胃镜下根据胃黏膜形态判断幽门螺杆菌感染的临床价值

Clinical value of routine endoscopic diagnosis of helicobacter pylori infection based on gastric mucosal appearances

目的:探讨胃镜常规检查时目测胃黏膜形态判断幽门螺杆菌(Hp)感染的准确性及其临床意义。方法:选取胃镜诊疗工作满15年、8年及3年的高、中、低3级医生,在胃镜检查时目测胃黏膜形态判断胃黏膜Hp感染情况,同时与胃黏膜活检快速尿激酶试验或病理检测Hp结果进行比较。Hp感染严重程度的判定分为阴性、+、++、+++共4个级别。结果 :共收集366例胃镜检查患者,其中高、中、低年资医生分别完成120例、127例和119例。(1)与黏膜活检结果相比,目测Hp感染的敏感性、特异性和准确性分别为85.9%、62.3%和71.0%,其中高年资医生的敏感性、特异性和准确性分别为78.1%、83.5%、81.7%,在特异性和准确性方面显著高于中、低年资医生(P<0.05)。(2)对Hp感染严重程度的目测判断与活检结果中度正相关(r=0.5794),其相关性在快检高于病理检测(r分别为0.8040、0.4034),在非萎缩性胃炎高于萎缩性胃炎(r分别为0.6575、0.4084),在高年资医生高于中、低年资医生(r分别为0.6627、0.5855、0.5296)。结论:常规胃镜检查时目测对判断Hp的感染有一定的准确性和临床价值,但在一定程度上受医生经验影响。

Objective：To investigate the accuracy and clinical significance of routine endoscopic diagnosis of helicobacter pylori（Hp）infection based upon features of gastric mucosal appearances.Methods：Doctors with 15,8 and 3 years＇ endoscopy experience respectively were randomly selected.Hp infection diagnosis based on gastric mucosal appearances and either rapid urea enzyme test or pathological examination was obtained.The severity of Hp infection was classified into four grades：negative,＋,＋＋,＋＋＋.Results：Endoscopy of 366 patients,120,127 and 119 were completed by the three grade doctors respectively.（1）Based on the results of biopsy,the overall sensitivity,specificity and accuracy of endoscopic diagnosis were 85.9%,62.3% and 71.0%.The sensitivity,specificity and accuracy of the senior doctors were 78.1%,83.5% and 81.7%,respectively.The diagnostic specificity and accuracy in the senior doctors were higher than that in young doctors（P〈0.05）.（2）The endoscopic diagnosis of the severity of Hp infection was better correlated to the rapid urea enzyme test than pathological examination（r=0.8040 vs 0.4034）.The coefficient was higher in superficial gastritis than that in atrophic gastritis（0.6575 vs 0.4084）,and the coefficient was higher in senior doctors（r=0.6627）than in junior doctors（r=0.5855,0.5296）.Conclusion：Routine endoscopic diagnosis of Hp infection based on mucosal appearances is simple but the clinical value depends on the doctor＇s experience.