超细胃镜结合京都胃炎分类在幽门螺杆菌感染中的应用及其药敏结果分析  

Application of ultrafine gastroscopy combined with Kyoto gastritis classification in Helicobacter pylori infection and analysis of drug sensitivity results

作　　者：刘时助 宋晓晖 王宏光[1] 沈宇佳 韩文文 陈宁[2] LIU Shizhu;SONG Xiaohui;WANG Hongguang;SHEN Yujia;HAN Wenwen;CHEN Ning(Department of Gastroenterology,Jilin City People′s Hospital,Jilin 132001,China;Department of Ultrasound,Jilin City People′s Hospital,Jilin 132001,China)

机构地区：[1]吉林市人民医院消化内科,吉林吉林132001 [2]吉林市人民医院超声科,吉林吉林132001

出　　处：《胃肠病学和肝病学杂志》2024年第2期171-176,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：吉林市科技创新发展计划项目(20163089)。

摘　　要：目的分析白光内镜下各种胃黏膜形态改变,评价其在我国H.pylori相关性胃炎人群中的诊断及应用价值。方法纳入同时行超细胃镜检查、^(14)C尿素呼气试验、组织病理学检查、H.pylori抗体患者共232例,采用京都胃炎分类的诊断标准,计算患者京都胃炎评分,分析内镜下胃黏膜表现诊断H.pylori的准确性及诊断效能,并进行药敏试验。结果京都胃炎评分≥2分预测H.pylori感染准确率为90.09%,灵敏度为94.54%,特异度为73.47%。其中皱襞增宽肿大蛇行灵敏度较高,特异度较低;弥漫性发红、白浊黏液、点状发红灵敏度、特异度均较高;萎缩、黏膜水肿灵敏度、特异度均较低。萎缩、皱襞增宽肿大蛇行、结节、弥漫性发红、白色浑浊黏液、点状发红、黏膜水肿在H.pylori感染患者中占比显著高于未感染H.pylori患者(P<0.05)。萎缩、皱襞增宽肿大蛇行、结节、弥漫性发红、白色浑浊黏液、点状发红、黏膜水肿是H.pylori感染的危险因素(P<0.05)。在H.pylori培养阳性的110例标本中,阿莫西林、克拉霉素、甲硝唑、左氧氟沙星、四环素、呋喃唑酮的药物耐药率分别为9.09%、66.36%、81.82%、60.91%、0.91%、0。胃镜表现有萎缩、皱襞增宽肿大蛇行、结节、弥漫性发红、白色浑浊黏液、点状发红的患者出现甲硝锉耐药显著高于未出现以上胃镜表现患者(P<0.05)。结论超细胃镜结合京都胃炎分类可提高H.pylori检出率,治疗上可优先选择耐药率低的阿莫西林、呋喃唑酮、四环素可提高H.pylori根除率,超细胃镜结合京都胃炎分类可有效及时发现H.pylori耐药性。Objective To analyze the morphological changes of gastric mucosa under white light endoscope,and to evaluate the diagnostic and practical value of the white light endoscopy in the diagnosis of H.pylori-associated gastritis in our country.Methods A total of 232 patients who underwent both ultrafine gastroscopy,^(14)C urea breath test(UBT),histopathology test and H.pylori antibody test were included in the study.The Kyoto gastritis score was calculated by the diagnostic criteria of Kyoto classification,the diagnostic accuracy and efficacy of endoscopic gastric mucosal manifestations in the diagnosis of H.pylori were analyzed,and the drug sensitivity test was performed.Results The accuracy,sensitivity and specificity of Kyoto gastritis score≥2 in predicting H.pylori infection were 90.09%,94.54%and 73.47%,respectively.The plicae widening and swelling had higher sensitivity and lower specificity.The sensitivity and specificity of diffuse redness,white mucous and spot redness were higher.The sensitivity and specificity of atrophy and mucosal edema were lower.The proportion of atrophy,plicae widening and swelling,tubercles,diffuse redness,white turbidous mucous,punctate redness and mucosal edema in H.pylori infection patients were significantly higher than those in H.pylori non-infection patients(P<0.05).The risk factors of H.pylori infection were atrophy,plicae widening and swelling,tubercles,diffuse redness,white turbidous mucous,punctate redness and mucosal edema(P<0.05).Among the 110 H.pylori positive specimens,the drug resistance rates of Amoxicillin,Clamycin,Metronidazole,Levofloxacin,Tetracycline and Furazolidone were 9.09%,66.36%,81.82%,60.91%,0.91%and 0,respectively.Metronidazole resistance was significantly higher in patients with gastroscopic atrophy,plicae widening and swelling,tubercles,diffuse redness,white turbidous mucous and spot-like redness than in patients without the above gastroscopic manifestations(P<0.05).Conclusion Ultrafine gastroscopy combined with Kyoto classification of gastritis can incre

关 键 词：超细胃镜 京都胃炎分类 幽门螺杆菌 培养及药敏试验 

分 类 号：R573[医药卫生—消化系统]