幽门螺杆菌PCR检测的研究进展

幽门螺杆菌是急性、慢性胃炎、和十二指肠溃疡的致病菌,并可能与胃癌有关,因此对该菌进行检测在临床上具有重要价值,本文仅就ＰＣＲ应用于该菌检测的标本处理,引物设计,扩增步骤、扩增产物的分析和ＰＣＲ诊断的临床意义等做简要介绍。     

用PCR快速检测胃活检标本中的幽门螺杆菌

本文用ＰＣＲ对１１６份胃活检标本进行幽门螺杜菌（ＨｅｔｉｃｏｂａｃｔｅｒＰｙｌｏｒｉＨｐ）检测,总阳性率７１．５５％（８３／１１６）,胃溃疡、十二指肠溃疡和胃炎的阳性率分别为８７．５％（１４／１６）、８６．９６％（２０／２３）和６３．５１％（４７／７４）,同时用尿素酶法作参照,其总阳性率为５８．６２％（６８／１１６）,上述疾病分别为４３．７５％（７／１６）、５６．５２％（１３／２３）和６２．１６（４６／７４）。结果表明ＰＣＲ能快速、敏感特异地检出ＨＰ,这对研究ＨＰ在胃、十二指肠疾病中的致病作用、传播途径及疗效观察具有重要意义。     

啮齿动物螺杆菌多重PCR检测方法的建立

目的建立一种可同时检测肝、胆汁、啮齿类三种螺杆菌的多重PCR方法。方法根据已公布的肝、胆汁、啮齿类三种螺杆菌16SrRNA基因序列设计三对特异性引物进行多重PCR并对反应条件进行优化。结果三对引物能分别扩增出特异性的417 bp、364 bp、324 bp目的条带。最佳退火温度为52℃,镁离子浓度为2.0mmol/L,dNTP浓度为200μmol/L,引物浓度为0.625μmol/L。在此条件下多重PCR同时检测的肝、胆汁、啮齿类三种螺杆菌敏感度均为10 fg。结论本实验建立的多重PCR是一种敏感、特异、高效的方法,为同时检测啮齿动物中肝、胆汁、啮齿类三种螺杆菌奠定了良好的基础。     

SYBR Green实时荧光定量PCR快速检测口腔幽门螺杆菌

目的建立一种快速、灵敏、特异的鉴定幽门螺杆菌实时荧光定量PCR方法。方法利用SYBR Green实时荧光定量PCR反应体系对口腔幽门螺杆菌进行检测。鉴定结果与临床常规鉴定方法相比较,评价其敏感度、特异度及重复性。结果通过48例样品的检测,结果显示实时荧光定量PCR法检测标本的鉴定结果与常规PCR鉴定方法的结果对比,特异度为100%,敏感度为100%;最小能检测到102个拷贝数的重组质粒;批内重复试验和批间重复试验结果均与常规鉴定方法结果相符。结论实时荧光定量PCR法鉴定口腔幽门螺杆菌,特异度和敏感度高,重复性好,且快速、简便。该方法有望成为检测口腔幽门螺杆菌感染的一种快速有效的方法。     

原位杂交及原位PCR检测幽门螺杆菌

本研究建立了检测幽门螺杆菌的原位杂交和原位ＰＣＲ技术,采用ＰＣＲ掺入的方法标记原位杂交的生物素探针,６份ＨＰ阳性胃活检组织冰冻切片杂交均为阳性,６份阴性对照组织为阴性。９／１２份ＨＰ阳性对照组织石蜡切片杂交阳性,２份阴性对照切片为阴性。３份阳性对照猫胃粘膜冰冻切片杂交也是阳性。原位ＰＣＲ的引物来自ＨＰ的１６ｓｒＲＮＡ基因,在扩增过程掺入生物素基因。４／４例ＨＰ阳性人胃粘膜冰冻切片原位扩增阳性,２／     

