白光胃镜下内镜征象诊断儿童幽门螺杆菌感染的临床研究

doi:10.7499/j.issn.1008-8830.2411069

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摘要目的探究白光胃镜下内镜征象对诊断儿童幽门螺杆菌（Helicobacter pylori, Hp）感染的临床价值。方法回顾性收集2022年7月—2023年6月因上消化道相关症状在无锡市儿童医院消化内科同时行胃镜检查和胃黏膜组织Hp培养检查的340例患儿的临床资料，根据Hp培养结果分为Hp感染组（146例）和Hp未感染组（194例）。比较两组胃黏膜不同内镜征象的检出率，分析各内镜征象与不同Hp感染状态的关联，并比较不同Hp感染状态下各内镜征象的诊断价值。结果 Hp感染组白色黏液、弥漫性发红、黏膜水肿、皱襞肿大、鸡皮样变、溃疡的比例高于Hp未感染组（P<0.05），规则排列的集合细静脉（regular arrangement of collecting venules, RAC）、脊状发红的比例低于Hp未感染组（P<0.05）。多因素logistic回归分析显示，弥漫性发红、皱襞肿大、黏膜水肿、鸡皮样变与Hp感染密切相关（P<0.05），RAC、脊状发红与Hp未感染密切相关（P<0.05）。受试者操作特征曲线分析显示，弥漫性发红、皱襞肿大、黏膜水肿、鸡皮样变预测Hp感染的曲线下面积分别为0.798、0.731、0.782、0.760（P<0.05）。RAC、脊状发红预测Hp未感染的曲线下面积分别为0.861、0.589（P<0.05）。结论白光胃镜下内镜征象与儿童Hp感染具有关联性，其中弥漫性发红、黏膜水肿、鸡皮样变、皱襞肿大对Hp感染的诊断价值较高。

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	周仁民
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关键词 ：幽门螺杆菌, 白光胃镜, 内镜征象, 儿童

Abstract：Objective To explore the clinical value of endoscopic findings under white light gastroscopy in diagnosing Helicobacter pylori (Hp) infection in children. Methods A retrospective analysis was conducted on the clinical data of 340 children who underwent gastroscopy and gastric mucosa tissue Hp culture from July 2022 to June 2023 in the Department of Gastroenterology at Wuxi Children's Hospital due to upper gastrointestinal symptoms. Based on the results of Hp culture, the children were categorized into an Hp-infected group (146 cases) and a non-infected group (194 cases). The detection rates of various endoscopic findings in the gastric mucosa between the two groups were compared, and the association between each endoscopic finding and different Hp infection statuses was analyzed, as well as the diagnostic value of each endoscopic finding under different Hp infection statuses. Results The proportions of white mucus, diffuse redness, mucosal edema, enlarged folds, chicken skin-like changes, and ulcers in the Hp-infected group were higher than those in the non-infected group (P<0.05), while the proportions of regular arrangement of collecting venules (RAC) and ridge-like redness were lower in the Hp-infected group compared to the non-infected group (P<0.05). Multivariate logistic regression analysis showed that diffuse redness, enlarged folds, mucosal edema, and chicken skin-like changes were closely associated with Hp infection (P<0.05), while RAC and ridge-like redness were closely associated with the absence of Hp infection (P<0.05). Receiver operating characteristic curve analysis indicated that the area under the curve for diffuse redness, enlarged folds, mucosal edema, and chicken skin-like changes in predicting Hp infection was 0.798, 0.731, 0.782, and 0.760, respectively (P<0.05). The area under the curve for RAC and ridge-like redness in predicting the absence of Hp infection was 0.861 and 0.589, respectively (P<0.05). Conclusions Endoscopic findings under white light gastroscopy are associated with Hp infection in children, with diffuse redness, mucosal edema, chicken skin-like changes, and enlarged folds showing significant diagnostic value for Hp infection.

