基于木村-竹本分类法对快速尿素酶试验诊断幽门螺杆菌感染最优取材部位的探讨  

Discussion on the optimal sampling site of rapid urease test for diagnosis of Helicobacter pylori infection based on Kimura-Takemoto classification

作　　者：张靖娟 曹雯 Zhang Jingjuan;Cao Wen(Department of Gastroenterology,Fuzhou Second Hospital Affiliated to Xiamen University,Fuzhou,Fujian 350000,China)

机构地区：[1]厦门大学附属福州第二医院消化内科,福建福州350000

出　　处：《感染．炎症．修复》2023年第1期24-27,共4页Infection Inflammation Repair

基　　金：福建省福州市卫生和计划生育委员会中青年科学研究项目(2018-S-WQ14)。

摘　　要：目的:结合木村-竹本分类法探讨胃镜检查中组织行幽门螺杆菌快速尿素酶试验(RUT)的最优取材部位。方法:回顾性分析2019年6月—2020年6月在福州第二医院接受胃镜检查的600例患者的临床资料,患者均行胃窦、胃体中部大弯两部位取样,分别进行RUT,如果两个RUT试剂中的任何一个显示阳性反应,则确认幽门螺杆菌感染。记录结果。将RUT阳性患者按木村-竹本分类法对胃黏膜萎缩程度进行分类,采用单因素和多因素Logistic回归分析方法分析仅胃体组织取材RUT阳性而同时胃窦组织取材RUT为阴性的相关因素。结果:248例患者两取材部位RUT均阴性,诊断为Hp阴性。352例诊断为Hp阳性,阳性率为58.7%;其中316例(89.8%)胃体和胃窦标本反应均为阳性,31例(8.8%)仅胃体部呈阳性,5例(1.4%)仅胃窦部呈阳性。352例Hp阳性者按胃萎缩程度分为无萎缩组179例(50.9%),闭合型萎缩组117例(33.2%),开放型萎缩组56例(15.9%)。病理检查结果示肠化生84例(23.9%)。开放型萎缩性胃炎(O1~O3)是仅胃体表现RUT阳性而胃窦阴性的独立危险因素(OR 5.126,95%CI 1.549-17.240,P<0.05)。结论:对于非萎缩性胃炎或闭合型萎缩性胃炎(C1~C3)的患者,单一胃窦取材检测并未增加假阴性结果,可予采用。而对于开放型萎缩性胃炎(O1~O3)患者,采用胃体活检取材可以减少假阴性结果,提高RUT的诊断效率。Objective:To discuss the optimal sampling site of Helicobacter pylori rapid urease test(RUT)in gastroscopy with Kimura-Takemoto classification.Methods:The clinical data of 600 patients who underwent gastroscopy in Fuzhou Second Hospital from Jun.2019 to Jun.2020 were retrospectively analyzed.RUT were performed on the samples taken from the gastric antrum and the great bend of the middle part of the gastric body respectively.If either of the two RUT reagents showed a positive reaction,Helicobacter pylori infection was confirmed.The results were recorded.Gastric mucosa atrophy degree of RUT positive patients were classified according to the Kimura-Takemoto classification.Univariate and multivariate logistic regression was used to analyze the relevant factors of RUT positive in gastric tissue and RUT negative in antrum tissue.Results:In both sampling site,the 248 cases were RUT positive and thwy were diagnosed as Hp negative.The other 352 cases were diagnosed as Hp positive.The positive rate was 58.7%.Among them,316 cases(89.8%)were positive in both gastric body and antrum,31 cases(8.8%)were positive in the gastric body and 5 cases(1.4%)were positive in the antrum only.According to the de⁃gree of gastric atrophy,the 352 Hp positive cases were divided into non-atrophic group(179 cases,50.9%),closed atrophy group(117 cases,33.2%)and open atrophy group(56 cases,15.96%).Pathological examination showed intestinal metaplasia in 84 cases(23.9%).Open atrophic gastritis(O1~O3)was an independent risk factor for RUT positive in the gastric body and negative in the gastric antrum.(OR 5.126,95%CI 1.549-17.240,P<0.05).Conclusions:For patients with non-atrophic gastritis or closed atrophic gastritis(C1~C3),single antral sample test does not increase false negative results and it could be used.For patients with open atrophic gastritis(O1~O3),the use of stomach biopsy can reduce false negative results and im⁃prove the diagnostic efficiency of RUT.

关 键 词：幽门螺杆菌 快速尿素酶试验 活检 胃炎 萎缩性 

分 类 号：R446.1[医药卫生—诊断学] R573[医药卫生—临床医学]