were a certain predisposition, but most scholars believed that human beings were the main source of infection and the susceptible populations in the natural environment. Indeed, the stomach was the main infection storage site for H.pylori. However, oral H.pylori is isolated and cultured which results in that mouth might be thought of another storage site besides the stomach. Some scholars have hypothesized that H.pylori spreaded in the ways of mouth-mouth spread, mouth-stomach spread, stomach-oral transmission and fecal-oral transmission. The stomach-oral transmission can be divided into two kinds. Firstly, gastrointestinal motility of acid reflux, nausea, vomiting, made H.pylori reflux from stomach into the mouth. The second way was the mouth-mouth contact or fecal-oral spread, such as family dinners and so on. H.pylori as a pathogen spreading through infected, built a bridge between gastrointestinal diseases and oral diseases.Helicobacter pylori(H.pylori) infection affected by the socio-economic level, region, age, race and diet has become one of the most common chronic bacterial infection in humans. Usually, the infection rate is 10% -50%in developed countries, while it could reach 40% -80%in developing countries and up to 90% in some African countries. The average infection rate is about 50%, while, only 10-15% of which performed typical clinical symptoms in China which is also a high prevalence of H.pylori infection. Therefore, early and accurate diagnosis of H.pylori infection has great significance in a variety of diseases, especially in prevention and treatment of gastric cancer. Current methods of clinical diagnosis of H.pylori infection mainly divided into invasive and non-invasive examinations. The former needing the help of endoscopy to complete, is a class-invasive examination method, including RUT, histology, bacterial culture and so on; the latter, which endoscopy is not required and thus with no invasion, including isotope-labeled 13C or 14C call gas test (UBT), stool antigen, serological and molecular biology (such as PCR), and so on. Invasive procedure possesses limitaions of a long time of operation, technically demanding, expensive equipment, poor tolerance and the existence of cross-infection, non-invasive examination has become a hot research. Helicobacter pylori saliva test board (HPS) is a non-invasive detection of H.pylori infection in recent years, which is different from previous antigen and antibody detection. Its principles is colloidal gold chromatography double antibody sandwich method, which can target on the specificity detection of urease secreted by human saliva H.pylori. Compared with conventional UBT, RUT and other testing, it is simple, fast, no pain, well tolerated by the patients and does not require any additional equipment, which results that some scholars consider HPS as reliable non-invasive way for the diagnosis of H.pylori infection.This study discussed three parts to investigate the clinical value of HPS detection on H.pylori infection. Firstly, HPS tested saliva H.pylori infection, which was compared with RUT and HE joint detection, rapid urea enzyme test (RUT), gastric mucosal tissue sections stained (HE staining). Secondly, pathology suggestive of gastric mucosa atrophy, erosion, gastric polyps, dysplasia and intestinal metaplasia five types of study were analyzed to compare the results of HPS and RUT. Third, while colonoscopy subjects of colonoscopy found polyps and polyps after endoscopic resection pathology suggestive of adenomatous polyps of cases, respectively, were compared and analyzed HPS RUT test results.METHODS1. General InformationFrom October 2013 to March 2014, A total of 228 cases who had no significant gastrointestinal symptoms in our hospital who underwent endoscopy examination, met the criteria, including 154 cases of male, female 74 cases; age 24-68 years of age, 47.5 years evaluated.146 cases simultaneously colonoscopy. All were obtaining informed consent. A total of 228 cases met the criteria, including 154 cases of male,74 cases of female, respectively, age from 24 to 68 years old, evaluateing 47.5 years old. 146 cases undertake colonoscopy simultaneously. Exclusion criteria:(1) serious heart, lung, liver and kidney dyfunction; (2) cancers; (3) Be treated with proton pump inhibitors, antibiotics, H2 receptor antagonists, or bismuth in months.2. HPS detection methodsFasting 8h before gastroscopy is being needed. Use HPS antigen test board, Follow the operating instructions:1) the patient is asked keep saliva specimens 1-2ml before gastroscopy; 2) the saliva is spit into a plastic cup; 3) the test panels on a flat table, with a straw draw 