白光胃镜下食管及胃黏膜不同表现与幽门螺杆菌感染的相关性研究

Correlation between esophageal and gastric mucosal manifestations and Helicobacter pylori infection under white light gastroscopy

目的探讨通过白光胃镜下食管及胃黏膜形态学表现判断幽门螺杆菌(Helicobacter pylori,HP)感染的临床价值。方法2018年9月—2019年8月就诊于陆军军医大学西南医院,同时行碳13-尿素呼气试验和白光胃镜检查的1339例病例纳入回顾性分析,运用χ2检验或Fisher确切概率法分析HP感染组(422例)和未感染组(917例)间22项胃镜下黏膜表现指标的检出率差异,然后差异性指标进一步行二元Logistic回归分析,最后绘制受试者工作特征曲线,计算曲线下面积和预测HP感染的灵敏度、特异度、阳性预测值、阴性预测值。结果弥漫性发红、点状发红、黏膜肿胀、皱襞肿大蛇形、白浊黏液、消化道溃疡、鸡皮样黏膜、增生性息肉、黄色素瘤、萎缩、肠化和凹陷性糜烂多见于感染组(P均<0.05)。二元Logistic回归分析显示弥漫性发红(P<0.001,OR=75.974,95%CI:32.551~177.327)、点状发红(P=0.002,OR=3.360,95%CI:1.536~7.349)、黏膜肿胀(P<0.001,OR=3.150,95%CI:1.654~5.996)均为提示HP感染的独立危险因素。受试者工作特征曲线分析显示弥漫性发红、点状发红、黏膜肿胀、皱襞肿大蛇形、白浊黏液、消化道溃疡、凹陷性糜烂预测HP感染的曲线下面积均大于0.5,且P<0.05,其中弥漫性发红、点状发红、黏膜肿胀预测HP感染的曲线下面积均大于0.7,三项指标对应的判断敏感度分别为0.735、0.512和0.445,特异度分别为0.992、0.983和0.971,阳性预测值分别为0.978、0.931和0.874,阴性预测值分别为0.890、0.814和0.792。结论通过白光胃镜观察食管及胃黏膜形态学表现,可较为准确地判断HP感染情况,其中内镜下表现为弥漫性发红、点状出血、黏膜肿胀的临床价值更大。

Objective To investigate the correlation between morphology of esophageal and gastric mucosal and Helicobacter pylori(HP)infection under white light gastroscope.Methods A retrospective analysis was performed on data of 1339 patients who underwent 13C-urea breath test and white light gastroscopy at the same time in the Southwest Hospital of Army Medical University from September 2018 to August 2019.Chi-square test or Fisher exact probability method was used to analyze the difference on detection rates of 22 indexes of gastroscopic mucosal manifestation between the HP infection group(n=422)and the non-infection group(n=917).Then the indexes with difference were further analyzed by binary logistic regression.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve and the sensitivity,specificity,positive predictive value and negative predictive value of prediction of HP infection was calculated.Results The diffuse redness,spotted redness,mucosal swelling,enlarged folds,sticky mucus,digestive tract ulcer,nodularity,hyperplastic polyp,xanthoma,atrophy,intestinal metaplasia,and depressive erosion were more common in patients with HP infection(all P<0.05).Binary logistic regression analysis showed that diffuse redness(P<0.001,OR=75.974,95%CI:32.551-177.327),spotted redness(P=0.002,OR=3.360,95%CI:1.536-7.349),mucosal swelling(P<0.001,OR=3.150,95%CI:1.654-5.996)were independent risk factors for HP infection.ROC curve analysis showed that the area under ROC curve of diffuse redness,spotted redness,mucosal swelling,enlarged folds,sticky mucus,peptic ulcer,and depressive erosion predicting HP infection were all greater than 0.5(P<0.05),among which,the area under curve of diffuse redness,spotted redness and mucosal swelling predicting HP infection were greater than 0.7.The sensitivities corresponding to the three indicators were 0.735,0.512,and 0.445,the specificities were 0.992,0.983,and 0.971,the positive predictive values were 0.978,0.931,and 0.874,and the negative predictive values were 0.890,0.814,and 0.792,respectively.Conclusion Morphological manifestations of esophageal and gastric mucosa,especially diffuse redness,spotted redness,and mucosal swelling,are excellent indicators for HP infection under white light gastroscopy.