高清胃镜观察胃黏膜形态预测幽门螺杆菌感染的探索*

目的通过高清胃镜观察、归纳幽门螺杆菌(Hp)感染时胃黏膜形态改变以预测Hp感染结果,从而探讨高清胃镜直接诊断Hp感染的临床价值。方法纳入2016年10月-2017年1月在深圳市龙岗区第二人民医院同时进行胃镜检查和13C-尿素呼气试验的连续性500例受检者,以高清胃镜在白光下直接观察胃黏膜形态,根据所见形态特点预测是否存在Hp感染,并与13C-尿素呼气试验结果进行比对,比较两者结果符合率。结果胃体、胃底黏膜充血或出血;胃黏膜水肿;胃底、胃体黏膜可见较多黏液;中度以上黏膜萎缩;黏膜肠上皮化生;十二指肠球部溃疡可能成为胃镜预测Hp感染阳性的特征点。胃体可见规则集合静脉(RAC);胃黏膜有光泽,无萎缩;胃底或胃体息肉;胃窦或胃体小弯的放射性充血可能成为胃镜预测Hp感染阴性的特征点。胃镜预测Hp感染的敏感性为90.1%,特异性为70.4%;阳性预测值为71.0%,阴性预测值为89.9%,总体符合率79.2%。结论高清胃镜直接观察胃黏膜形态表现可有效预测Hp感染情况,可在临床上进一步推广验证。

Gastroscopic diagnosis of Helicobacter pylori infection based on gastric mucosal features*

Abstract: Objective?The study explored and summarized mucosal features of H. pylori gastritis, attempting to assess the clinical value of high-definition gastroscopy in diagnosing H. pylori infection.?Methods?From October 2016 to January 2017, 500 subjects were enrolled and examined with gastroscopy. Researchers made predictions according to mucosal features observed with high-definition gastroscopy and compared those with results of urea breath test to assess the accuracy.?Results?Features including diffuse gastric mucosal hyperaemia; mucosal edema; hypersecretion of gastric mucus; severe mucosal atrophy; intestinal metaplasia and duodenal ulcer suggested H. pylori infection, while regular arrangement of collecting venules; lack of atrophy; polyps and radiating gastric mucosal hyperaemia suggested uninfected status. The sensitivity, specificity, positive and negative predictive values of H. pylori infection was 90.1%, 70.4%, 71.0% and 89.9%, while the overall accuracy was 79.2%.?Conclusions?By observing typical mucosal patterns resulting from H. pylori infection, high-definition gastroscopy may become a reliable and efficient method of predicting H. pylori infection status in clinical practice.