Key words： Helicobacter pylori White light gastroscopy Endoscopic finding Child

收稿日期: 2024-11-13

基金资助:无锡市卫生健康委妇幼健康项目（FYKY202108）；无锡市医学创新团队（CXTD2021011）。

通讯作者: 林琼，女，教授，主任医师。Email：linqiong76@163.com。 E-mail: linqiong76@163.com

作者简介: 周仁民，男，硕士，主治医师；

引用本文:

周仁民,陈颖,林琼. 白光胃镜下内镜征象诊断儿童幽门螺杆菌感染的临床研究[J]. 中国当代儿科杂志, 2025, 27(4): 438-443.

ZHOU Ren-Min,CHEN Ying,LIN Qiong. Diagnostic value of endoscopic findings under white light gastroscopy for Helicobacter pylori infection in children[J]. CJCP, 2025, 27(4): 438-443.

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	Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis[J]. Gastroenterology, 2017, 153(2): 420-429. PMID: 28456631. DOI: 10.1053/j.gastro.2017.04.022.
	Seo JH, Bortolin K, Jones NL. Review: Helicobacter pylori infection in children[J]. Helicobacter, 2020, 25Suppl 1:e12742. PMID: 32918353. DOI: 10.1111/hel.12742.
	3 龙梅, 朱莉, 包林林, 等. 贵阳地区儿童时期幽门螺杆菌感染后胃镜检查和病理组织学特点及疗效研究[J]. 中国全科医学, 2020, 23(36): 4562-4566. DOI: 10.12114/j.issn.1007-9572.2020.00.357.
	4 中华医学会儿科学分会消化学组, 国家儿童医学中心消化专科联盟, 中华儿科杂志编辑委员会. 中国儿童幽门螺杆菌感染诊治专家共识（2022）[J]. 中华儿科杂志, 2023, 61(7): 580-587. DOI:10.3760/cma.j.cn112140-20220929-00849.
	Makristathis A, Hirschl AM, Mégraud F, et al. Review: diagnosis of Helicobacter pylori infection[J]. Helicobacter, 2019, 24Suppl 1:e12641. PMID: 31486244. DOI: 10.1111/hel.12641.
	6 李沛颖, 黄金狮, 李久伟, 等. 胃镜下幽门螺杆菌感染慢性萎缩性胃炎儿童的胃黏膜病变严重程度与炎症因子的关系[J]. 临床消化病杂志, 2023, 35(4): 280-283. DOI: 10.3870/lcxh.j.issn.1005-541X.2023.04.07.
	7 中华医学会消化病学分会,中华医学会消化病学分会消化系统肿瘤协作组, 房静远. 中国慢性胃炎诊治指南（2022年, 上海）[J]. 胃肠病学, 2023, 28(3): 149-180. DOI: 10.3969/j.issn.1008-7125.2023.03.004.
	8 耿甜, 李中跃. 13C-尿素呼气试验诊断儿童幽门螺杆菌感染相关影响因素[J]. 中华实用儿科临床杂志, 2022, 37(7): 552-555. DOI: 10.3760/cma.j.cn101070-20201117-01770.
	Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis[J]. Gut, 2015, 64(9): 1353-1367. PMID: 26187502. PMCID: PMC4552923. DOI: 10.1136/gutjnl-2015-309252.
	10 张梦娇, 吴练练, 徐铭, 等. 基于京都胃炎评分判断胃镜下幽门螺杆菌感染状态的研究[J]. 中华消化内镜杂志, 2022, 39(9): 707-713. DOI: 10.3760/cma.j.cn321463-20210712-00436.
	11 张琳珂, 代剑华, 李彦, 等. 白光胃镜下食管及胃黏膜不同表现与幽门螺杆菌感染的相关性研究[J]. 中华消化内镜杂志, 2021, 38(2): 120-126. DOI: 10.3760/cma.j.cn321463-20200930-00668.
	Sakae H, Iwamuro M, Okamoto Y, et al. Evaluation of the usefulness and convenience of the Kyoto classification of gastritis in the endoscopic diagnosis of the Helicobacter pylori infection status[J]. Digestion, 2020, 101(6): 771-778. PMID: 31536988. DOI: 10.1159/000502573.
