京都胃炎评分联合白光内镜评估幽门螺杆菌感染状态的应用价值

The application value of Kyoto gastritis score combined with white light endoscopy in evaluating the status of Helicobacter pylori infection

摘要:

验证京都胃炎评分联合白光内镜下黏膜表现对幽门螺杆菌(Helicobacter pylori，HP)的诊断价值。回顾性分析2023年9月至2024年6月于青海大学附属医院就诊并完善胃镜及13C呼气试验检查的患者资料，根据13C呼气试验结果分为HP感染组及HP未感染组，以京都胃炎分类为标准，计算患者京都胃炎评分，记录内镜下黏膜改变并进行影响因素分析，评估京都胃炎评分及内镜下黏膜表现对HP感染的诊断效能。研究纳入851例患者，其中HP感染组514例，HP未感染组337例。多因素分析发现弥漫性发红、点状发红、斑片状发红、黏膜肿胀、皱襞肿大蛇形、白浊黏液、肠上皮化生、胃溃疡、十二指肠溃疡、鸡皮样黏膜、增生样息肉、黄素瘤是HP感染的独立预测因素，而胃底腺息肉、隆起性糜烂是HP未感染的独立预测因素。京都胃炎评分预测HP感染的曲线下面积为0.924（95%CI：0.905~0.944），灵敏度及特异度分别为88.7%和89.3%，且最佳阈值为2分。京都胃炎评分中萎缩预测HP感染的灵敏度较高，特异度较低，而弥漫发红、皱襞肿大蛇形、鸡皮样黏膜、肠上皮化生特异度较高，灵敏度较低。京都胃炎评分联合内镜下黏膜表现能够提高中国人群HP感染的检出率。

Abstract:

To validate the diagnostic value of the Kyoto gastritis score combined with mucosal findings under white-light endoscopy for Helicobacter pylori (HP) infection. A retrospective analysis was conducted on patient data from Qinghai University Affiliated Hospital between September 2023 and June 2024, where patients underwent gastroscopy and 13C breath tests. Patients were categorized into HP-infected and HP-uninfected groups based on 13C breath test results. Kyoto gastritis scores were calculated using the Kyoto gastritis classification system, and endoscopic mucosal changes were documented for factor analysis. The diagnostic efficacy of Kyoto gastritis scores and endoscopic mucosal findings for HP infection was evaluated. The study included 851 patients: 514 in the HP-infected group and 337 in the HP-uninfected group. Multivariate analysis identified diffuse erythema, punctate erythema, patchy erythema, mucosal edema, enlarged serpentine folds, white turbid mucus, intestinal metaplasia, gastric ulcer, duodenal ulcer, goose-flesh mucosa, hyperplastic polyps, xanthoma were independent predictors of HP infection, while fundic gland polyps and elevated erosions were independent predictors of non-HP infection. The Kyoto Gastritis Score demonstrated an area under the curve (AUC) of 0.924 (95% CI: 0.905–0.944) for predicting HP infection, with sensitivity and specificity of 88.7% and 89.3%, respectively, and an optimal cutoff score of 2 points. Within the Kyoto Gastritis Score, atrophy showed high sensitivity but low specificity for predicting HP infection, whereas diffuse redness, enlarged and serpentine folds, chicken skin-like mucosa, and intestinal metaplasia exhibited high specificity but low sensitivity. Combining the Kyoto Gastritis Score with endoscopic mucosal findings enhances the detection rate of HP infection in the Chinese population.