幽门螺杆菌无血培养方法的建立

目的比较幽门螺杆菌（Ｈｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ，Ｈｐ）羊血培养基及自制的活性碳无血培养基培养效果。方法５２例Ｈｐ阳性患者胃粘膜，分别接种于经典的羊血培养基及自制的活性碳无血培养基，３７℃厌氧培养Ｈｐ。结果用羊血培养基培养，Ｈｐ阳性率均高于用活性碳无血培养基培养的阳性率，但没有统计学差异（ｐ＞００５）；两种培养基培养出来的Ｈｐ，菌落、镜下形态及生化特性完全一致，唯后者培养出来的Ｈｐ生长较慢、菌落较小。４位近期服过抑酸药、抗Ｈｐ药物的患者，用羊血培养基培养阴性，而用活性碳无血培养基却能分离培养出Ｈｐ。无论用哪种培养基，培养７天Ｈｐ阳性率均高于培养３天Ｈｐ阳性率，有极显著性差异（ｐ＜００１）。结论羊血培养基适合于一般Ｈｐ分离培养；特殊情况下，特别是抗Ｈｐ治疗后复查，则用活性碳无血培养基较合适。适当延长培养时间，可以提高阳性率。     

C57BL/6小鼠幽门螺杆菌感染动物模型的建立

目的：建立幽门螺杆菌（Helicobacter pylori,Hp）小鼠感染模型。方法：建立Hp经口感染SPF级小鼠的动物模型,取小鼠胃粘膜组织,利用PCR技术、尿素酶实验、细菌培养等方法检测接种小鼠,对结果进行判定。结果：Hp可感染C57BL／6小鼠并在小鼠胃部定植。     

改良幽门螺杆菌抗原检测试剂盒检测粪便幽门螺杆菌抗原的临床评价

目的 评估改良幽门螺杆菌抗原检测试剂盒检测粪便幽门螺杆菌抗原（Helicobacter pylori stool antigen,HpSA）的准确性以及临床应用价值。方法 采用随机、双盲、双验证和与13C呼气试验（13C-UBT）对比的方法,对门诊175例接受13C-UBT检测的患者,采用最新研制出的一种改良幽门螺杆菌抗原检测试剂盒（胶体金法）检测粪便幽门螺杆菌抗原,以13C-UBT检测结果为诊断H. pylori感染的“金标准”,并将两者进行对比研究,所有检测结果均拍照存档,采用随机、双盲和双验证法,以期客观真实地评价改良幽门螺杆菌抗原检测试剂盒检测粪便幽门螺杆菌的效果。结果 改良幽门螺杆菌抗原检测试剂盒检测HpSA敏感度为90.48%,特异度为90.00%,Youden指数为80.48%,Kappa值为0.799;HpSA检测ROC曲线下面积为0.902±0.027,与完全无诊断价值的机会线下面积0.50相比,差异有统计学意义（P=0.000）;Spearman相关系数r=0.800,P=0.000。结论 改良幽门螺杆菌抗原检测试剂盒能准确检测H. pylori感染,其操作简便,可作为非侵入性诊断H. pylori感染筛查以及流行病调查的一种方法,将来有望成为患者家庭自查幽门螺杆菌的一种方法     

球形幽门螺杆菌分子生物学研究

为研究幽门螺杆菌（ＨＰ）球形变异本质,作者通过延期培养和采用亚抑菌浓度抗生素,使３株ＨＰ发生球形变异,对弯曲形和球形ＨＰ作了ＳＤＳ－ＰＡＧＥ、免疫印迹及４个毒力基因片段ＰＣＲ和ＰＣＲ－ＳＳＣＰ分析。ＳＤＳ－ＰＡＧＥ图谱显示球形ＨＰ分子量在７４×１０４以上的蛋白含量减少,免疫印迹显示球形ＨＰ１２５×１０４蛋白条带反应减弱,而抗生素诱变的球形ＨＰ分子量为１１×１０４和６３×１０４的蛋白条带反应增强。ＰＣＲ及ＰＣＲ－ＳＳＣＰ结果表明球形ＨＰ的ｈｐａＡ,ＶａｃＡ,ＣａｇＡ和ＵｒｅＡ４个毒力基因片段未发生缺失,但在ｈｐａＡ或ＶａｃＡ基因中存在点突变     

儿童再发性腹痛中幽门螺杆菌不同检测方法

目的 评价幽门螺杆菌（H.pylori）的不同检测方法及H.pylori感染在儿童再发性腹痛（RAP）诊断中的应用.方法 对在我院诊治的儿童RAP 72例,分为学龄期组24例,少年组48例,同时进行细菌培养、快速尿素酶试验、病理组织学检查、血清学H.pylori抗体检测和粪便H.pylori抗原（HpSA）检测.将前3项检查中2项阳性或细菌培养一项阳性作为诊断H.pylori感染的金标准.结果 金标准诊断H.pylori感染,阳性占37例,阴性占35例,总阳性率为51.4%;学龄期儿童组H.pylori检出阳性率为37.5%,少年组H.pylori检出阳性率为58.3%,两组比较差异有显著性（P＜0.01）;比较6种不同检测方法的敏感性、特异性、准确性,经x2检验,差异均无显著性（P＞0.10）.结论 H.pylori感染与儿童RAP之间存在一定的联系,少年组H.pylori感染率高于学龄期儿童组,而粪便HpSA检测有较高的敏感性和特异性,是一种简便可靠,非侵入性的诊断H.pylori感染的方法,尤其适合儿童.     

