胃镜下黏膜表现预测幽门螺杆菌感染的风险:基于列线图模型的构建与验证

目的 构建一种基于胃镜下黏膜表现的预测模型,用于预测幽门螺杆菌感染的风险。方法 对2022年1月至2023年1月在我院进行诊断的300例病人的¹³C检查和胃镜检查结果进行回顾性分析。根据¹³C检查结果,将病人分为HP阴性组(n=200)和HP阳性组(n=100)。利用卡方检验分析了与HP感染相关的胃镜黏膜表现因素;采用单因素和多因素逻辑回归分析,确定了HP感染的独立危险因素;使用randomForest和party程辑包绘制了HP感染危险因素的单因素和多因素森林图;最后构建和验证了与HP感染相关的危险因素的列线图。结果 对比分析了两组患者的胃镜下黏膜表现,发现集合静脉形态、胃小凹形态、黏膜颜色、黏膜肿胀、黏膜损伤、鸡皮样黏膜、白浊黏液和溃疡表现在两组之间存在显著差异(P<0.05);通过单因素和多因素逻辑回归分析,集合静脉形态、胃小凹形态、黏膜肿胀、白浊黏液和溃疡是HP感染独立危险表现因素,P<0.05,OR>1;根据HP感染的危险因素绘制了森林图,HP感染的独立危险因素从高到低分别是黏膜肿胀、鸡皮样黏膜、白色黏液和溃疡。列...     

基于胃镜下黏膜表现预测幽门螺杆菌感染风险列线图的建立与评价

目的:通过分析幽门螺杆菌(Hp)感染相关胃镜下黏膜表现,建立预测Hp感染风险的列线图模型并评价其诊断效能。方法:收集2021年1月—2022年3月因上消化道症状于中国中医科学院望京医院行胃镜及碳13呼气检查患者的临床资料,通过logistic回归分析寻找Hp感染的独立预测因素。应用R软件建立预测Hp感染风险的列线图模型,采用C指数、受试者工作特征曲线下面积(AUC)和Calibration校正曲线评价列线图的预测性能。结果:胃小凹形态(线状、稀疏而粗大的线状、斑块状)、集合静脉形态(不规则型、消失型)、黏膜颜色(点状发红、弥漫性发红)、黏膜肿胀、鸡皮样黏膜、黏膜损伤(隆起性、凹陷性)、白浊黏液是预测Hp感染的独立危险因素,列线图的AUC为0.986(95%CI:0.979～0.993),Calibration校正曲线拟合良好(C指数为0.986),通过约登指数计算出列线图的最佳临界值为250.7分,临界值下的灵敏度、特异度分别为96.3%、95.1%。结论:基于胃镜下黏膜表现构建的Hp感染风险列线图模型具有良好的区分度和准确度,可为直观、个体化地反映Hp感染风险,甄别高风险人群,为进一...     

基于京都胃炎评分判断胃镜下幽门螺杆菌感染状态的研究

目的　探讨京都胃炎评分判断国人幽门螺杆菌（Helicobacter pylori,HP）感染状态的价值。方法　回顾性收集2020年1—12月在武汉大学人民医院消化内镜中心同时间段行13C呼气试验和胃镜检查的902例受检者资料,其中HP阳性患者345例,HP阴性患者557例。分析HP阳性及HP阴性受检者的黏膜表现及京都胃炎评分差异,并绘制京都胃炎评分预测HP感染的受试者工作特征曲线。结果　与HP阴性患者相比,结节［8.1%（28/345）比0.2%（1/557）,χ2=86.29,P<0.001］、弥漫性发红［47.8%（165/345）比6.6%（37/557）,χ2=413.63,P<0.001］、萎缩［27.8%（96/345）比13.8%（77/557）,χ2=52.90,P<0.001］和皱襞肿大［69.0%（238/345）比36.6%（204/557）,χ2=175.38,P<0.001］在HP阳性患者中发生率高。对预测HP感染,结节表现出最高的特异度［99.8%（556/557）］和阳性预测值［96.6%（28/29）］;弥漫性发红表现出最高的受试者工作特征曲线下面积（area under the curve ,AUC）（0.707）;皱襞肿大表现出最高的灵敏度［69.0%（238/345）］和阴性预测值［76.7%（353/460）］。HP阳性患者的京都胃炎评分高于HP阴性患者［2（1,2）比0（0,1）,Z=20.82,P<0.001］。此外,在最佳阈值为2时,京都胃炎评分预测HP感染的AUC为0.779。结论　结节、弥漫性发红、萎缩及皱襞肿大对预测HP阳性均具有一定的提示作用,且京都胃炎评分≥2分时,有助于判断HP阳性,从而为临床工作者判断HP感染状态提供参考依据。     

