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首页> 美国卫生研究院文献>Journal of Clinical Microbiology >Evaluation of Two Commercial Enzyme Immunoassays Testing Immunoglobulin G (IgG) and IgA Responses for Diagnosis of Helicobacter pylori Infection in Children
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Evaluation of Two Commercial Enzyme Immunoassays Testing Immunoglobulin G (IgG) and IgA Responses for Diagnosis of Helicobacter pylori Infection in Children

机译：评估两种商业酶免疫测定法检测免疫球蛋白G（IgG）和IgA反应以诊断儿童幽门螺杆菌感染

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Serological testing to diagnose Helicobacter pylori infection in children is still controversial, although commonly used in clinical practice. We compared the immunoglobulin G (IgG) and IgA results of two commercially available enzyme immunoassays (EIAs) (Pyloriset IgG and IgA and Enzygnost II IgG and IgA) for 175 children with abdominal symptoms divided into three age groups (0 to ≤6 years, n = 47; >6 to ≤12 years, n = 77; >12 years, n = 51). A child was considered H. pylori infected if at least two of three tests (histology, rapid urease test, 13C-urea breath test) or culture were positive and noninfected if all results were concordantly negative. Of 175 children, 93 (53%) were H. pylori negative and 82 were H. pylori positive. With the recommended cutoff values, the overall specificity was excellent for all four EIAs (95.7 to 97.8%) regardless of age. Sensitivity varied markedly between tests and was 92.7, 70.7, 47.5, and 24.4% for Enzygnost II IgG, Pyloriset IgG, Enzygnost II IgA, and Pyloriset IgA, respectively. Sensitivity was low in the youngest age group (25 to 33.3%), except for Enzygnost II IgG (91.6%). Receiver-operating curve analyses revealed that lower cutoff values would improve the accuracy of all of the tests except Enzygnost II IgG. Measurement of specific IgA, in addition to IgG, antibodies hardly improved the sensitivity. The specificity of commercial serological tests is high in children when the cutoff values obtained from adults are used. In contrast, sensitivity is variable, with a strong age dependence in some, but not all, tests. We speculate that young children may have a different immune response to H. pylori, with preferable responses to certain antigens, as well as lower titers than adults. The Pyloriset test may fail to recognize these specific antibodies.
机译：尽管在临床实践中经常使用血清学检测方法诊断儿童幽门螺杆菌感染，但仍存在争议。我们比较了两种市售酶免疫测定（EIA）（幽门螺杆菌IgG和IgA以及Enzygnost II IgG和IgA）对175名腹部症状分为三大年龄段（0至≤6岁）的儿童的免疫球蛋白G（IgG）和IgA结果n = 47；> 6至≤12年，n = 77；> 12年，n = 51）。如果三个测试（组织学，快速尿素酶测试， 13 C-尿素呼气测试）中的至少两个或培养物呈阳性反应，而所有结果均呈阴性，则未感染，则认为该儿童感染了幽门螺杆菌。在175名儿童中，有93名（53％）幽门螺杆菌阴性，有82名幽门螺杆菌阳性。使用推荐的临界值，无论年龄如何，所有四个EIA的总体特异性都非常好（95.7至97.8％）。两次测试之间的灵敏度差异显着，对于Enzygnost II IgG，幽门螺杆菌IgG，Enzygnost II IgA和幽门螺杆菌IgA分别为92.7％，70.7、47.5和24.4％。除Enzygnost II IgG（91.6％）外，最年轻年龄组的敏感性较低（25％至33.3％）。接受者操作曲线分析表明，较低的临界值将提高除Enzygnost II IgG外的所有测试的准确性。除IgG外，测量特异性IgA抗体几乎无法提高灵敏度。当使用从成人获得的临界值时，儿童商业血清学检测的特异性很高。相反，灵敏度是可变的，在一些（但不是全部）测试中，年龄的依赖性很大。我们推测，幼儿对幽门螺杆菌的免疫反应可能不同，对某些抗原的免疫反应更好，且滴度比成人低。幽门螺杆菌测试可能无法识别这些特异性抗体。

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