切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 152 -156. doi: 10.3877/cma.j.issn.1674-0785.2022.02.008

临床研究

白光胃镜下胃黏膜形态变化对幽门螺杆菌感染的诊断价值分析
李微1,(), 陈晓莉1, 蔡仁颂1, 朱莉1, 闾素婷1, 邢小丽1   
  1. 1. 570311 海口,海南医学院第二附属医院消化内镜科
  • 收稿日期:2021-06-22 出版日期:2022-02-15
  • 通信作者: 李微
  • 基金资助:
    海南省卫生计生行业科研项目(20A200212)

Diagnostic value of gastric mucosal morphology changes detected by white light gastroscopy in Helicobacter pylori infection

Wei Li1,(), Xiaoli Chen1, Rensong Cai1, Li Zhu1, Suting Yan1, Xiaoli Xing1   

  1. 1. Department of Digestive Endoscopy, Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China
  • Received:2021-06-22 Published:2022-02-15
  • Corresponding author: Wei Li
引用本文:

李微, 陈晓莉, 蔡仁颂, 朱莉, 闾素婷, 邢小丽. 白光胃镜下胃黏膜形态变化对幽门螺杆菌感染的诊断价值分析[J]. 中华临床医师杂志(电子版), 2022, 16(02): 152-156.

Wei Li, Xiaoli Chen, Rensong Cai, Li Zhu, Suting Yan, Xiaoli Xing. Diagnostic value of gastric mucosal morphology changes detected by white light gastroscopy in Helicobacter pylori infection[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(02): 152-156.

目的

探究白光胃镜下胃黏膜形态变化对幽门螺杆菌(H. pylori)感染相关性胃炎的诊断价值。

方法

回顾性分析2018年7月至2020年7月在海南医学院第二附属医院进行白光胃镜检查和13-尿素呼气试验(13C-UBT)检查的1160例病例,依据13C-UBT检查结果分为2组:H. pylori感染组(812例)和无H. pylori感染组(348例)。比较2组白光胃镜下胃粘膜形态差异,进行Logistic回归分析筛选出H. pylori感染独立相关的胃黏膜形态特征,并应用受试者工作特征曲线(ROC)评价相关指标的预测价值。

结果

H. pylori感染组白光胃镜下弥漫性胃黏膜充血、点状发红、胃黏膜肿胀、胃体皱襞肿大蛇形、胃体黏膜呈“龟纹样”等检出率均显著高于无H. pylori感染组。多因素Logistic回归分析显示,弥漫性胃黏膜充血(OR=116.280)、点状发红(OR=4.821)、胃黏膜肿胀(OR=3.432)、胃体皱襞肿大蛇形(OR=4.336)、胃体黏膜呈“龟纹样”(OR=9.346)是H. pylori感染的独立相关因子。ROC曲线分析显示,弥漫性胃黏膜充血、点状发红、胃黏膜肿胀、胃体皱襞肿大蛇形、胃体黏膜呈“龟纹样”预测H. pylori感染的曲线下面积分别为0.829(95%CI:0.796~0.859)、0.687(95%CI:0.648~0.725)、0.750(95%CI:0.713~0.785)、0.578(95%CI:0.537~0.619)、0.619(95%CI:0.578~0.619),其中以弥漫性胃黏膜充血、胃黏膜肿胀较大,它们的敏感度和特异度分别为93.68%和72.17%、97.13%、52.96%。

结论

白光胃镜下胃黏膜形态变化与H. pylori感染具有相关性,以弥漫性胃黏膜充血、胃黏膜肿胀对H. pylori感染的诊断价值较大。

Objective

To explore the diagnostic value of gastric mucosal morphology changes detected by white light gastroscopy in Helicobacter pylori (H. pylori) infection-related gastritis.

Methods

A retrospective analysis was performed on 1160 patients who underwent white light gastroscopy and 13-urea breath test (13C-UBT) at the Second Affiliated Hospital of Hainan Medical University from July 2018 to July 2020, and the patients were divided either an H. pylori infection group (812 cases) or a non-H. pylori infection group (348 cases) based on the results of 13C-UBT. The differences in gastric mucosal morphology detected by white light gastroscopy were compared between the two groups, and Logistic regression analysis was performed to screen out the gastric mucosa morphological characteristics independently related to H. pylori infection. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of the related indicators.

