Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
권호 표지

Diagnostic Performance for Detection of Hezicobacter Pyzori Infection in Gastric Biopsy Specimens with No Gold Test: Non-linear Regression Approach

위 조직 생검 시료의 Helicobacter pylori 균 검출에 사용되는 진단검사의 특성을 추정하기 위한 비선형 모형의 응용

  • Pak, Son-Il (Department of Veterinary Medicine, Kangwon National University) ;
  • Kim, Doo (Department of Veterinary Medicine, Kangwon National University)
  • Published : 2003.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

The selection of a test as a reference with no perfect sensitivity and specificity may lead to bias, yielding distortion of the diagnostic performance. This means it is inappropriate to use imperfect diagnostic tests as a reference method to identify infected patients in clinical environments. In this study, diagnostic performance of rapid urease test, polymerase chain reaction (PCR), and histology of gastric biopsy specimens for diagnosing Helicobacter pylori infection separately and in combination was estimated by using non-linear regression. Based on this approach, the sensitivity, specificity and likelihood ration positive and negative values for each test were as follows: urease test 99.9%, 99.9%, 99.9%, 99.6%, respectively; PCR 88.6%, 99.9%, 99.9%, 70.5%, respectively; histology 78.3%, 97%, 78.3%, 97%, respectively. Predictive values for positive and negative changes with varying Combination of three diagnostic tests employed in the study gives no substantial benefit for practitioners to screen infected patients, and urease test or PCR represents an appropriate single test in clinical environments.

감염된 환축을 찾는 진단과정에 완벽하지 못한 진단검사를 사용하는 경우 진단검사 결과는 흔히 왜곡되어 나타난다. 본 연구에서 저자는 Helicobacter pylori 감염을 진단하는데 사용되는 urease 검사, PCR 검사 및 조직학적인 검사법을 단독으로 사용하는 경우와 병행하여 사용하는 상황으로 구분하여 각각 진단적 특성을 평가하였다. 비선형 회귀모형 분석결과 민감도, 특이도, 양성우도비 및 음성우도비는 urease 검사법의 경우 99.9%, 99.9%, 99.9%, 99.6%, PCR 검사의 경우 88.6%, 99.9%, 99.9%, 70.5%, 조직검사법의 경우 78.3%, 97%, 78.3%, 97%fh 나타났다. 예측도는 유병율의 변화에 따라 다양한 값을 보였으며 Helicobacter pylori 감염의 유병율이 35% 이상일 때 조직 검사상 양성결과는 90% 이상의 일치도를 보였고, 유병율이 25% 미만일 때 조직 검사상 음성결과는 90% 이상의 일치도를 보였다. 본 연구결과 임상에서 감염된 개체를 스크리닝하는 목적으로 세가지 진단검사를 병행하는 것은 실질적인 이익이 없으며 단독검사로서 urease 검사와 PCR 검사가 가장 적합한 것으로 나타났다.

