高清胃镜观察胃黏膜形态预测幽门螺杆菌感染的探索

Gastroscopic diagnosis of Helicobacter pylori infection based on gastric mucosal features

目的通过高清胃镜观察、归纳幽门螺杆菌(Hp)感染时胃黏膜形态改变以预测Hp感染结果,从而探讨高清胃镜直接诊断Hp感染的临床价值。方法纳入2016年10月-2017年1月在深圳市龙岗区第二人民医院同时进行胃镜检查和13C-尿素呼气试验的连续性500例受检者,以高清胃镜在白光下直接观察胃黏膜形态,根据所见形态特点预测是否存在Hp感染,并与13C-尿素呼气试验结果进行比对,比较两者结果符合率。结果胃体、胃底黏膜充血或出血;胃黏膜水肿;胃底、胃体黏膜可见较多黏液;中度以上黏膜萎缩;黏膜肠上皮化生;十二指肠球部溃疡可能成为胃镜预测Hp感染阳性的特征点。胃体可见规则集合静脉(RAC);胃黏膜有光泽,无萎缩;胃底或胃体息肉;胃窦或胃体小弯的放射性充血可能成为胃镜预测Hp感染阴性的特征点。胃镜预测Hp感染的敏感性为90.1%,特异性为70.4%;阳性预测值为71.0%,阴性预测值为89.9%,总体符合率79.2%。结论高清胃镜直接观察胃黏膜形态表现可有效预测Hp感染情况,可在临床上进一步推广验证。

Objective The study explored and summarized mucosal features of H. pylori gastritis, attempting to assess the clinical value of high-definition gastroscopy in diagnosing H. pylori infection. Methods From October 2016 to January 2017, 500 subjects were enrolled and examined with gastroscopy. Researchers made predictions according to mucosal features observed with high-definition gastroscopy and compared those with results of urea breath test to assess the accuracy. Results Features including diffuse gastric mucosal hyperaemia; mucosal edema; hypersecretion of gastric mucus; severe mucosal atrophy; intestinal metaplasia and duodenal ulcer suggested H. pylori infection, while regular arrangement of collecting venules; lack of atrophy; polyps and radiating gastric mucosal hyperaemia suggested uninfected status. The sensitivity, specificity, positive and negative predictive values of H. pylori infection was 90.1%, 70.4%, 71.0% and 89.9%, while the overall accuracy was 79.2%. Conclusions By observing typical mucosal patterns resulting from H. pylori infection, high-definition gastroscopy may become a reliable and efficient method of predicting H. pylori infection status in clinical practice.