传统胃镜下幽门螺杆菌感染表现

幽门螺杆菌(Helicobacter pylori:HP)感染在慢性胃炎、消化性溃疡、MALT淋巴瘤和胃癌等疾病的发生中起重要致病作用,诊断HP感染是众多胃肠道疾病诊治方案的重要组成部分和关键环节。临床中有多种方法诊断HP感染,但缺乏统一金标准。随着胃镜检查技术的发展和成熟,通过传统胃镜、窄带成像和高分辨率内镜检查技术对胃粘膜形态的分析,能够有效诊断HP感染。本文就传统胃镜下HP感染的一些特征表现及根除治疗后表现进行综述,旨在提高诊断HP感染的准确性,为临床医生制定有效的治疗方案提供重要的参考依据。     

蒙古沙鼠感染幽门螺旋杆菌后胃黏膜细胞因子水平的改变

目的探讨幽门螺旋杆菌感染后胃黏膜重要细胞因子的改变，为免疫治疗提供理论依据。方法制作幽门螺旋杆菌感染蒙古沙鼠的动物模型，感染6周后处死动物，证实幽门螺旋杆菌定植成功，以RT—PCR方法检测胃黏膜IFN-γ、IL-12、IL-18的水平。结果幽门螺旋杆菌感染组IFN／G3PDH、IL-12／G3PDH分别为1．19±0．86、1．85±0．96，高于对照组；感染组和对照组之间IL-18／G3PDH无显著性差异。结论 IFN-1、IL-12水平的改变可能参与了幽门螺旋杆菌的致病过程。     

指压内关穴解除胃镜下幽门痉挛62例观察

我院胃镜室自2006年5月—2008年12月，共胃镜检查5000多例，对每位胃镜受检者，在检查前均按常规口服利多卡因胶浆10ml，臀部肌注解痉剂，仍发现幽门痉挛62例，经指压内关穴，可以减轻胃镜检查的副反应，如体动、疼痛、恶心、呕吐、呃逆、呛咳、口咽分泌物多、嗳气，幽门均瞬时开放。使胃镜检查顺利进行，十二指肠壶腹部及壶腹后病变获得及时诊断，现报告如下。     

