蓝激光内镜联动成像联合京都胃炎分类构建全科医生消化亚专长培训模式

Linked color imaging combined with Kyoto gastritis classification to build a general practitioner digestive sub-specialty training model

目的本研究联合蓝激光内镜联动成像(LCI)与京都胃炎分类构建一个全科医生消化亚专长培训模式,旨在提高全科医生判断幽门螺旋杆菌(H.pylori)感染状态的能力。方法随机收集2020年1月至2020年10月经南方医科大学第七附属医院内镜中心行胃镜检查并行13C-尿素呼气试验的受检者71例,使用蓝激光内镜LCI及普通白光模式(WLI)分别进行标准胃镜留图记录,依据专家组分析结果与呼气试验检测结果设计问卷测试,对全科医生、专科医生进行培训,使用问卷进行考核。采用统计软件SPSS 26.0分析。结果(1)专家组对京都胃炎分类中不同胃镜下黏膜表现判断H.pylori感染状态差异分析上,单因素分析显示,黏膜萎缩、血痂、黏膜肿胀、白浊黏液、排列规则的集合静脉在专家组判断H.pylori感染中有帮助作用(P<0.05),多因素Logistic回归分析显示,京都胃炎中各项胃镜下黏膜表现对于专家组判断H.pylori感染与否有影响的有黏膜萎缩、血痂、黏膜肿胀、白浊黏液,差异具有统计学意义(P<0.05)。(2)经过学习培训后,全科医生的考核总分数有了明显提升(3.48±1.35 vs 4.45±1.92,P<0.05),完成时间与初级消化内科医生没有差异。(3)完成培训后,全科医生问卷考核WLI、LCI病例分数均有所提高,LCI病例考核分数提升幅度较WLI病例高,且LCI病例培训前后分数差异具有统计学意义(LCI:1.45±0.99 vs 2.14±1.22,P<0.05),而WLI病例培训前后分数差异无统计学意义。结论京都胃炎分类联合蓝激光内镜LCI有利于判断内镜下H.pylori感染,经过培训,可提高全科医生通过内镜图片判断H.pylori感染的能力。

Objective This study combined linked color imaging(LCI)with Kyoto classification of gastritis to construct a general practitioner digestive sub-specialty training model,aiming to improve general practitioners’ability to determine the status of Helicobacter pylori(H.pylori)infection.Methods A random collection of 71 patients who had undergone gastroscopy and13 C-urea breath test in the Endoscopy Center of the Seventh Affiliated Hospital of Southern Medical University from January 2020 to October 2020 were included.We used LCI and white light imaging(WLI)mode to perform standard gastroscopy recordings.We designed a questionnaire test based on the analysis results of the expert and the test results of the 13 C-urea breath test.Then we trained GPs and SGs,and used questionnaires for assessment.Statistical software SPSS 26.0 was used for analysis.Results(1)On the expert endoscopists’analysis of the different gastroscopic mucosal manifestations in Kyoto classification of gastritis,univariate analysis showed that mucosal atrophy,hematin,mucosal swelling,sticky mucus and regular arrangement of collecting venules(RAC)were helpful in determining H.pylori infection(P-values<0.05),and multivariate Logistic regression analysis showed that the gastroscopic mucosal manifestations including mucosal atrophy,hematin,mucosal swelling,and sticky mucus had an impact on the expert endoscopists’judgment of H.pylori infection(P-values<0.05).(2)After the training,the GPs’total scores were improved(3.48±1.35 vs 4.45±1.92,P-values<0.05),and there was no difference in completion time compared with SGs.(3)After the training,the GPs’questionnaire scores of WLI and LCI case have improved.The scores of LCI cases have increased more than WLI cases(LCI:1.45±0.99 vs 2.14±1.22,P-values<0.05,WLI:2.04±0.87 vs 2.31±1.22,P-values=0.355).Conclusion The Kyoto classification of gastritis combined with LCI is beneficial for H.pylori infection diagnosis under endoscopy,and the ability of GPs to diagnose H.pylori infection through endoscopic pictures can be improved after training.