소아에서 Helicobacter pylori 대변 항원 양성 결과와 빈혈의 연관성에 대한 다기관 연구
Multicenter Study on the Association of Positive Helicobacter pylori Stool Antigen to Anemia in Children
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배경: 소아에서 Helicobacter pylori 감염은 위장관 증상 외에 철겹핍성 빈혈을 유발할 수 있다. 이 연구에서는 소아에서 H. pylori 대변항원검사 양성률 추세와 H. pylori 대변항원검사 결과와 빈혈과의 연관성을 알아보고자 하였다. 방법: 2008년부터 2014년까지 서울지역 단일 3차 의료기관에서 0-18세 소아를 대상으로 시행된 2,762건의 H. pylori 대변항원검사[EZ-STEP H. pylori Ag ELISA (Dinona Inc., Korea)]의 연도별, 연령별 양성률과 혈색소의 상관관계를 분석하였다. 또한, 2015년 1-5월 서울 지역 3차 의료기관 3곳, 경기 지역 2차 의료기관 1곳, 충북 지역 2차 의료기관 1곳의 소아에서 얻은 352검체의 H. pylori 대변항원검사[ASAN Easy Test H. pylori Ag 키트(Asan Pharm. Co., LTD., Seoul, Korea)] 결과와 혈색소의 상관관계를 분석하였다. 결과: 2008-2014년까지 H. pylori 대변항원검사 양성률은 5.8%였으며, 2012년에 9.1%로 가장 높았고 2013년에 2.3%로 가장 낮았다. 연령별 양성률은 0-6세는 2.9%, 7-12세 5.8%, 13-18세 10.6%로 연령군에 따라 양성률이 증가하였다(P＜ 0.0001). 빈혈 환자에서의 H. pylori 대변항원검사 양성률(7.0%)과 빈혈이 없는 소아에서의 H. pylori 대변항원검사 양성률(5.7%)에 차이가 없었다. H. pylori 대변항원검사 양성, 음성 환자에서 ferritin은 각각 40.6±27.9 ng/mL, 56.8±42.0 ng/mL로 H. pylori 대변항원검사 양성 환자에서 음성 환자보다 ferritin이 유의하게 낮았다(P=0.0001). 다기관 연구에서 H. pylori 대변항원검사 양성률은 16.8%였다. 결론: 2008년에서 2014년까지 단일기관 소아 환자에서 H. pylori 대변항원 양성률은 5.8%였으며, 연령에 따라 양성률이 증가하였다. H. pylori 대변항원검사 양성 환자에서 음성 환자보다 ferritin이 유의하게 낮아 H. pylori 감염이 철 결핍 상태와 연관성이 있을 것으로 판단하였다. [Ann Clin Microbiol 2018;21:58-63]
Abstract
Background: Helicobacter pylori infection in children causes gastrointestinal symptoms and iron deficiency anemia. This study aimed to investigate trends in H. pylori stool antigen (HpSA) positivity in children and the relationship between HpSA test results and anemia. Methods: We analyzed the results of 2,762 HpSA tests and the correlation of hemoglobin and ferritin with HpSA in patients aged 0-18 years from 2008 to 2014 at a tertiary care center. Additionally, we prospectively evaluated HpSA test results and correlation with hemoglobin in 352 specimens obtained from five centers. Results: From 2008-2014, the mean positive rate of the HpSA test was 5.8%, with a high of 9.1% in 2012 and a low of 2.3% in 2013. The positive rate correlated with age: 2.9% in 06-year-olds, 5.8% in 712-year-olds, and 10.6% in 13-18-year-olds (P＜0.0001). There was no difference in HpSA positivity in patients with (7.0%) and without (5.7%) anemia. Ferritin was significantly lower in patients with positive HpSA results than in those with negative results (P=0.0001). In a multicenter study, the positive rate of HpSA was 16.8%. Conclusion: The rate of HpSA positivity was 5.8% in pediatric patients at a single center from 20082014, and this rate increased with age. Helicobacter pylori infection may be associated with iron deficiency, as ferritin level was significantly lower in HpSA-positive patients than HpSA-negative patients. (Ann Clin Microbiol 2018;21:-63)
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