幽门螺旋杆菌感染与结直肠腺瘤复发的相关性分析

背景结直肠腺瘤(colorectal adenoma, CRA)是结直肠癌(colorectalcancer,CRC)的癌前病变,早期切除及预防其复发是预防结肠癌的有效措施.但腺瘤切除后容易复发,有研究显示幽门螺旋杆菌(Helicobacter pylori,H. pylori)感染是CRA发生原因之一,本研究拟分析H.pylori感染及根除H. pylori对CRA复发的影响.目的探讨CRA术后复发的危险因素,尤其是H. pylori感染对CRA复发的影响.方法收集本院门诊及病房行肠镜检查并病理证实为CRA的病例,根据13C呼气试验结果,将其分为A组(H. pylori阴性组)和B组(H. pylori阳性组); B组病例再随机分成两组:C组根除H. pylori, D组未根除H. pylori. 1年后复查肠镜及呼气试验,根据随访肠镜的结果,比较息肉复发病例和未复发病例的一般资料,并对CRA复发的危险因素进行Logistic回归分析.结果共有733例CRA患者纳入本研究,各组中患者的一般资料以及术前息肉的大小、数目、病理类型及手术方式等均无显著差异(P0.05).术后1年复查, H. pylori感染组(B组)患者息肉复发率显著高于A组(23.02%vs15.79%, P 0.05);而根除H. pylori后的C组息肉复发率则显著低于未根除的D组(17.37%vs 28.36%, P0.05).在息肉复发的所有危险因素中,男性患者、BMI≥25kg/m2,息肉个数≥3枚、息肉大小≥20mm及H. pylori感染等因素存在统计学差异(P0.05); Logistic回归分析显示, H. pylori感染是息肉复发的独立危险因素(OR=1.556, P 0.05),而根除H. pylori与息肉的复发呈负相关性(OR=0.509, P0.05).结论H. pylori感染会增加CRA的复发,是CRA术后复发的独立危险因素,根除H. pylori后能显著降低CRA的复发.     

胆总管结石与幽门螺旋杆菌感染的关系

目的: 研究胆总管结石患者幽门螺旋杆菌(H pylori )感染率, 并进行临床分析.方法: 采用对照研究方法, 对胆总管结石患者(实验组)105例和对照就诊者(对照组)132例行电子胃镜检查, 内镜下快速尿素酶以及14C呼气试验(14C-UBT)检查H pylori 感染.结果: 实验组H pylori 阳性患者68例, H pylori感染率为64.8%. 对照组H pylori 阳性就诊者51例, 占38.6%. 2组比较具有统计学差异(P <0.01).结论: 胆总管结石患者中存在H pylori 高感染率, H pylori 与胆总管结石的发病可能存在一定联系.     

Concentrations of gastric mucosal cytokines in children with food allergy and Helicobacter pylori infection

AIM: To measure the concentrations of chosen cytokines in the antrum mucosa depending on the kind of harmful pathogenic factors and to compare the concentrations with the values of controls without allergy and coexisting Helicobacter pylori (H pylori) infection. METHODS: The patients (97 children) were divided into three groups according to the data obtained from the case history, to the main cause of the disease and to the dominant clinical symptoms. Group Ⅰ: children with food allergy (Fa); group Ⅱ: children infected with H pylori; group Ⅲ (control group): children with functional disorders of the alimentary tract (without Fa and Hp infection). H pylori infection was determined by the presence of anti-Hp antibodies in serum (ELISA method) and urease test performed during endoscopic examination. Cytokine concentration in homogenates of gastric mucosa was detected by ELISA method. RESULTS: The IL-2 concentration in gastric mucosa bioptates was the highest in children with Hp infection (116.5±179.5 pg/mg of the protein) and Fa and Hp infection (98.1±101.0 pg/mg), while decreased in children with Fa (44.8±50.3 pg/mg) and controls (45.7±23.5 pg/mg). The lowest mean concentration of IFN-Y was observed in children with Hp infection (18.9±16.4 pg/mg), with Fa and Hp infection (25.5±27.7 pg/mg), with Fa (40.6±39.7 pg/mg) and controls (49.9±33.4 pg/mg). The highest IL-4 concentrations were observed in children with Hp infection (35.3±52.8 pg/mg) and in children with Fa and Hp infection (37,2±51.7 pg/mg), while lower IL-4 concentration (23.6±35.8 pg/mg) was found in children with Fa compared to the controls (22.7±13.8 pg/mg). The analysis of IL-4 concentrations in children with Hp infection regarding the intensity of gastritis showed the highest value (62.2±61.2 pg/mg) in mild and moderate gastritis. The concentrations of IL-5 in the gastric mucosa of children with or without Fa did not differ significantly and were comparable to the control group. The highest mean IL-8 value was observed in Hp-infected children with or without Fa. The highest concentration of mucosal IL-10 was detected in children with Hp infection (79.3±41.2 pg/mg) and decreased in children with Fa and Hp infection (50.1±18.8 pg/mg) and in children with Fa (39.9±35.5 pg/mg). The intensity and activity of the inflammation did not affect IL-10 concentrations in the gastric mucosa. In children with Hp infection, TNF-α concentration was the highest (45.9±49.3 pg/mg) and in children with Fa and Hp infection was low (45.3±32.6 pg/mg), whereas decreased in children with Fa (21.7±34.2 pg/mg) and in controls (31.6±14.5 pg/mg). CONCLUSION: The morphological changes of the gastric mucosa in children with Hp infection are comparable to those in children with Fa and coexisting Hp infection. Cytokine concentration in children with Fa and Hp infection is significantly different in IFN-γ,IL-2,IL-8,and TNF-α.     