Detection of Helicobacter pylori in water by direct PCR

AIMS: This paper demonstrates a rapid, simple method for the detection of Helicobacter pylori in water that eliminates the need for recovery of cells or DNA extraction prior to PCR. METHODS AND RESULTS: Direct polymerase chain reaction (DPCR) with primers specific for H. pylori ureA (urease, subunit A) were used to detect H. pylori added to groundwater. DPCR also detected H. pylori in a naturally contaminated water sample. CONCLUSIONS: DPCR should provide an improved method to assess contamination of water by H. pylori. SIGNIFICANCE AND IMPACT OF THE STUDY: This simple, rapid method for detection of H. pylori in water will provide an improved means to investigate the possible role of water as a disease vector.     

Detection of Helicobacter pylori DNA by a simple stool PCR method in adult dyspeptic patients

INTRODUCTION: Helicobacter pylori is the major agent causing peptic ulcer, gastric cancer and mucosa-associated lymphoid tissue (MALT) gastric lymphoma. A simple stool polymerase chain reaction (PCR) method was performed and compared with the gold standards for the diagnosis of H. pylori infection. MATERIAL AND METHODS: A total of 54 adult patients (mean age, 46.41 +/- 13.12 years) with dyspeptic symptoms from Gastroenterology at Dokuz Eylül University Hospital between May and November 2003 were included. Two antrum and corpus biopsies were taken from each patient. Infection by H. pylori was defined as positivity and negativity of the gold standards. DNA extraction of stool specimens was done using QIAamp DNA Stool Mini Kit (QIAGEN) and PCR conditions included amplification and reamplification steps using the H. pylori ureA gene specific primers (HPU1, HPU2) and were visualized on 1% agarose gel stained with ethidium bromide. RESULTS: Forty-six of 54 patients (85.2%) were diagnosed positive and eight (14.8%) were negative for H. pylori infection by the gold standard methods. Thirty-two patients were positive (59.3%) and 22 of them (40.7%) were detected negative by stool PCR method. The stool PCR method and gold standard methods showed a statistical difference for the detection of H. pylori infection (p < .0001). Sensitivity, specificity, likelihood ratio, and positive and negative predictive values were 65.22%, 75%, 2.61%, 93.75%, and 27.7%, respectively. DISCUSSION: The PCR on the stool specimens resulted as being a very specific test. We suggest that a simple stool PCR method that we developed can be used to detect H. pylori, virulence genes, and in drug resistance studies either first line diagnostic methods in the laboratory or in the clinical management of dyspeptic patients.     

PCR detection of Helicobacter pylori in string-absorbed gastric juice

Molecular methods for detection of Helicobacter pylori infection have been shown to be highly sensitive in gastric biopsies and cultures. The objective of this work was to compare PCR detection of H. pylori DNA in string-absorbed gastric juice and in gastric biopsies. The study was performed in 47 dyspeptic adult patients undergoing endoscopy, and infection was detected by amplification of a segment of H. pylori ureA gene. Of the 29 patients positive in biopsy analysis, 23 (79%) were also positive in the gastric string. PCR analysis of gastric strings is a sensitive and safe procedure to detect H. pylori when endoscopy is not indicated, and may be of great clinical and epidemiological usefulness in determining effectiveness of eradication therapies, typing virulence genes and detecting antibiotic resistance mutations.     