Results

The detection rates for diffuse gastric mucosal congestion, punctate redness, gastric mucosal swelling, snake-shaped enlarged gastric folds, and moire gastric mucosa by white light gastroscopy in the H. pylori infection group were significantly higher than those in the non-H. pylori infection group. Multivariate Logistic regression analysis showed that diffuse gastric mucosal congestion (odds ratio [OR]=116.280), punctate redness (OR=4.821), gastric mucosal swelling (OR=3.432), snake-shaped enlarged gastric folds (OR=4.336), and moire gastric mucosa (OR=9.346) were independent factors for H. pylori infection. ROC curve analysis showed that the areas under the curves of diffuse gastric mucosal congestion, punctate redness, gastric mucosal swelling, snake-shaped enlarged gastric folds, and moire gastric mucosa in predicting H. pylori infection were 0.829 (95%CI: 0.796~0.859), 0.687 (95%CI: 0.648~0.725), 0.750 (95%CI: 0.713~0.785), 0.578 (95%CI: 0.537~0.619), and 0.619 (95%CI: 0.578~0.619), respectively. Among them, the areas of curves of diffuse gastric mucosal congestion and gastric mucosal swelling were larger, and the sensitivity and specificity were 93.68% and 72.17%, and 97.13% and 52.96%, respectively.

Conclusion

Gastric mucosal morphology changes detected by white light gastroscopy are related to H. pylori infection. Diffuse gastric mucosal congestion and gastric mucosal swelling are more valuable in the diagnosis of H. pylori infection.