不同类型胃息肉与幽门螺杆菌感染、粘膜炎症相关性的研究

目的 探讨不同类型胃息肉与幽门螺杆菌（Hp）感染以及与胃粘膜炎症、萎缩和肠上皮化生的相关性。方法 对2203例胃粘膜活检发现的278例胃息肉（检出率12.6%）进行组织学分类,并对胃窦粘膜活检组织同时行Hp检测及粘膜炎症、萎缩和肠上皮化生的观察,比较不同类型胃息肉的Hp感染率及其与癌相关病变的关系。结果 278例息肉中,组织学分类以小凹上皮增生型息肉为多见,有130例,占息肉总数的46.8%,胃体腺型增生性息肉67例,占24.1%,炎性息肉和腺瘤性息肉较少见,分别为55例（19.8%）和26例（9.4%）。约53.9%的胃息肉患者存在Hp感染,其中以小凹上皮增生型息肉感染率最高,达73.1%。这型息肉常伴有胃粘膜的活动性炎症,且粘膜萎缩和肠上皮化生的发生率均近腺瘤性病变。胃体腺型增生性息肉,Hp感染率、活动性炎症及萎缩、肠上皮化生等发生率均较低,提示这两种息肉在组织发生和病理生物学形态上存在差异。结论 小凹上皮增生型息肉的发生可能与Hp感染有关,且常伴有明显的活动性炎症以及粘膜萎缩的肠上皮化生,因此可能与胃癌的发生有潜在的关系。     

Hematologic manifestations of Helicobacter pylori infection

Helicobacter pylori (H. pylori) is the most common infection in humans, with a marked disparity between developed and developing countries. Although H. pylori infections are asymptomatic in most infected individuals, they are intimately related to malignant gastric conditions such as gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to benign diseases such as gastritis and duodenal and gastric peptic ulcers. Since it was learned that bacteria could colonize the gastric mucosa, there have been reports in the medical literature of over 50 extragastric manifestations involving a variety medical areas of specialization. These areas include cardiology, dermatology, endocrinology, gynecology and obstetrics, hematology, pneumology, odontology, ophthalmology, otorhinolaryngology and pediatrics, and they encompass conditions with a range of clear evidence between the H. pylori infection and development of the disease. This literature review covers extragastric manifestations of H. pylori infection in the hematology field. It focuses on conditions that are included in international consensus and management guides for H. pylori infection, specifically iron deficiency, vitamin B₁₂ (cobalamin) deficiency, immune thrombocytopenia, and MALT lymphoma. In addition, there is discussion of other conditions that are not included in international consensus and management guides on H. pylori, including auto-immune neutropenia, antiphospholipid syndrome, plasma cell dyscrasias, and other hematologic diseases.     

