Anticuerpos frente a Helicobacter pylori en saliva. Estudio de su validez frente a la prueba del aliento y de su concordancia con la serología
Helicobacter pylori antibodies in saliva. study of their validity versus the breath test and their concordance with serology
R. García Valriberas, J.P. Gisbert
, C. Hermida, M.M. Cabrera, J. Díaz Blasco, J.M. Pajares
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gisbert@meditex.es
Correspondencia: Playa de Mojácar 29. Urb. Bonanza. 28669 Boadilla del Monte. Madrid.
Correspondencia: Playa de Mojácar 29. Urb. Bonanza. 28669 Boadilla del Monte. Madrid.
Servicio de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid
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Subías Loren, J.R. García-Mata, L. Pérula de Torres" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P.J." "apellidos" => "Subías Loren" ] 1 => array:2 [ "nombre" => "J.R." "apellidos" => "García-Mata" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Pérula de Torres" ] 3 => array:1 [ "colaborador" => "Grupo de Evaluación del PAPPS" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0212656700785271?idApp=UINPBA00004N" "url" => "/02126567/0000002500000006/v1_201307091809/S0212656700785271/v1_201307091809/es/main.assets" ] "es" => array:14 [ "idiomaDefecto" => true "titulo" => "Anticuerpos frente a <span class="elsevierStyleItalic">Helicobacter pylori</span> en saliva. Estudio de su validez frente a la prueba del aliento y de su concordancia con la serología" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "390" "paginaFinal" => "394" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. García Valriberas, J.P. Gisbert, C. Hermida, M.M. Cabrera, J. Díaz Blasco, J.M. Pajares" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García Valriberas" ] 1 => array:4 [ "nombre" => "J.P." "apellidos" => "Gisbert" "email" => array:1 [ 0 => "gisbert@meditex.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Hermida" ] 3 => array:2 [ "nombre" => "M.M." "apellidos" => "Cabrera" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Díaz Blasco" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Pajares" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Playa de Mojácar 29. Urb. Bonanza. 28669 Boadilla del Monte. Madrid." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Helicobacter pylori</span> antibodies in saliva. study of their validity versus the breath test and their concordance with serology" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1999-11-03" "fechaAceptado" => "1999-11-03" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec195141" "palabras" => array:6 [ 0 => "Anticuerpos" 1 => "Diagnóstico" 2 => "ELISA" 3 => "Enzimoinmunoanálisis" 4 => "<span class="elsevierStyleItalic">Helicobacter pylori</span>" 5 => "Prueba aliento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar prospectivamente la validez de un nuevo método diagnóstico a partir de una muestra de saliva, tomando como referencia la prueba del aliento con urea marcada con 13C, así como comparar los resultados de esta técnica con otro método indirecto basado en la detección de anticuerpos, la serología «clásica» realizada a partir de sangre venosa.