白光内镜下不同评分直接判断幽门螺杆菌现症感染的诊断效能

Clinical comparative study of different scoring in directly judging Helicobacter pylori current infection under white light endoscopy

目的 评估内镜医师运用京都胃炎评分及改良京都胃炎评分在白光内镜下直接判断幽门螺杆菌(Hp)感染与^(13)C-尿素呼气试验的一致性,明确改良京都胃炎评分的临床应用价值。方法 对重庆市某医院消化内镜医师进行京都胃炎分类专项培训,筛选1周内同时进行上消化道内镜检查及^(13)C-尿素呼气试验的患者,同时应用京都胃炎评分及改良京都胃炎评分对目标人群进行内镜下胃黏膜特征评分,计算出总分并与^(13)C-尿素呼气试验结果进行对比。结果纳入研究患者共1 342例,京都胃炎评分和改良京都胃炎评分在白光内镜下诊断Hp现症感染的灵敏度分别为74.03%、90.70%,特异度分别为95.85%、95.39%,阳性预测值分别为80.93%、82.39%,阴性预测值分别为93.94%、97.73%。改良京都胃炎评分与京都胃炎评分在白光内镜下诊断Hp现症感染比较,灵敏度、阴性预测值差异均有统计学意义(P均<0.01)。结论 经京都胃炎专项培训的内镜医师,运用改良京都胃炎评分在白光内镜下直接判断Hp现症感染,具有较高的诊断效能。

Objective To evaluate the consistency between Kyoto classification scoring of gastritis and modified Kyoto classification scoring of gastritis in directly determining Helicobacter pylori(Hp)infection under white light endoscopy by endoscopists with ^(13)C urea breath test,and to clarify the clinical application value of the modified Kyoto classification scoring of gastritis.Methods Digestive endoscopists in a county hospital in Chongqing received special training on the Kyoto classification of gastritis.Patients who underwent both the upper gastrointestinal endoscopy and ^(13)C urea breath test within one week were screened.At the same time,the Kyoto classification scoring of gastritis and the modified Kyoto classification scoring of gastritis were used to score the endoscopic gastric mucosa characteristics of the target population.The total score was calculated and compared with the ^(13)C urea breath test.Results A total of 1342 patients were included in the study.The sensitivity of the Kyoto classification scoring of gastritis and the modified Kyoto classification scoring of gastritis for the diagnosis of Hp infection under white light endoscopy were 74.03%and 90.70%,the specificity was 95.85%and 95.39%,and the positive predictive values were 80.93%and 82.39%,the negative predictive values were 93.94%and 97.73%,respectively.The sensitivity,negative predictive value and AUC of the modified Kyoto classification scoring of gastritis in the diagnosis of Hp infection under white light endoscopy had statistical significance compared with the Kyoto classification scoring of gastritis(all P<0.01).Conclusion For endoscopists receiving special training for Kyoto classification of gastritis,the modified Kyoto classification scoring of gastritis yields high diagnostic consistency in directly determining Hp infection under white light endoscopy.