Keywords

References

  1. Aliment Pharmacol Ther v.16 Evaluation of Helicobacter pylori diagnostic methods in patients with liver cirrhosis Calvet X;Sanfelieu I;Musulen E;Mas P;Dalmau B;Gil M;Bella MR;Campo R;Brullet E;Valero C;Puig J https://doi.org/10.1046/j.1365-2036.2002.01293.x
  2. Gastroenterol v.109 Accuracy of invasive and non-invasive tests to diagnose H. pylori Cutler AF;Havstad S;Ma CK;Blaser MJ;Perez-Perez GI;Schubert TT https://doi.org/10.1016/0016-5085(95)90278-3
  3. Int J Syst Bacteriol v.44 Phylogeny of Helicobacter isolates from bird and swine feces and description of Helicobacter pametensis sp. Nov Dewhirst FE;Seymour G;Fraser BJ;Fox JG https://doi.org/10.1099/00207713-44-3-553
  4. Am J Gastroenterol v.93 Prospective comparison of rapid urease tests (PyloriTek, CLO test) for the diagnosis of Helicobacter pylori infection in symptomatic children: a pediatric multicenter study Elitsur Y;Hill I;Lichtman SN;Rosenberg AJ https://doi.org/10.1111/j.1572-0241.1998.00217.x
  5. Gut v.35 Polymerase chain reaction assay for the detection of Helicobacter pylori in gastric biopsy specimens: comparison with culture, rapid urease test, and histopathologic tests Fabre R;Sobhani I;Laurent-Puig P;Hedef N;Yazigi N;Vissuzaine C;Rodde I;Potet F;Mignon M;Etienne JP https://doi.org/10.1136/gut.35.7.905
  6. N Engl J Med v.293 Nomogram for Bayes theorem Fagan TJ
  7. Dig Dis Sci v.41 New noninvasive tests for Helicobacter pylori gastritis. Comparison with tissue-based gold standard Faigel DO;Childs M;Furth EE;Alavi A;Metz DC https://doi.org/10.1007/BF02213130
  8. Am J Vet Res v.47 Campylobacter like organisms isolated from the gastric mucosa of ferrets Fox JG;Edrise BM;Cabot EB;Beaucage C;Murphy JC;Prostak K
  9. Infect Immun v.63 Helicobacter pylori-induced gastritis in the domestic cat Fox JG;Batchelder M;Marini R;Yan L;Handt L;Li X;Shames B;Hayward A;Campbell J;Murphy JC
  10. J Comp Pathol v.115 Comparison of diagnostic methods for detecting gastric Helicobacter-like organisms in dogs and cats Happonen I;Saari S;Gastren L;Tyni O;Hanninen ML;Westmarck E https://doi.org/10.1016/S0021-9975(96)80034-X
  11. Am J Gastroenterol v.92 Incorrect gold standard in diagnostic tests for Helicobacter pylori Jamart J
  12. Diagn Microbiol Infect Dis v.43 The evaluation of diagnostic methods for the detection of Helicobacter pylori in gastric biopsy speciemens Kisa O;Albay A;Mas MR;Celasum B;Doganci L https://doi.org/10.1016/S0732-8893(02)00409-1
  13. J Med Microbiol v.51 Gastric mucosal density of Helicobacter pylori estimated by realtime PCR compared with results of urea breath test and histological grading Kobayashi D;Eishi Y;Ohkusa T;Ishige I;Suzuki T;Minami J;Yamada T;Takizawa T;Koike M https://doi.org/10.1099/0022-1317-51-4-305
  14. Gastrointest Endosc v.44 Prospective comparison of commercially available rapid urease tests for the diagnosis of Helicobacter pylori Laine L;Lewin D;Naritoku W;Estrada R;Cohen H https://doi.org/10.1016/S0016-5107(96)70002-0
  15. Am J Gastroenterol v.95 Rapid urease tests lack sensitivity in Helicobacter pylori diagnosis when peptic ulcer disease presents with bleeding Lee JM;Breslin NP;Fallon C;O'Morain CA https://doi.org/10.1111/j.1572-0241.2000.02004.x
  16. Infect Immun v.56 Isolation of a spiral-shaped bacterium from the cat stomach Lee A;Hazell SL;ORourke J;Kouprach S
  17. Vet Pathol v.29 Role of Helicobacter felis in chronic canine gastritis Lee A;Krakowka S;Fox JG;Otto KA;Eaton KA;Murphy JC https://doi.org/10.1177/030098589202900601
  18. Yale J Biol Med v.71 Realities of diagnosing Helicobacter pylori infection in clinical practice: a case for non-invasive indirect methodologies Metz D;Furth EE;Faigel DO;Kroser JA;Alavi A;Barrett DM;Montone K
  19. Am J Gastroenterol v.96 Diagnosis of Helicobacter pylori infection: noninvasive methods compared to invasive methods and evaluation of two new tests Monteiro L;de Mascarel A;Sarrasqueta AM;Bergey B;Barberis C;Talby P;Roux D;Shouler L;Goldfain D;Lamouliatte H;Megraud F https://doi.org/10.1111/j.1572-0241.2001.03518.x
  20. J Vet Clin v.18 Diagnostic accuracy of urease and polymerase chain reaction to detect Helicobacter species infection in dogs Pak SI;Oh TH
  21. J Immunol Methods v.242 Quantitative analysis of Helicobacter pylori infection in a mouse model Smythies LE;Chen JA;Lindsey RJ;Ghiara P;Smith PD;Waites KB https://doi.org/10.1016/S0022-1759(00)00215-5
  22. J Gen Microbiol v.139 Helicobacter canis sp. Nov., a new species from dogs: an integrated study of phenotype and genotype Stanley J;Lonton D;Burnens AP;Dewhirst FE;Owen RJ;Porter A;On SLW;Costas M https://doi.org/10.1099/00221287-139-10-2495
  23. Microbiol v.140 Helicobacter pullorum sp. Nov.-genotype and phenotype of a new species isolated from poultry and from human patients with gastroenteritis Stanley J;Lonton D;Burdens AP;Dewhirst FE;On SL;Porter A;Owens RJ;Costas M https://doi.org/10.1099/13500872-140-12-3441
  24. Am J Gastroenterol v.91 Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard Thijs JC;van Zwet AA;Thijs WJ;Oey HB;Karrenbeld A;Stellaard F;Luijt DS;Meyer BC;Kleibeuker JH
  25. J Med Assoc Thai v.85 no.suppl.1 Gastric juice urease test and brushing urease test for Helicobacter pylori detection Vilaichone RK;Mahachai V;Tumwasorn S;Kullavanijaya P
  26. Diagn Microbiol Infect Dis v.24 A new urea broth-based test to detect Helicobacter pylori presence in upper gastrointestinal biopsies Weiss K;Poirier L;Laverdiere M;Ducic S https://doi.org/10.1016/0732-8893(95)00274-X
  27. Am J Gastroenterol v.91 Prospective, multivariate evaluation of CLO test performance Weston AP;Capbell DR;Hassanein RS;Cherian R;Dixon A;McGregor DH
  28. Archives Med Res v.31 Comparison of invasive and noninvasive methods for the diagnosis and evaluation of Helicobacter pylori infection in children Yaoez P;la Garza AM;Perez-Perez G;Cabrera L;Muooz O;Torres J https://doi.org/10.1016/S0188-4409(00)00087-4