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron prospectivamente 48 individuos, 24 voluntarios sanos y 24 pacientes consecutivos con enfermedad ulcerosa gastroduodenal. Se consideró criterio de exclusión el tratamiento durante el último mes con fármacos gastroerosivos, antibióticos, inhibidores de la bomba de protones y derivados del bismuto, la administración previa de tratamiento erradicador de <span class="elsevierStyleItalic">H. pylori</span>, la cirugía gástrica y la presencia de enfermedades asociadas. Para la realización del test diagnóstico en saliva se empleó un enzimoinmunoanálisis (ELISA) comercial (Helisal®). Para la serología en sangre se empleó un ELISA comercial (Helico-G®). El personal responsable de la lectura del test en saliva, de la serología y de la prueba del aliento desconocían el resultado de los demás métodos diagnósticos. Como patrón de referencia de infección por <span class="elsevierStyleItalic">H. pylori</span> se consideró el resultado de la prueba del aliento con 13C-urea (TAU-kit®).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La edad media de los voluntarios sanos fue de 23 ± 0,7 años y de 55 ± 18 en los ulcerosos. La prevalencia de infección por <span class="elsevierStyleItalic">H. pylori</span>, valorada por el «patrón oro», fue del 79,2% en los ulcerosos y del 54% en los voluntarios. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica del test en saliva en los ulcerosos fue, respectivamente: 100% (IC del 95%, 79-99), 60% (17-93), 90% (68-98), 100% (31-97) y 92% (71-98). Por su parte, dichos valores en los voluntarios fueron: 46% (20-74), 73% (39-93), 67% (31-91), 53% (27-78) y 58% (37-77). Los resultados de la serología fueron mejores, destacando una sensibilidad del 100% en ambos grupos, con una notable exactitud diagnóstica (92% y 96%, respectivamente para los ulcerosos y los voluntarios). La concordancia entre la serología y el test en saliva en los enfermos ulcerosos fue perfecta (kappa, 1), mientras que en los individuos asintomáticos fue deficiente (kappa, 0,28) y las prevalencias de infección diagnosticadas con ambas pruebas en este último grupo no fueron homogéneas (McNemar, 2,8; p < 0,05).</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El test diagnóstico de infección por <span class="elsevierStyleItalic">H. pylori</span> en saliva posee una deficiente exactitud diagnóstica en los individuos sanos, lo que indica que no es útil para el cribado de la infección en la población asintomática. El valor de esta técnica en los pacientes ulcerosos es mayor, aunque no alcanza los valores de especificidad deseables. Por todo ello, el test en saliva evaluado en el presente estudio no puede ser recomendado para realizar el diagnóstico de la infección por <span class="elsevierStyleItalic">H. pylori</span>.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate prospectively the validity of a new diagnostic method based on a saliva sample, taking as reference the breath test with 13C-marked urea, and to compare the results of this technique with another indirect method based on the detection of antibodies, «classical» serology using venous blood.