摘要
目的探讨白光胃镜常规检查时根据不同的胃体黏膜形态判断幽门螺杆菌(H.pylori)感染的准确性及其病理表现,了解胃体黏膜形态变化的临床意义。方法选择2017年3月至2018年9月于本院行胃镜检查的520例患者为研究对象,对患者胃体和胃窦同时进行组织病理学和快速尿素酶检查及白光胃镜检查,根据白光胃镜检查结果分为胃体黏膜病变组(232例)和无胃体黏膜病变组(288例),分析胃镜下不同黏膜组织病变与H.pylori的感染情况,采用四格表分析白光胃镜检测对H.pylori感染的诊断价值。结果与无胃体黏膜病变组比较,胃体黏膜病变组患者H.pylori感染率显著升高,同时胃体黏膜黏液分泌增多、胃体黏膜广泛充血、胃体皱襞肥大、黏膜水肿、胃体黏膜"龟纹样"改变、胃体(单发或多发)息肉、胃体可见RAC。不同胃体黏膜病变患者H.pylori感染率差异有统计学意义(χ^2=62.711,P<0.001)。胃体黏膜病变患者H.pylori感染率与十二指肠炎、十二指肠溃疡无关(均P>0.05),与反流性食管炎、胃溃疡、胃窦糜烂有关(χ^2=7.087、6.230、17.934,P=0.008、0.013、<0.001)。白光胃镜诊断H.pylori感染的灵敏度为71.43%,特异度为90.27%,准确度为79.62%,阳性预测值为90.52%,阴性预测值为70.83%。结论白光胃镜下胃体黏膜形态与H.pylori感染率及与炎症、肠化生、黏膜萎缩、非典型增生、反流性食管炎、胃溃疡、胃窦糜烂有关,白光胃镜检查可能对H.pylori感染有一定诊断价值。白光胃镜下较常见且易识别的胃体黏膜充血、水肿、"龟纹样"改变、胃体可见RAC等可能成为白光胃镜预测H.pylori感染的特异性表现。
Objective To investigate the accuracy of routine white light gastroscopy and pathological manifestations of Helicobacter pylori(H.pylori)infection according to different gastric mucosal morphology,and explore clinical significance of the changes of gastric mucosal morphology.Methods A total of 520 patients who underwent gastroscopy in our hospital from March 2017 to September 2018 were selected.Histopathological examination,rapid urease examination and white-light gastroscopy were performed simultaneously.According to the white-light gastroscopy result,they were divided into the gastric mucosal lesion(GML)group(n=232)or non-GML group(n=288).The pathological changes of different mucosa and the infection of H.pylori under gastroscopy were analyzed,and the diagnosis value of white light gastroscopy for H.pylori infection was analyzed using four-grid table.Results Compared with the non-GML group,the infection rate of H.pylori in the GML group was significantly higher.There were significant differences in H.pylori infection rates among patients with increased mucus secretion of gastric mucosa,extensive congestion of gastric mucosa,hypertrophy of gastric folds,mucosal edema,tortoise-like changes of gastric mucosa,single or multiple gastric polyps and different gastric mucosal lesions with RAC in the gastric body(χ^2=62.711,P<0.001).H.pylori infection rate was not associated with duodenitis and duodenal ulcer(all P>0.05),but was associated with reflux esophagitis,gastric ulcer disease and gastric antrum erosion(χ^2=7.087,6.230,17.934,P=0.008,0.013,<0.001).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of white light gastroscopy in the diagnosis of H.pylori infection were 71.43%,90.27%,79.62%,90.52%and 70.83%,respectively.Conclusion The morphology of gastric mucosa under white-light gastroscopy is related to the infection rate of H.pylori and to inflammation,intestinal metaplasia,mucosal atrophy,atypical hyperplasia,reflux esophagitis,gastric ulcer,gastric antral erosion.White-light gastroscopy may have some diagnostic value for H.pylori infection.Gastric mucosa congestion,edema and tortoise-like changes which were common and easily recognized under white-light gastroscopy may become predictive specific manifestations of H.pylori-positive infection under white-light gastroscopy.
作者
徐涛
于淑霞
张东海
朱彦贺
祁晓莉
陈娟
XU Tao;YU Shuxia;ZHANG Donghai;ZHU Yanhe;QI Xiaoli;CHEN Juan(Department of Gastroenterology,Daxing Teaching Hospital,Capital Medical University,Beijing 102600,China;不详)
出处
《中国微生态学杂志》
CAS
CSCD
2020年第10期1162-1166,共5页
Chinese Journal of Microecology
基金
大兴区人民医院科研课题(4201716178)。
关键词
白光胃镜
胃体黏膜
幽门螺杆菌
病理学特征
White-light gastroscopy
Gastric mucosa
Helicobacter pylori
Pathological characteristics
