幽门螺杆菌根除后内镜下胃黏膜萎缩的变化及其预测因素研究

Endoscopic gastric mucosal atrophy changes after Helicobacter pylori eradication and their predictive factors

摘要:

目的 筛选幽门螺杆菌（Helicobacter pylori，HP）根除后内镜下胃黏膜萎缩进展的危险因素，构建风险评分系统，建立慢性胃炎患者HP根除后个体化内镜随访方案。方法 采用回顾性队列设计，纳入2018年1月至2021年10月在北京友谊医院消化内科就诊并成功根除HP的慢性胃炎患者，收集患者的一般资料、胃镜检查结果及其他临床病历资料，比较随访前后胃镜检查结果，判断患者的内镜下胃黏膜萎缩转归情况，并将患者分为进展组和非进展组。依次进行单因素分析和多因素回归分析探讨慢性胃炎患者内镜下萎缩进展的相关危险因素，并建立风险评分系统。结果 纳入218例慢性胃炎患者，HP根除后胃黏膜萎缩非进展组153例，进展组65例。多因素logistic回归分析显示：合并胃溃疡（P=0.008，OR=4.24，95%CI：1.46~12.25）、质子泵抑制剂用药史（P=0.007，OR=4.06，95%CI：1.46~11.27）、饮酒（P=0.002，OR=3.77，95%CI：1.64~8.67）、高盐饮食（P=0.008，OR=2.90，95%CI：1.32~6.41）以及高红肉类饮食（P=0.025，OR=2.33，95%CI：1.11~6.31）为HP根除后内镜下胃黏膜萎缩进展的独立危险因素。以该5个危险因素建立的预测模型受试者工作特征曲线下面积为0.813（95%CI：0.755~0.876，P<0.001），最佳截点为1.5分，风险分层低风险组评分为0~2分，高风险组评分为3~5分。结论 慢性胃炎患者在成功根除HP后仍面临疾病进展的风险，应结合患者的既往病史、用药情况、日常生活及饮食习惯进行个体化内镜随访。

Abstract:

Objective To identify risk factors associated with endoscopic atrophic progression of gastric mucosa after Helicobacter pylori (HP) eradication and to develop a risk scoring system for establishing an individualized endoscopic follow‑up strategy for patients with chronic gastritis. Methods This retrospective cohort study included chronic gastritis patients with successful HP eradication at the Department of Gastroenterology, Beijing Friendship Hospital between January 2018 and October 2021. Demographic characteristics, endoscopic findings, and other clinical data were analyzed. Endoscopic outcomes of gastric mucosal atrophy before and after follow-up were compared to classify patients into progression and non-progression groups. Univariate and multivariate analyses were performed to identify independent risk factors for endoscopic atrophic progression. A risk scoring system was then constructed based on these factors. Results A total of 218 patients with chronic gastritis were included, including 153 in the non-progression group and 65 in the progression group. Multivariate logistic regression analysis showed that gastric ulcer (P=0.008, OR=4.24, 95%CI: 1.46-12.25), history of proton pump inhibitor use (P=0.007, OR=4.06, 95%CI: 1.46‑11.27), alcohol consumption (P=0.002, OR=3.77, 95%CI: 1.64‑8.67), high-salt diet (P=0.008, OR=2.90, 95%CI: 1.32-6.41), and high red meat intake (P=0.025, OR=2.33, 95%CI: 1.11-6.31) were independent risk factors for endoscopic atrophic progression after HP eradication. The predictive model based on these 5 factors demonstrated strong discriminative capacity, with an area under the receiver operating characteristic curve of 0.813 (95%CI: 0.755-0.876, P<0.001). The optimal cut-off value was 1.5 points, stratifying patients into low-risk (0-2 points) and high-risk (3-5 points) groups. Conclusion Patients with chronic gastritis remain susceptible to progression even after successful HP eradication. Individualized endoscopic follow-up strategies should be considered based on patients'' medical history, medication use, lifestyle, and dietary habits.