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">48 individuals, 24 healthy volunteers and 24 consecutive patients with gastro-duodenal ulcer disease, were studied prospectively. Treatment during the previous month with gastro-erosive medication, antibiotics, proton-pump inhibitors or bismuth-derived drugs, prior treatment to eradicate H. pylori, gastric surgery and the presence of linked illnesses, were all considered criteria of exclusion from the study. For the diagnostic test in saliva a commercial enzyme-linked immunosorbent assay (ELISA, trademark Helisal) was used; and for blood serology, another commercial ELISA (Helico-G). The staff responsible for reading the saliva, serology and breath tests did not know the result of the other diagnostic methods. The result of the breath test with 13C-urea (TAU-kit) was taken as the reference standard for <span class="elsevierStyleItalic">H. pylori</span> infection.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mean age of the healthy volunteers was 23 ± 0.7 years; and of ulcer patients, 55 ± 18. The prevalence of H. pylori infection, valued by the gold standard, was 79.2% in the ulcer patients and 54% in the volunteers. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the saliva test in the ulcer patients were, respectively: 100% (95% CI, 79-99), 60% (17-93), 90% (68-98), 100% (31-97) and 92% (71-98). In the volunteers these figures were: 46% (20-74), 73% (39-93), 67% (31-91), 53% (27-78) and 58% (37-77). The serology results were better, with 100% sensitivity in both groups and outstanding diagnostic accuracy (92% and 96% for ulcer patients and volunteers, respectively). Concordance between serology and the saliva test in ulcer patients was perfect (kappa, 1). However, in asymptomatic individuals concordance was deficient (kappa, 0.28), and the prevalence of infection diagnosed with the two tests was not homogeneous (McNemar, 2.8; p < 0.05).</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The diagnostic test for <span class="elsevierStyleItalic">H. pylori</span> infection in saliva is lacking in diagnostic accuracy in healthy individuals, which indicates that it cannot be used for screening infection in the asymptomatic population. The technique is more valuable in ulcer patients, although it does not reach the specificity desirable. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 2 | 1 | 3 |
| 2024 Octubre | 23 | 26 | 49 |
| 2024 Septiembre | 18 | 23 | 41 |
| 2024 Agosto | 17 | 20 | 37 |
| 2024 Julio | 26 | 25 | 51 |
| 2024 Junio | 24 | 25 | 49 |
| 2024 Mayo | 15 | 19 | 34 |
| 2024 Abril | 27 | 25 | 52 |
| 2024 Marzo | 37 | 55 | 92 |
| 2024 Febrero | 28 | 37 | 65 |
| 2024 Enero | 32 | 33 | 65 |
| 2023 Diciembre | 29 | 46 | 75 |
| 2023 Noviembre | 40 | 61 | 101 |
| 2023 Octubre | 74 | 37 | 111 |
| 2023 Septiembre | 53 | 35 | 88 |
| 2023 Agosto | 33 | 34 | 67 |
| 2023 Julio | 20 | 49 | 69 |
| 2023 Junio | 77 | 30 | 107 |
| 2023 Mayo | 83 | 7 | 90 |
| 2023 Abril | 57 | 6 | 63 |
| 2023 Marzo | 35 | 2 | 37 |
| 2023 Febrero | 47 | 13 | 60 |
| 2023 Enero | 28 | 4 | 32 |
| 2022 Diciembre | 41 | 16 | 57 |
| 2022 Noviembre | 75 | 38 | 113 |
| 2022 Octubre | 60 | 18 | 78 |
| 2022 Septiembre | 56 | 12 | 68 |
| 2022 Agosto | 66 | 28 | 94 |
| 2022 Julio | 35 | 12 | 47 |
| 2022 Junio | 32 | 14 | 46 |
| 2022 Mayo | 52 | 22 | 74 |
| 2022 Abril | 56 | 31 | 87 |
| 2022 Marzo | 48 | 15 | 63 |
