Seroreaktivnost protiv Helicobacter pylori VacA, 50 kDa i 30 kDa zajedno sa simptomima i znacima alarma može unaprediti dijagnostički pristup neistraženoj dispepsiji – pilot studija
Sažetak
Uvod/Cilj. Simptomi i znaci alarma (SZA) su od ograničene koristi u predikciji endoskopskih nalaza i većina pacijenata sa neistraženom dispepsijom neće imati nalaz organske patologije tokom gornje gastrointestinalne endoskopije. U našoj prethodnoj studiji istakli smo seroreaktivnost protiv Helicobacter pylori (HP) antigena VacA, 50 kDa i 30 kDa kao biomarkere karcinoma želuca, peptičkih ulkusa i funkcionalne dispepsije. Ova pilot studija je dizajnirana i sprovedena sa ciljem da se uporedi dijagnostička korist seroreaktivnosti protiv HP VacA, 50 kDa i 30 kDa sa onom od SZA i da se istraži mogućnost i adekvatnost njihovog zajedničkog korišćenja. Metode. Od 123 bolesnika sa dispepsijom među kojima je bilo 31 sa karcinomom želuca, 31 sa ulkusom duodenuma, 31 sa ulkusom želuca i 30 sa gastritisom i funkcionalnom dispepsijom uzeta je pažljiva anamneza i obavljen fizikalni pregled sa posebnim osvrtom na SZA. Svim bolesnicima je urađena ezofagogastroduodenoskopija sa biopsijom, ultrazvuk abdomena ili kompjuterizovana tomografija, kompletna krvna slika (KKS) i biohemijske analize, Western Blot IgG prema HP antigenima VacA, 50 kDa i 30 kDa. Analizirana je pojava SZA naspram različitih kombinacija seroreaktivnosti protiv HP VacA, 50 kDa i 30 kDa kod bolesnika sa funkcionalnom dispepsijom i ostalih bolesnika. Analizirana je sinhrona i alternativna seroreaktivnost protiv VacA, 50 kDa i 30 kDa sa/bez SZA kod funkcionalne dispepsije i drugih grupa. Rezultati. Seropozitivnost VacA i 50 kDa ili SZA imaju odličan dijagnostički klinički indeks korisnosti kod neistražene dispepsije. Odsustvo SZA i seroreaktivnosti protiv VacA bilo sa 50 kDa ili 30 kDa seropozitivnosti ili 50 kDa i 30 kDa seropozitivnosti imaju odličan klinički indeks korisnosti za skrining kod neistražene dispepsije. Zaključak. Seroreaktivnost protiv HP antigena VacA, 50 kDa i 30 kDa može unaprediti naš pristup bolesnicima sa neistraženom dispepsijom ukoliko se koristi zajedno sa SZA.
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