中国检验幽门螺杆菌感染方法诊断效能的分析

目的:对有关幽门螺杆菌(H pylori)感染诊断方法的研究文献进行分析,评价感染H pylori诊断方法的诊断效能.方法:检索1994-2005的H pylori感染诊断方法的文献资料,对检索到的相关文献按诊断方法种类分别进行原始数据合并,然后对10种诊断方法的灵敏度(Se)、特异度(Sp)、正确率(π)进行分析.结果:有56项研究符合选择标准,综合评价结果如下,H pylori培养试验:Se为78.39%,Sp为89.13%,π为86.51%:病理组织学切片检查:Se为91.47%,Sp为93.98%,π为91.89%;~(13)C-尿素呼吸试验:Se为95.49%,Sp为94.76%,π为95.53%;~(14)C-尿素呼吸试验:Se为96.38%,Sp为90.80%,π为94.34%;血清抗H pylori-IgG的ELISA法试验:Se为92.04%,Sp为87.70%,π为98.83%;快速尿素酶诊断:Se为88.14%,Sp为89.08%,π为88.42%;胃黏膜涂片法诊断试验:Se为94.53%,Sp为95.56%,π为96.65%;PCR法试验:Se为97.57%,Sp为89.09%,π为95.44%;H pylori粪便抗原试验(H pylori SA)-酶免疫法:Se为95.57%,Sp为93.17%,π为94.24%;唾液抗H pylori-IgG试验Se为93.06%,Sp为86.96%,π为91.32%.结论:目前临床常用的各种诊断方法诊断效能对比显示,各种诊断方法各有优缺点.临床上采用何种诊断方法,应根据具体情况和不同要求来决定.     

Helicobacter pylori infection: Beyond gastric manifestations

Helicobacter pylori(H. pylori) is a bacterium that infects more than a half of world's population. Although it is mainly related to the development of gastroduodenal diseases, several studies have shown that such infection may also influence the development and severity of various extragastric diseases. According to the current evidence, whereas this bacterium is a risk factor for some of these manifestations, it might play a protective role in other pathological conditions. In that context, when considered the gastrointestinal tract, H. pylori positivity have been related to Inflammatory Bowel Disease, Gastroesophageal Reflux Disease, Non-Alcoholic Fatty Liver Disease, Hepatic Carcinoma, Cholelithiasis, and Cholecystitis. Moreover, lower serum levels of iron and vitamin B12 have been found in patients with H. pylori infection, leading to the emergence of anemias in a portion of them. With regards to neurological manifestations, a growing number of studies have associated that bacterium with multiple sclerosis, Alzheimer's disease, Parkinson's disease, and Guillain-Barré syndrome. Interestingly, the risk of developing cardiovascular disorders, such as atherosclerosis, is also influenced by the infection. Besides that, the H. pylori-associated inflammation may also lead to increased insulin resistance, leading to a higher risk of diabetes mellitus among infected individuals. Finally, the occurrence of dermatological and ophthalmic disorders have also been related to that microorganism. In this sense, this minireview aims to gather the main studies associating H. pylori infection with extragastric conditions, and also to explore the main mechanisms that mayexplain the role of H. pylori in those diseases.     

溴甲酚紫色素内镜诊断胃幽门螺杆菌感染的价值

病例收集2003年6月～8月期间，因上腹部疼痛或不适为主要症状者，作上消化道内镜检查，用色素内镜标示H．pylori者256例，男185例，女71例，平均年龄40．5岁（19—70岁）。试剂：溴甲酚素H．pylori识别液的主要成份是尿素和溴甲酚素（BCP），每安瓶为5mL。内镜检查：全部患者按常规上消化道内镜检查。将内镜插到十二指肠降部，然后循着球、幽门、胃窦、胃角、胃体、胃底顺序检查。在内镜直视下，把H．pylori识别液5～10mL分别喷洒在十二指肠球部，胃窦幽门区，以及充血、水肿、糜烂、溃疡等病变处。过1～2min后，若在喷洒部位的胃黏膜呈紫色，形若地图样，点片状分布不均者，即提示有H．pylori存在。在黏膜着色与不着色例，随机10％病例活检用快速尿素酶法检查H．pylori，以对照色素内镜的可靠性。     

Helicobacter pylori infection in Icelandic children

Objective: The prevalence of Helicobacter pylori (HP) infection is decreasing in the western world. The seroprevalence among 25–50-year-old Icelandic adults was recently shown to be 30–40%. Information on the seroprevalence in Nordic children is limited. We aimed at ascertaining the infection prevalence among healthy Icelandic children.