| 2022 Febrero | 38 | 9 | 47 |
| 2022 Enero | 38 | 9 | 47 |
| 2021 Diciembre | 75 | 16 | 91 |
| 2021 Noviembre | 62 | 23 | 85 |
| 2021 Octubre | 72 | 16 | 88 |
| 2021 Septiembre | 50 | 18 | 68 |
| 2021 Agosto | 39 | 9 | 48 |
| 2021 Julio | 58 | 9 | 67 |
| 2021 Junio | 39 | 10 | 49 |
| 2021 Mayo | 33 | 9 | 42 |
| 2021 Abril | 60 | 18 | 78 |
| 2021 Marzo | 41 | 12 | 53 |
| 2021 Febrero | 61 | 11 | 72 |
| 2021 Enero | 51 | 7 | 58 |
| 2020 Diciembre | 54 | 10 | 64 |
| 2020 Noviembre | 60 | 18 | 78 |
| 2020 Octubre | 29 | 10 | 39 |
| 2020 Septiembre | 40 | 17 | 57 |
| 2020 Agosto | 39 | 8 | 47 |
| 2020 Julio | 31 | 9 | 40 |
| 2020 Junio | 54 | 21 | 75 |
| 2020 Mayo | 28 | 16 | 44 |
| 2020 Abril | 20 | 10 | 30 |
| 2020 Marzo | 29 | 6 | 35 |
| 2020 Febrero | 73 | 16 | 89 |
| 2020 Enero | 61 | 28 | 89 |
| 2019 Diciembre | 73 | 35 | 108 |
| 2019 Noviembre | 46 | 5 | 51 |
| 2019 Octubre | 66 | 15 | 81 |
| 2019 Septiembre | 60 | 7 | 67 |
| 2019 Agosto | 46 | 12 | 58 |
| 2019 Julio | 55 | 11 | 66 |
| 2019 Junio | 83 | 53 | 136 |
| 2019 Mayo | 282 | 112 | 394 |
| 2019 Abril | 71 | 55 | 126 |
| 2019 Marzo | 27 | 8 | 35 |
| 2019 Febrero | 15 | 18 | 33 |
| 2019 Enero | 24 | 10 | 34 |
| 2018 Diciembre | 11 | 11 | 22 |
| 2018 Noviembre | 14 | 19 | 33 |
| 2018 Octubre | 13 | 14 | 27 |
| 2018 Septiembre | 1 | 21 | 22 |
| 2018 Agosto | 5 | 52 | 57 |
| 2018 Julio | 1 | 33 | 34 |
| 2018 Junio | 5 | 53 | 58 |
| 2018 Mayo | 4 | 59 | 63 |
| 2018 Abril | 8 | 43 | 51 |
| 2018 Marzo | 3 | 44 | 47 |
| 2018 Febrero | 7 | 23 | 30 |
| 2018 Enero | 2 | 32 | 34 |
| 2017 Diciembre | 1 | 21 | 22 |
| 2017 Noviembre | 2 | 33 | 35 |
| 2017 Octubre | 1 | 27 | 28 |
| 2017 Septiembre | 0 | 20 | 20 |
| 2017 Agosto | 2 | 16 | 18 |
| 2017 Julio | 11 | 18 | 29 |
| 2017 Junio | 2 | 25 | 27 |
| 2017 Mayo | 5 | 10 | 15 |
| 2017 Abril | 5 | 29 | 34 |
| 2017 Marzo | 18 | 16 | 34 |
| 2017 Febrero | 3 | 6 | 9 |
| 2017 Enero | 3 | 9 | 12 |
| 2016 Diciembre | 9 | 2 | 11 |
| 2016 Noviembre | 13 | 2 | 15 |
| 2016 Octubre | 12 | 1 | 13 |
| 2016 Septiembre | 11 | 3 | 14 |
| 2016 Agosto | 8 | 0 | 8 |
| 2016 Julio | 14 | 0 | 14 |
| 2016 Junio | 54 | 1 | 55 |
| 2016 Mayo | 46 | 20 | 66 |
| 2016 Abril | 44 | 31 | 75 |
| 2016 Marzo | 58 | 42 | 100 |
| 2016 Febrero | 36 | 9 | 45 |
| 2016 Enero | 35 | 26 | 61 |
| 2015 Diciembre | 37 | 14 | 51 |
| 2015 Noviembre | 48 | 13 | 61 |
| 2015 Octubre | 49 | 26 | 75 |
| 2015 Septiembre | 32 | 28 | 60 |
| 2015 Agosto | 35 | 30 | 65 |
| 2015 Julio | 24 | 10 | 34 |
| 2015 Junio | 14 | 0 | 14 |
| 2015 Mayo | 38 | 0 | 38 |
| 2015 Abril | 56 | 0 | 56 |
| 2015 Marzo | 20 | 0 | 20 |
| 2015 Febrero | 13 | 0 | 13 |
| 2015 Enero | 14 | 0 | 14 |
| 2014 Diciembre | 26 | 0 | 26 |
| 2014 Noviembre | 14 | 0 | 14 |
| 2014 Octubre | 13 | 0 | 13 |
| 2014 Septiembre | 15 | 0 | 15 |
| 2014 Agosto | 12 | 0 | 12 |
| 2014 Julio | 15 | 0 | 15 |
| 2014 Junio | 16 | 0 | 16 |
| 2014 Mayo | 8 | 0 | 8 |
| 2014 Abril | 9 | 0 | 9 |
| 2014 Marzo | 7 | 0 | 7 |
| 2014 Febrero | 17 | 0 | 17 |
| 2014 Enero | 11 | 0 | 11 |
| 2013 Diciembre | 18 | 0 | 18 |
| 2013 Noviembre | 16 | 0 | 16 |
| 2013 Octubre | 23 | 0 | 23 |
| 2013 Septiembre | 7 | 0 | 7 |
| 2013 Agosto | 13 | 0 | 13 |
| 2000 Abril | 1110 | 0 | 1110 |
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