图1 白光胃镜下黏膜表现。图a为点状发红表现;图b为黄色素瘤;图c为隆起性糜烂;图d为胃体黏液多且浑浊表现;图e为黏膜充血表现;图f为点状发红表现;图g为黏膜肿胀表现;图h为黏膜肿胀发红表现;图I为胃体皱襞肿大蛇形表现
表1 2组白光胃镜下黏膜形态变化比较[例(%)]
表2 白光胃镜下黏膜形态与H. pylori感染相关性的多因素Logistic回归分析
图2 白光胃镜下预测幽门螺杆菌感染的ROC曲线
表3 白光胃镜下黏膜形态预测幽门螺杆菌感染的准确性分析结果
1
Nishikawa Y, Ikeda Y, Murakami H, et al. Classification of atrophic mucosal patterns on Blue LASER imaging for endoscopic diagnosis of helicobacter pylori-related gastritis: a retrospective, observational study [J]. PLoS One, 2018, 13(3): e0193197.
2
Choi IJ, Kook MC, Kim YI, et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer [J]. N Engl J Med, 2018, 378(12):1085-1095.
3
Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of helicobacter pylori infection: systematic review and meta-analysis [J]. Gastroenterology, 2017, 153(2): 420-429.
4
Dohi O, Majima A, Naito Y, et al. Can image-enhanced endoscopy improve the diagnosis of Kyoto classification of gastritis in the clinical setting? [J]. Dig Endosc, 2020, 32(2): 191-203.
5
魏茂桂. 两种内镜下胃黏膜形态改变诊断幽门螺杆菌感染的临床价值 [J]. 中医临床研究, 2018, 10(19): 120-122.
6
Yamasaki Y, Uedo N, Kanzaki H, et al. Investigation of mucosal pattern of gastric antrum using magnifying narrow-band imaging in patients with chronic atrophic fundic gastritis [J]. Ann Gastroenterol, 2017, 30(3): 302-308.
7
龚伟, 朱颖, 肖冰,等. 蓝激光内镜联动成像模式对幽门螺杆菌感染相关性胃炎的诊断价值 [J]. 中华消化内镜杂志, 2018(6): 381-384.
8
叶丽芳, 黎丽旋, 陈睿妍, 等. 放大胃镜联合窄带成像判断幽门螺杆菌感染的价值 [J]. 现代消化及介入诊疗, 2020, 25(8): 1112-1114.
9
Yagi K, Saka A, Nozawa Y, et al. Prediction of helicobacter pylori status by conventional endoscopy, narrow-band imaging magnifying endoscopy in stomach after endoscopic resection of gastric cancer [J]. Helicobacter, 2014, 19(2): 111-5.
10
Kono S, Gotoda T, Yoshida S, et al. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan [J]. World J Gastroenterol, 2015, 21(46): 13113-13123.
11
加藤元嗣, 井上和彦, 村上和成, 等. 京都胃炎分类 [M]. 沈阳: 辽宁科学技术出版社, 2018: 27-31.
12
王万亮, 秦青, 王伟, 等. 内镜下胃黏膜形态变化判断幽门螺杆菌感染的价值 [J]. 现代消化及介入诊疗, 2019, 24(6): 668-671.
13
Venneman K, Huybrechts I, Gunter MJ, et al. The epidemiology of helicobacter pylori infection in Europe and the impact of lifestyle on its natural evolution toward stomach cancer after infection: A systematic review [J]. Helicobacter, 2018, 23(3): e12483.
14
Scida S, Russo M, Miraglia C, et al. Relationship between helicobacter pylori infection and GERD [J]. Acta Biomed, 2018, 89(8-S): 40-43.
15
Toyoshima O, Nishizawa T, Koike K. Endoscopic Kyoto classification of helicobacter pylori infection and gastric cancer risk diagnosis [J]. World J Gastroenterol, 2020, 26(5): 466-477.
16
徐涛, 于淑霞, 张东海, 等. 白光胃镜下胃体黏膜形态与幽门螺杆菌感染的关系及其病理特征 [J]. 中国微生态学杂志, 2020, 32(10): 1162-1166.
17
Kato T, Yagi N, Kamada T, et al. Study group for establishing endoscopic diagnosis of chronic gastritis. Diagnosis of helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study [J]. Dig Endosc, 2013, 25(5): 508-518.
18
汪剑波, 付丽霞, 刘俊伟, 等. 胃镜下肉眼观察胃黏膜形态直接判断幽门螺杆菌感染的临床价值 [J]. 世界华人消化杂志, 2017, 25(28): 2568-2574.
19
Watanabe K, Nagata N, Nakashima R, et al. Predictive findings for helicobacter pylori-uninfected, infected and eradicated gastric mucosa: validation study [J]. World J Gastroenterol, 2013, 19(27): 4374-4379.
[1] 付泽辉, 王思齐, 卢叶君, 张剑, 贺烨, 陈卉. 超声对易误诊的等回声、高回声甲状腺结节良恶性的鉴别[J]. 中华医学超声杂志(电子版), 2023, 20(05): 517-523.
[2] 李梦声, 韩中博. 胃癌的高危可控因素——幽门螺杆菌感染[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(03): 145-150.
[3] 李殷南, 王乾, 孙宾. 膀胱壁、逼尿肌壁厚度与老年女性膀胱过度活动症相关性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(02): 178-182.
[4] 赵军, 李超杰, 李佳. 雷贝拉唑联合康复新液对治疗幽门螺杆菌阳性的十二指肠溃疡的疗效[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 254-258.
[5] 石小琼, 殷国建. 不同观察时间对幽门螺杆菌快速尿素酶试验诊断准确性的研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(03): 150-154.
[6] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[7] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[8] 董青, 丁飞, 郭浩, 李峰. Nesfatin-1/NUCB2在幽门螺杆菌感染相关早期胃癌患者中的表达及临床意义[J]. 中华临床医师杂志(电子版), 2023, 17(07): 783-789.
[9] 魏红涛, 普布仓决, 格桑央宗, 黎燕, 益西旺扎, 李鹏. 拉萨地区上消化道溃疡患者幽门螺杆菌感染及治疗分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 662-665.
[10] 林燕霞, 吴才标, 王小霞. 实时超声造影定量分析对体检初次发现肝脏局灶性病变的诊断价值分析[J]. 中华临床医师杂志(电子版), 2023, 17(02): 176-181.
[11] 蒋蔚茹, 徐三荣. 要努力弄清"慢性胃炎"的临床意义[J]. 中华诊断学电子杂志, 2023, 11(04): 266-270.
[12] 高明生, 张盼盼, 包楠迪, 孟繁森, 李婷婷, 徐世平. 一种新型乳链菌素混合物体外杀灭幽门螺杆菌的实验研究[J]. 中华胃肠内镜电子杂志, 2023, 10(04): 258-263.
[13] 简文华, 何朝晖. 改良二联方案与标准四联方案治疗幽门螺杆菌感染临床对照研究[J]. 中华胃肠内镜电子杂志, 2023, 10(02): 103-108.
[14] 张金颖, 哈力甫•阿布拉, 张艳君. 扶正消萎汤对慢性萎缩性胃炎大鼠胃黏膜修复作用及Nrf2/ARE通路的影响研究[J]. 中华胃食管反流病电子杂志, 2023, 10(02): 82-89.
[15] 阿孜古丽·阿力木江, 买买提·依斯热依力, 王婧, 王永康, 陆萍, 克力木·阿不都热依木. 心理应激对雌性小鼠胃黏膜炎症和卵巢功能早衰的影响[J]. 中华胃食管反流病电子杂志, 2023, 10(02): 69-76.
阅读次数
全文


摘要