京都胃炎分类在白光胃镜下直接判断幽门螺杆菌感染中的应用价值

Diagnostic value of Kyoto gastritis classification for Helicobacter pylori infection under white light endoscope

目的应用京都胃炎分类,通过肉眼观察白光胃镜下的胃黏膜形态,评价其直接判断幽门螺杆菌感染(Hp)的应用价值。方法纳入同时进行白光胃镜和^13C/^14C尿素呼气试验的患者584例,采用京都胃炎分类的诊断标准,以普通白光胃镜直接观察胃黏膜形态,根据形态特点判断是否存在Hp感染,并与呼气试验对比。结果白光胃镜下,弥漫性发红、点状发红、黏膜肿胀多见于Hp感染者,而胃体和胃角可见集合细静脉的规则排列、陈旧性出血斑、胃底腺息肉常见于Hp未感染者。以符合弥漫性发红、点状发红和黏膜肿胀至少三种之一的胃黏膜改变作为胃镜下判断Hp感染的标准,与呼气试验比较,白光模式的受试者工作特征曲线的曲线下面积为0.783,灵敏度为77.44%,特异度为79.31%,阳性预测值为75.74%,阴性预测值为80.83%,总体符合率为78.46%。结论在白光胃镜观察胃黏膜形态时,应用京都胃炎分类,对直接判断Hp感染具有一定的辅助价值。

Objective To evaluate the application value of Kyoto gastritis classification in the diagnosis of Helicobacter pylori (Hp) infection based on the observation of mucosal features under white light endoscope.Methods A total of 584 patients who simultaneously received white light endoscopy and ^13C or ^14C urea breath test (UBT) were recruited in this investigation. The Kyoto gastritis classification was adopted. Hp infection was diagnosed by observing the mucosal features under white light endoscope. The results were statistically compared with 13C or 14C UBT. The results between two detection methods was calculated. Results Patients with mucosal features including diffuse redness, spotty redness and mucosal swelling under white light endoscope were diagnosed with Hp infection. Those with regular arrangement of collecting venules , hemorrhagic erosion and fundic gland polyposis were not infected by Hp. The gastric mucosal changes including at least one of the diffuse redness, spotty redness and mucosal swelling were considered as positive Hp under endoscope. Compared with UBT, the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Hp infection under white light endoscope were 0.783, 77.44 %, 79.31 %, 75.74 % and 80.83 %, respectively. The overall consistency rate was 78.46 %.Conclusion Kyoto gastritis classification can be helpful in diagnosing Hp infection when observing gastric mucosal morphology under white light endoscope.