	Calvet X, Ramírez Lázaro MJ, Lehours P, et al. Diagnosis and epidemiology of Helicobacter pylori infection[J]. Helicobacter, 2013, 18 Suppl 1: 5-11. PMID: 24011238. DOI: 10.1111/hel.12071.
	Yoshii S, Mabe K, Watano K, et al. Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis[J]. Dig Endosc, 2020, 32(1): 74-83. PMID: 31309632. DOI: 10.1111/den.13486.
	Shiotani A, Kamada T, Kumamoto M, et al. Nodular gastritis in Japanese young adults: endoscopic and histological observations[J]. J Gastroenterol, 2007, 42(8): 610-615. PMID: 17701123. DOI: 10.1007/s00535-007-2073-5.
	Zhao J, Xu S, Gao Y, et al. Accuracy of endoscopic diagnosis of Helicobacter pylori based on the Kyoto classification of gastritis: a multicenter study[J]. Front Oncol, 2020, 10: 599218. PMID: 33344250. PMCID: PMC7746828. DOI: 10.3389/fonc.2020.599218.
	Hojo M, Nagahara A, Kudo T, et al. Endoscopic findings of Helicobacter pylori gastritis in children and young adults based on the Kyoto classification of gastritis and age-associated changes[J]. JGH Open, 2021, 5(10): 1197-1202. PMID: 34622008. PMCID: PMC8485397. DOI: 10.1002/jgh3.12652.
	Mao T, Wang Y, Yin F, et al. Association of endoscopic features of gastric mucosa with Helicobacter pylori infection in Chinese patients[J]. Gastroenterol Res Pract, 2016, 2016: 6539639. PMID: 27974885. PMCID: PMC5128703. DOI: 10.1155/2016/6539639.
	19 周世平, 贾玉婷, 赵希, 等. 内镜下评估慢性胃炎患者胃黏膜形态预测幽门螺杆菌感染[J]. 中国实验诊断学, 2020, 24(8): 1280-1283. DOI: 10.3969/j.issn.1007-4287.2020.08.016.
	20 张涛, 苏晓兰, 张涛, 等. 基于胃镜下黏膜表现预测幽门螺杆菌感染风险列线图的建立与评价[J]. 中国中西医结合消化杂志, 2022, 30(7): 480-486.
	21 杜会卿, 马翠华, 陈红玉, 等. 不同幽门螺旋杆菌感染状态胃镜下黏膜特点分析[J]. 中华胃肠内镜电子杂志, 2019, 6(4): 163-171. DOI: 10.3877/cma.j.issn.2095-7157.2019.04.004.
	22 杨洋, 高广周, 郝英霞. 白光胃镜下内镜征象诊断幽门螺杆菌感染的临床研究[J]. 河北医科大学学报, 2022, 43(4): 391-396. DOI: 10.3969/j.issn.1007-3205.2022.04.005.
	Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection[J]. J Gastroenterol Hepatol, 2002, 17(1): 39-45. PMID: 11895551. DOI: 10.1046/j.1440-1746.2002.02665.x.
	Ebigbo A, Marienhagen J, Messmann H. Regular arrangement of collecting venules and the Kimura-Takemoto classification for the endoscopic diagnosis of Helicobacter pylori infection: evaluation in a Western setting[J]. Dig Endosc, 2021, 33(4): 587-591. PMID: 32767790. DOI: 10.1111/den.13808.
	Garcés-Durán R, García-Rodríguez A, Córdova H, et al. Association between a regular arrangement of collecting venules and absence of Helicobacter pylori infection in a European population[J]. Gastrointest Endosc, 2019, 90(3): 461-466. PMID: 31108089. DOI: 10.1016/j.gie.2019.05.027.