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

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。

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

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