Application of real-time PCR stool assay for Helicobacter pylori detection and clarithromycin susceptibility testing in Brazilian children

Background: Helicobacter pylori ClariRes assay is a novel commercially available real‐time PCR assay allowing H. pylori detection and clarithromycin susceptibility testing in either gastric biopsy or stool specimens. Objective: The aim of this study was to validate the novel biprobe real‐time assay in stool specimens from 217 dyspeptic children. Methods: DNA from gastric biopsies and stool specimens were obtained and submitted to the biprobe real time assay for H. pylori detection and clarithromycin susceptibility testing. Results: The sensitivity, specificity, and test accuracy were 69, 100 and 93.9% for the detection of H. pylori infection and 83.3, 100 and 95.6%, for detection of clarithromycin resistance. Conclusion: This assay proved to be appropriate for H. pylori clarithromycin susceptibility testing, particularly in children populations where a high prevalence of clarithromycin‐resistant strains is suspected.     

Identification of Helicobacter pylori and the cagA genotype in gastric biopsies using highly sensitive real-time PCR as a new diagnostic tool

The CagA protein is one of the virulence factors of Helicobacter pylori, and two major subtypes of CagA have been observed, the Western and East Asian type. CagA is injected from the bacteria into gastric epithelial cells, undergoes tyrosine phosphorylation, and binds to Src homology 2 domain-containing protein-tyrosine phosphatase SHP-2. The East Asian type CagA binds to SHP-2 more strongly than the Western type CagA. Here, we tried to distinguish the CagA type by highly sensitive real-time PCR with the objective of establishing a system to detect H. pylori and CagA subtypes from gastric biopsies. We designed primers and probe sets for Western or East Asian-cagA at Western-specific or East Asian-specific sequence regions, respectively, and H. pylori 16S rRNA. We could detect the H. pylori 16S rRNA gene, Western and East Asian-cagA gene from DNA of gastric biopsies. The sensitivity and specificity for H. pylori infection was 100% in this system. In Thai patients, 87.8% (36/41) were cagA-positive; 26.8% (11/41) were Western-cagA positive and 53.7% (22/41) were East Asian-cagA positive, while 7.3% (3/41) reacted with both types of cagA. These results suggest that this real-time PCR system provides a highly sensitive assessment of CagA type as a new diagnostic tool for the pathogenicity of H. pylori infection.     

Detection of Helicobacter pylori by PCR but not culture in water and biofilm samples from drinking water distribution systems in England

AIMS: To investigate treated water distribution systems in England as a source of Helicobacter pylori. METHODS AND RESULTS: Water and biofilms were obtained from 11 domestic and seven educational properties and from hydrants, reservoirs and water meters supplied by three water utilities. Samples were cultured on nonselective and antibiotic containing media combined with immunomagnetic separation concentration. Viable helicobacters were not detected in any of the 151 samples but Helicobacter-specific PCR assays detected DNA in 26% of samples from domestic properties, schools and hydrants with the highest frequency in biofilms (42%). Direct sequencing of six selected amplicons confirmed >95% sequence homology to H. pylori. CONCLUSIONS: While viable helicobacters were not isolated, evidence was obtained for the presence of Helicobacter DNA, including that of H. pylori. Biofilms on surfaces within water distribution systems may act either as sites for the passive accumulation of helicobacters or as potentially important reservoirs of infection. SIGNIFICANCE AND IMPACT OF THE STUDY: Our findings strengthen evidence that H. pylori may be transmitted through drinking water. However, there is currently no evidence that viable cells can survive the disinfection levels used in UK mains supplies and the health risk from this source remains unclear.     

Detection of Helicobacter pylori DNA in feces and saliva by polymerase chain reaction: a review

The polymerase chain reaction (PCR), known for its high sensitivity and specificity, has been used for the detection of Helicobacter pylori DNA in bodily materials such as feces and saliva. Since fecal specimens contain PCR inhibitors, DNA before PCR amplification has been purified using various biochemical, immunological and physical pre-PCR steps. Several PCR protocols, differing from each other in the selection of genomic targets and primers, have produced varying degrees of specificity and sensitivity in detecting H. pylori DNA. PCR identified antimicrobial resistance of H. pylori in feces. It also detected virulence factor genes such as the cytotoxin-associated gene (cagA) and vacuolating cytotoxin gene (vacA) in feces and saliva. While the cagA gene was detected in 50-60% of fecal specimens, it was found in 25% of salivary specimens from patients. There was considerable variation in the detection rate of H. pylori DNA in salivary samples. The detection rate in saliva with the most effective primer pair was lower than that observed in feces, making saliva a less suitable specimen for the diagnosis of H. pylori infection. There is controversy regarding the permanent presence of H. pylori in saliva. Whether the salivary and gastric specimens of an individual harbor identical or different strains has not been resolved. PCR cannot distinguish between living and dead organisms. However, it can offer quick results on fecal and salivary specimens, which may contain fastidious and slow-growing H. pylori in low numbers.     