4 drops of saliva, drip into sample cup; 4) dropping 2 drops of buffer into the sample cup; 5) Replace the straw, mix liquid thoroughly, drawing 3-4 drops of the mixture liquid into the loading window, and observe in 5 to 15 minutes. Results interpretation:ribbon appearance of both test tape (T zone) and the control band (C zone) in observing window indicating H.pylori positive; C ribbon display only means Hp-negative; no ribbon appearance indicate simple invalid.3. Fast urokinase experimental gastric mucosa (rapid urease test, RUT) detection method uses rapid urease of Helicobacter pylori detection reagents produced by our hospital laboratory, and the results of operations in accordance with the routine determination. Observing change of pink color in five minutes means positive of H.pylori infection.4. Remove the gastric mucosa tissue sections stained (HE stain) endoscopic gastric mucosa detection method, by the pathology department routinely dehydrated, fixed, sliced and dyeing operations. Observing of Helicobacter pylori in microscope is considered infection positive.5. Statistical Methods SPSS 13.0 statistical software for data processing. The first part of the HPS and joint detection(RUT and HE stain), HPS and RUT, between HPS and HE staining the results of detection, Mcnemar fourfold table test is used to compare paired data.Secondly, the test results of three parts HPS and HE staining between the two groups are compared using chi-square test. P<0.05 is considered statistically significant.RESULTS1. Comparison of HPS, RUT, HE detection of H.pylori infection:1) HPS, combined detection (RUT or HE stain) compared to the positive rates are 47.8%,41.67%, in line with the positive rate (sensitivity) is 84.2%, in line with the rate of negative (specificity) is 78.2%, the accuracy is 75.4%. The positive predictive value is 73.4% and the negative predictive value is 87.4%;2) HPS compared with HE stain detection shows that the positive rates are 47.8%, 40%, respectively. Meanwhile, in line with the positive rate (sensitivity) is 85.7%, in line with the rate of negative (specificity) is 68.7%, the accuracy is 75.4%, the positive predictive value is 64.5% and the negative predictive value is 87.8%;3) HPS and RUT detection comparation shows that in line with the positive rate (sensitivity) is 88.7%, in line with the rate of negative (specificity) is 67.5%, the accuracy is 73.2%, the positive predictive value of 50.5% and the negative predictive value is 94.1%.2.Pathological type corresponds HPS and HE stain detection:175 cases of gastric mucosa biopsy, the pathological diagnosis which show as atrophy, erosion, gastric polyps, cases of intestinal metaplasia and dysplasia, H.pylori infection all have high detection rate. HE stain results for HPS and chi-square test, atrophy, intestinal metaplasia and dysplasia, the difference between HPS and HE stain detection methods is statistically significant (p<0.05).3 Colon polyps and adenomatous polyps detected corresponding HPS and HE stain: 78 cases out of all 146 cases who accept the colonoscopy at the same time found polyps as well. And the positive rate of H.pylori infection of HPS and HE stain is 69.2%,,45.4%, respectively. What is more, the difference is statistically significant. Within polyps after endoscopic resection diagnosed 24 cases of adenomatous polyps, the corresponding HPS, HE stain positive rate is 66.7% and 47.4%.CONCLUSIONS1. HPS is simple, fast, painless and well-tolerated method of H.pylori test.2. HPS, with positive rate of 47.8%, is more consistent with the average infection rate of H.pylori. Comparing with RUT and HE, HPS shows not only high sensitivity and specifically, but also meaningful positive predictive value and negative predictive value on H.pylori infection. It is suggested that HPS is an valuable non-invasive screening method for clinical H.pylori infection, which is worthy of further clinical validation.3. Atrophy and intestinal metaplasia by non-atrophic gastritis to gastric lesions is an important evolution stage, eradication treatment of H.pylori can not only eliminate inflammation, slow down or stop the development of atrophy, but also may reverse part of the mucosa atrophy. In addition, as is known to all, adenomatous polyp is the most important precancerous lesion in colorectal cancer. Recent studies suggest that, H.pylori and virulence factor CagA as well may be risky factors for the development of colorectal cancer. Therefore, HPS may have some value in screening for precancerous lesions such as atrophy, intestinal metaplasia, dysplasia and colorectal adenomatous polyps. |
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