京都胃炎评分对内镜下预测幽门螺杆菌感染的价值与意义

Clinical value and significance of the Kyoto classification score of gastritis for the endoscopic prediction of Helicobacter pylori infection

目的验证京都胃炎评分在我国行内镜检查人群中预测幽门螺杆菌(H.pylori)感染状态的准确性。方法收集2020年6月至2021年1月在浙江中医药大学附属第一医院消化内镜中心行胃镜检查的489例患者的临床资料,根据京都胃炎分类记录白光内镜下胃黏膜表现(包括萎缩、肠化生、皱襞增宽、结节、弥漫性发红、白浊黏液等)。根据13C尿素呼气试验、组织病理学检查、抗H.pylori抗体检查确定患者是否有H.pylori感染。计算每例患者的京都胃炎评分,分析各项内镜下表现预测H.pylori感染的灵敏度、特异度和比值比[95%可信区间(95%CI)]等。统计学方法采用卡方检验。结果489例患者中H.pylori感染者246例,H.pylori未感染者243例。京都胃炎评分≥2分者共242例,其中H.pylori感染者215例,H.pylori未感染者27例;京都胃炎评分<2分者共247例,其中H.pylori感染者31例,H.pylori未感染者216例,京都胃炎评分≥2分预测胃黏膜H.pylori感染的准确率为88.14%(431/489)。肠化生在H.pylori感染者与未感染者中的发生率比较差异无统计学意义(P>0.05),萎缩、皱襞增宽、结节、弥漫性发红在H.pylori感染者中的发生率均高于未感染者[68.3%(140/205)比31.7%(65/205)、95.2%(99/104)比4.8%(5/104)、89.7%(35/39)比10.3%(4/39)、85.0%(227/267)比15.0%(40/267)],差异均有统计学意义(χ^(2)=45.68、106.46、26.37、283.48,P均<0.01),萎缩、皱襞增宽、结节、弥漫性发红预测H.pylori感染的灵敏度、特异度、比值比(95%CI)分别为56.91%、73.25%、3.62(2.47~5.29),40.24%、97.94%、32.06(12.76~80.57),14.23%、98.35%、9.91(3.47~28.35),以及92.28%、83.54%、60.63(34.02~108.08),其中萎缩预测H.pylori感染的灵敏度、特异度均较低,诊断效能一般。白浊黏液和胃底至胃体斑点状发红在H.pylori感染者中的发生率均高于未感染者[86.5%(32/37)比13.5%(5/37)、86.9%(146/168)比13.1%(22/168)],差异均有统计学意义(χ^(2)=20.96、137.12,P均<0.01),该2项指标预测H.pylori感染的灵敏度、特异度、比值比(95%CI)分别为13.01%、97.94%、7.12(2.72~18.60)和59.35%、90.95%、14.67(8.84~24.34),诊断效能均较理想。结论运用京都胃炎评分内镜下预测H.pylori感染适用于我国人群,但在单项表现中,萎缩和肠化生的诊断效能不佳,应同时关注有无白浊黏液或胃底至胃体斑点状发红。

Objective To verify the accuracy of the Kyoto classification score of gastritis for the endoscopic prediction of the Helicobacter pylori(H.pylori)infection in Chinese population.Methods From June 2020 to January 2021,at the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang Chinese Medical University,the clinical data of 489 patients who underwent gastroscopy examination were collected and the gastric mucosal manifestations under white light endoscopy(including atrophy,intestinal metaplasia,widening of gastric fold,nodularity,diffuse redness,white sticky mucus,etc.)were recorded according to the Kyoto classification of gastritis.H.pylori infection of the patients was determined according to 13C-urea breath test,histopathological examination and anti-H.pylori antibody test.The Kyoto classification score of gastritis of each patient was calculated.The sensitivity,specificity and odds ratio(OR)(95%confidence interval(95%CI))of various endoscopic appearances in prediction of H.pylori infection were analyzed.Chi-square test was used for statistical analysis.Results Among the 489 patients,246 patients had H.pylori infection and 243 patients did not have H.pylori infection.There were 242 patients with Kyoto gastritis score≥2,among them 215 cases had H.pylori infection and 27 cases did not have H.pylori infection.The accuracy of Kyoto classification score of gastritis in predition of H.pylori infection was 88.14%(431/489).Among the five indexes of the Kyoto classification score of gastritis,there was no significant difference in the incidence of intestinal metaplasia between patients with H.pylori infection and patients without H.pylori infection(P>0.05).The incidence rates of atrophy,widening of gastric fold,nodularity and diffuse redness were higher in patients with H.pylori infection than those in patients without H.pylori infection(68.3%,140/205 vs.31.7%,65/205;95.2%,99/104 vs.4.8%,5/104;89.7%,35/39,vs.10.3%,4/39;85.0%,227/267 vs.15.0%,40/267),and the differences were statistically significant(χ^(2)=45.68,106.46,26.37 and 283.48,all P<0.01).The sensitivity,specificity and OR(95%CI)of atrophy,widening of gastric fold,nodularity and diffuse redness in prediction of H.pylori infection were 56.91%,73.25%,and 3.62(2.47 to 5.29);40.24%,97.94%and 32.06(12.76 to 80.57);14.23%,98.35%,9.91(3.47 to 28.35);and 92.28%,83.54%and 60.63(34.02 to 108.08),respectively.The sensitivity and specificity of atrophy in prediction of H.pylori infection were low,and the diagnostic efficacy was general.The incidence rates of white sticky mucus and spotty redness of the gastric fundus and body were higher in patients with H.pylori infection than those in patients without H.pylori infection(86.5%,32/37 vs.13.5%,5/37;86.9%,146/168,vs.13.1%,22/168),and the differences were statistically significant(χ^(2)=20.96 and 137.12,both P<0.01).The sensitivity,specificity,and OR(95%CI)of the two indicators in prediction of H.pylori infection were 13.01%,97.94%and 7.12(2.72 to 18.60),and 59.35%,90.95%and 14.67(8.84 to 24.34),respectively,and the diagnostic efficacy was ideal.Conclusions The Kyoto classification score of gastritis used for the endoscopic prediction of H.pylori infection is suitable for Chinese population.However,from the perspective of individual indicator,the diagnostic efficiency of atrophy and intestinal metaplasia is unsatisfactory.At the same time,attention should be paid to whether there is sticky mucus or spotty redness of the gastric fundus and body.