High Level of Antimicrobial Resistance in French Helicobacter pylori Isolates

Background:  Helicobacter pylori is a human pathogen responsible for serious diseases including peptic ulcer disease and gastric cancer. The recommended triple therapy included clarithromycin but increasing resistance has undermined its effectiveness. It is therefore important to be aware of the local prevalence of antimicrobial resistance to adjust treatment strategy.
Materials and Methods:  Overall, 530 biopsies were collected between 2004 and 2007. The antimicrobial susceptibility of H. pylori was determined by E-test and molecular methods.
Results:  Among these, 138/530 (26%) strains were resistant to clarithromycin, 324/530 (61%) to metronidazole and 70/530 (13.2%) to ciprofloxacin. Whereas no resistance against amoxicillin and tetracycline was observed, only one strain was resistant to rifampicin. Compared to the patients never treated for H. pylori infection, the prevalence of resistance was significantly higher in patients previously treated (19.1% vs 68% for clarithromycin; 13.2% vs 53.3% for both clarithromycin and metronidazole). The trend analysis revealed an increase of primary resistance to ciprofloxacin between 2004 and 2005 (7.3%) vs 2006–2007 (14.1%) ( p  = .04) and the secondary resistance reached 22.7% in 2007. Interestingly, 27 biopsies (19.6%) contained a double population of clarithromycin-susceptible and -resistant strains.
Conclusions:  The reported high prevalence of clarithromycin and multiple resistances of H. pylori suggest that the empiric therapy with clarithromycin should be abandoned as no longer pretreatment susceptibility testing has assessed the susceptibility of the strain. As culture and antibiogram are not routinely performable in most clinical laboratories, the use of molecular test should be developed to allow a wide availability of pretreatment susceptibility testing.     

Quantitative detection of Helicobacter pylori in water samples by real-time PCR amplification of the cag pathogenicity island gene, cagE

Aims:  A new real-time PCR assay that simultaneously amplifies a 102-bp fragment of the cagE gene from Helicobacter pylori and a new internal positive control containing a specific sequence of the gyrB gene from Aeromonas hydrophila , was developed and validated for the detection of H. pylori in environmental samples.
Methods and Results:  The specificity, limits of detection and quantification, repeatability, reproducibility, and accuracy of the method were calculated. The resulting values confirmed the applicability of the method for the quantitative detection of H. pylori . The feasibility of the method was also evaluated by testing 13 pyloric antrum-positive biopsies and 69 water samples, including potable (10), surface (19) and wastewater (40) matrices. The results showed that all the biopsies and 3 of the 40 wastewater samples analysed were positive.
Conclusions:  This real-time PCR method provides a sensitive, specific, and accurate method for the rapid quantification of H. pylori in environmental samples.
Significance and Impact of the Study:  The PCR diagnostic system proposed in this work, provides a suitable tool for the quantitative detection of H. pylori in environmental samples and can be useful for verifying the role of water as a potential route of its transmission.     

Differentially expressed genes in response to amoxicillin in Helicobacter pylori analyzed by RNA arbitrarily primed PCR

Because the molecular mechanism of amoxicillin resistance in Helicobacter pylori seems to be partially explained by several mutational changes in the pbp1A gene, the aim of the present study was to evaluate the gene expression pattern in response to amoxicillin in the Amx(R) Hardenberg strain using RNA arbitrarily primed PCR (RAP-PCR). In the experiments, c. 100 differentially expressed RAP-PCR products were identified using five arbitrary primers. The cDNAs that presented the highest levels of induction or repression were cloned and sequenced, and the sequences were compared with those present in databases using the blast search algorithm. The differential expression of the isolated cDNAs was confirmed by real-time PCR. The preliminary results showed that amoxicillin alters the expression of five cDNAs involved in biosynthesis, two involved with pathogenesis, four related to cell envelope formation, two involved in cellular processes, three related with transport and binding proteins, one involved with protein degradation, one involved with energy metabolism and seven hypothetical proteins. Further analysis of these cDNAs will allow a better comprehension of both the molecular mechanism(s) of amoxicillin resistance and the adaptative mechanism(s) used by H. pylori in the presence of this antibiotic.