Methods: The infection status in stored frozen blood samples from two cross-sectional studies on the health of 7–9-year-old children (n?=?125) and 16–18-year-old adolescents (n?=?80) was determined by enzyme-linked immunosorbent assay (ELISA). Information on family demographics and GI symptoms was obtained by standardized questionnaires.

Results: Overall, 3.4% (7/205) of the children were infected with H. pylori. The prevalence was 2.6% (5/190), missing data n?=?3, among children with both parents born in a low prevalence country compared to 17% (2/12) among those with at least one parent born in a high prevalence area (p?=?.026). When at least one parent was born in a high prevalence country, the odds ratio for being H. pylori seropositive was 2.2 (95% CI, 1.02–54.67), when adjusted for the educational status of the mother. There was no significant association between H. pylori infection and gastrointestinal symptoms.

Conclusion: Prevalence of H. pylori infection in Iceland has become very low, suggesting a great reduction in transmission from older generations. There was an association between H. pylori infection and origin from high prevalence areas but not with gastrointestinal symptoms. The results mirror recent studies of children of Scandinavian ancestry.     

Association between mucosal surface pattern under near focus technology and Helicobacter pylori infection

BACKGROUND Many studies evaluated magnification endoscopy(ME) to correlate changes on the gastric mucosal surface with Helicobacter pylori(H. pylori) infection. However, few studies validated these concepts with high-definition endoscopy without ME.AIM To access the association between mucosal surface pattern under near focus technology and H. pylori infection status in a western population.METHODS Cross-sectional study including all patients referred to routine upper endoscopy. Endoscopic exams were performed using standard high definition(S-HD) followed by near focus(NF-HD) examination. Presence of erythema, erosion, atrophy, and nodularity were recorded during S-HD, and surface mucosal pattern was classified using NF-HD in the gastric body. Biopsies were taken for rapid urease test and histology.RESULTS One hundred and eighty-seven patients were analyzed from August to November 2019. Of those, 47(25.1%) were H. pylori+, and 42(22.5%) had a previous H. pylori treatment. In the examination with S-HD, erythema had the best sensitivity for H. pylori detection(80.9%). Exudate(99.3%), nodularity(97.1%), and atrophy(95.7%) demonstrated better specificity values, but with low sensitivity(6.4%-19.1%). On the other hand, the absence of erythema was strongly associated with H. pylori-(negative predictive value = 92%). With NF-HD, 56.2% of patients presented type 1 pattern(regular arrangement of collecting venules, RAC), and only 5.7% of RAC+ patients were H. pylori+. The loss of RAC presented 87.2% sensitivity for H. pylori detection, 70.7% specificity, 50% positive predictive value, and 94.3% negative predictive value, indicating that loss of RAC was suboptimal to confirm H. pylori infection, but when RAC was seen, H. pylori infection was unlikely.CONCLUSION The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of H. pylori negative status. On the other hand, the loss of RAC had a suboptimal correlation with the presence of H. pylori.     

幽门螺杆菌感染内镜下的诊疗方法

目的探讨活检部位与Ｈｐ的检出率，观察内镜下喷洒美蓝治疗Ｈｐ的效果．方法选择内镜下诊断的慢性萎缩性胃炎或其它胃病伴有萎缩改变及肠上皮化生改变者２６８例．对其萎缩面的形态、肠上皮化生的特点进行分型．结果闭合型萎缩性胃炎以窦部Ｈｐ检出率高，而开放型以体部检出率高（Ｐ＜００１），肠上皮化生广泛的部位，Ｈｐ检出率低（Ｐ＜００１）．美蓝喷洒法与口服法比较具有相同治疗效果．结论内镜下取活检的部位及肠上皮化生的程度可影响Ｈｐ检出率．喷洒美蓝治疗Ｈｐ法，经济、效果好、副作用少．