白光胃镜下内镜征象诊断幽门螺杆菌感染的临床研究

Clinical study of endoscopic signs for diagnosing Helicobacter pylori infection by white light endoscopy

目的探讨利用白光胃镜下内镜征象直接诊断幽门螺杆菌(Helicobacter pylori,Hp)感染的临床价值。方法纳入行普通白光胃镜检查及^(13)C尿素呼气试验的患者786例,回顾内镜图片判读是否存在各种内镜征象。以^(13)C尿素呼气试验结果为Hp感染诊断标准,分为Hp阳性组(386例)和Hp阴性组(400例)。比较两组各种内镜征象检出率,有统计学意义的内镜征象进一步行二元Logistic回归分析,最后计算各种内镜征象的受试者工作特征曲线下面积及其诊断Hp感染状态的敏感度、特异度、阳性预测值、阴性预测值。结果786例患者中Hp感染率49.1%。Hp阳性组中弥漫性发红、点状发红、黏膜肿胀、皱襞肿大、鸡皮样改变、增生性息肉、胃溃疡、十二指肠球部溃疡、闭合型萎缩的比例高于Hp阴性组,差异均有统计学意义(P<0.05)。Hp阴性组中规则排列的集合细静脉(regular arrangement of collecting venules,RAC)、脊状发红、胃底腺息肉、陈旧性出血点的比例高于Hp阳性组(P<0.05)。二元Logistic回归分析显示弥漫性发红、点状发红、黏膜肿胀、皱襞肿大、十二指肠球部溃疡是Hp感染的独立危险因素(P<0.05)。RAC、胃底腺息肉与Hp感染呈负相关(P<0.05)。受试者工作特征曲线分析显示弥漫性发红、黏膜肿胀预测Hp感染的曲线下面积分别为0.729、0.751,对应的敏感度分别为71.8%、65.5%,特异度分别为74.5%、85.3%。RAC预测Hp未感染的曲线下面积为0.804,敏感度为68.5%、特异度为92.5%。结论白光胃镜下内镜征象可较准确诊断Hp感染情况,尤其是弥漫性发红、黏膜肿胀、RAC诊断效能最好。

Objective To investigate the clinical value of endoscopic signs for diagnosing Helicobacter pylori(Hp)infection by white light endoscopy.Methods In total,786 patients who underwent ordinary white light gastroscopy and ^(13)C urea breath test were included.The endoscopic images were reviewed to judge whether there were various endoscopic signs.Taking the results of ^(13)C urea breath test as the diagnostic standard of Hp infection,they were divided into Hp positive group(n=386)and Hp negative group(n=400).The detection rates of various endoscopic signs in the two groups were compared.The statistically significant endoscopic signs were further analyzed by binary logistic regression.Finally,the area under the receiver operating characteristic(ROC)curve of subjects with various endoscopic signs and the sensitivity,specificity,positive predictive value and negative predictive value of diagnosing Hp infection were calculated.Results The Hp infection rate in 786 patients was 49.1%.The proportion of diffuse redness,punctate redness,mucosal swelling,fold enlargement,chicken skin like changes,hyperplastic polyps,gastric ulcer,duodenal ulcer and closed atrophy in Hp positive group was higher than that in Hp negative group(P<0.05).The proportion of regular arrangement of collecting venules(RAC),ridge redness,gastric fundus gland polyps and old bleeding points in Hp negative group was higher than that in Hp positive group(P<0.05).Binary logistic regression analysis showed that diffuse redness,punctate redness,mucosal swelling,fold enlargement and duodenal ulcer were independent risk factors of Hp infection(P<0.05).RAC and gastric fundus gland polyps were negatively correlated with Hp infection(P<0.05).The are aunder the ROC curve(AUC)showed that the areas under the ROC curve of diffuse redness and mucosal swelling to predict Hp infection were 0.729 and 0.751 respectively,the corresponding sensitivity was 71.8%and 65.5%respectively,and the specificity was 74.5%and 85.3%respectively.The AUC of RAC in predicting non-Hp infection was 0.804,the sensitivity was 68.5%,and the specificity was 92.5%.Conclusion The endoscopic signs by white light endoscopy can accurately diagnose Hp infection,especially the diffuse redness,mucosal swelling and RAC.