目的 探究幽门螺杆菌（Helicobacter pylori, HP）毒力因子联合胃蛋白酶原（pepsinogen, PG）对儿童HP感染相关性胃黏膜损伤的评估价值。 方法 采取横断面研究设计，选取2023年8月—2024年12月因消化道症状就诊于无锡市儿童医院的儿童，根据胃镜病理结果分为胃黏膜轻度损伤组（66例）和中/重度损伤组（51例）。检测血清PG水平及HP毒力因子分型（分为Ⅰ/Ⅱ型），分析联合检测对黏膜损伤程度的诊断价值。 结果 中/重度损伤组PGⅠ和PGⅡ水平高于轻度损伤组（P<0.05），且以Ⅰ型HP感染为主（85.7%）。受试者操作特征曲线分析显示，Ⅰ型HP+PGⅠ阳性诊断中/重度胃黏膜损伤的曲线下面积为0.781，特异度为62.1%，灵敏度为82.4%；Ⅰ型HP+PGⅡ阳性诊断中/重度胃黏膜损伤的曲线下面积为0.742，特异度为90.9%，灵敏度为47.1%；Ⅰ型HP+PGⅠ阳性+PGⅡ阳性诊断中/重度胃黏膜损伤的曲线下面积为0.775，特异度为60.6%，灵敏度为82.4%。 结论 血清PG水平和Ⅰ型HP感染与胃黏膜损伤程度密切相关，二者联合检测对胃黏膜损伤程度有较高的诊断效能，为儿童HP感染相关性胃黏膜损伤的临床评估提供非侵入性检查诊断方案。

Objective To investigate the value of combining Helicobacter pylori (HP) virulence factor typing with pepsinogen (PG) in assessing HP infection-related gastric mucosal injury in children. Methods A cross-sectional study enrolled children presenting with gastrointestinal symptoms at Wuxi Children's Hospital from August 2023 to December 2024. Based on gastroscopic pathology, participants were assigned to a mild injury group (n=66) or a moderate/severe injury group (n=51). Serum PG levels and HP virulence factor typing (type I/II) were examined to evaluate the diagnostic performance of combined testing for mucosal injury severity. Results The moderate/severe injury group had higher serum PGI and PGII levels than the mild injury group (P<0.05), and type I HP infection predominated (85.7%). Receiver operating characteristic curve analysis showed the following diagnostic performance for moderate/severe gastric mucosal injury: type I HP plus PGI positivity yielded an area under the curve (AUC) of 0.781, specificity 62.1%, and sensitivity 82.4%; type I HP plus PGII positivity yielded an AUC of 0.742, specificity 90.9%, and sensitivity 47.1%; simultaneous positivity for type I HP, PGI, and PGII yielded an AUC of 0.775, specificity 60.6%, and sensitivity 82.4%. Conclusions Serum PG levels and type I HP infection are closely associated with gastric mucosal injury severity. Their combined detection demonstrates good diagnostic performance for grading injury severity and provides a noninvasive strategy for clinical assessment of HP-related gastric mucosal damage in children.