胃镜下肉眼观察胃黏膜形态直接判断幽门螺杆菌感染的临床价值

Feasibility of gastroscopic diagnosis of Helicobacter pylori infection based on gastric mucosal appearances

目的研究胃镜下肉眼观察胃黏膜形直接判断幽门螺杆菌(Helicobacter pylori,H.pylori)感染的可行性.方法随机选取丽水市中心医院行胃镜检查患者2255例,通过2位内镜医师肉眼观察其内镜下的胃黏膜表现形态判断有无H.pylori感染,分为A组(H.pylori感染组)和B组(非H.pylori感染组),仅满足1项A组黏膜表现为A1组;满足两项及以上A组黏膜表现为A2,同样方法将B组分为B1、B2组.最后与^(13)C或^(14)C尿素呼气试验结果进行对比统计分析.结果A1组共计547例,A2组共计636例,二者之间存在统计学差异(P<0.01).B1组共计489例,B2组共计398例,二者之间存在统计学差异(P<0.01).内镜诊断与^(13)C或^(14)C尿素呼气试验诊断H.pylori感染之间符合率为90.8%.其中满足1项内镜表现判断有无H.pylori感染的准确率为85.6%,其灵敏性84.6%,特异性为86.8%,而满足两项及以上内镜表现判断有无H.pylori感染的准确率为96.0%,其灵敏性为97.3%,特异性为94.1%,二者之间存在统计学差异(P<0.01).结论内镜下肉眼观察直接判断有无H.pylori感染的准确率较高,值得临床进一步研究及推广应用.

AIM To assess the feasibility of gastroscopic diagnosis of Helicobacter pylori（H.pylori） infection based on gastric mucosal appearances.METHODS A total of 2255 patients who underwent gastroscopic examination at our hospital were included in this study. These patients were divided into two groups（A and B） according to the diagnosis of H.pylori infection or not by two endoscopic physicians based upon gastric mucosal appearances. Based on meeting only one criterion or two or above criteria of gastric mucosal appearances for the diagnosis of H.pylori infection, group A was further divided into two subgroups（A1 and A2）.Similarly, group B was fur ther divided into subgroups B1 and B2. Finally, the diagnostic results based on gastric mucosal appearances were compared with those based on （13）C or （14）C urea breath test.RESULTS There were 547 and 636 patients in subgroups A1 and A2（P〈 0.01）, and 489 and 398 patients in subgroups B1 and B2（P〈 0.01）, respectively.The concordant rate between the endoscopicdiagnosis and 13 C or 14 C urea breath test in the diagnosis of H.pylori infection was 90.8%.The accuracy, sensitivity and specificity of one criterion of gastric mucosal appearances were 85.6%, 84.6%, and 86.8%, respectively.The accuracy, sensitivity and specificity of the two or above criteria of gastric mucosal appearances were 96%, 97.3%, and 94.1%,respectively. There was a statistical difference between the two groups（P〈 0.05）.CONCLUSION The accuracy of endoscopic diagnosis of H.pylori infection based on gastric mucosal appearances is high. Further research is needed to confirm our findings.