幽门螺杆菌感染对内镜检出早期胃癌及癌前病变的影响

Effect of Helicobacter pylori infection on endoscopic detection of early gastric cancer and precancerous lesions

摘要:

目的 探讨幽门螺杆菌（Hp）感染对早期胃癌（EGC）及癌前病变部位、胃黏膜表现及内镜诊断的影响。方法 回顾性分析2018年1月1日－2020年12月31日该院行白光内镜检查（WLE）和Hp检测的1 107例患者的临床资料，分为Hp阴性组（608例）和Hp阳性组（499例）。以病理结果为诊断EGC及癌前病变的金标准，分析Hp感染对EGC及癌前病变部位、内镜下表现及诊断的影响。结果 Hp阳性组中，检出EGC及癌前病变64例，病变以胃窦（45.31%）及胃体（26.56%）多见。Hp阴性组中，检出EGC及癌前病变62例，病变以胃窦（37.10%）及贲门（37.10%）多见。WLE下观察，存在结节或隆起、充血、糜烂及溃疡为Hp阴性EGC及癌前病变的独立危险因素，而存在结节或隆起、糜烂及溃疡为Hp阳性EGC及癌前病变的独立危险因素。虽溃疡为EGC及癌前病变的最强危险因素，但Hp阴性组OR＾值为26.86，高于Hp阳性组的14.43。进一步分析Hp感染对WLE诊断EGC及癌前病变的影响，Hp阳性组的灵敏度为78.13%，特异度为82.99%，均低于Hp阴性组的80.95%及87.91%。绘制WLE诊断不同Hp状态EGC及癌前病变的受试者操作特征曲线（ROC曲线），Hp阴性组的ROC曲线下面积（AUC）为0.79，高于Hp阳性组的0.74。结论 Hp感染不仅可改变EGC及癌前病变的发病部位，亦可影响WLE下病变黏膜表现，进而增加诊断EGC及癌前病变的难度。

Abstract:

Objective To investigate the effect of Helicobacter pylori (Hp) infection on the lesion site, gastric mucosal manifestations and endoscopic diagnosis of early gastric cancer (EGC) and precancerous lesions.Methods Clinical data of 1 107 patients underwent white light endoscopy (WLE) and Hp detection from January 1, 2018 to December 31, 2020 were retrospectively analyzed, then they were divided into HP-negative group (608 cases) and HP-positive group (499 cases). Using pathological findings as the gold standard for the diagnosis of EGC and precancerous lesions, and retrospectively analyzing the effects of Hp infection on the lesion sites, endoscopic manifestations and diagnosis of EGC and precancerous lesions.Results Hp-positive group were detected with EGC and precancerous lesions in 64 patients, and lesions were more common in the gastric sinus (45.31%) and body (26.56%). In the Hp-negative group, 62 cases of EGC and precancerous lesions were detected, with the gastric sinus (37.10%) and cardia (37.10%) being more common. The presence of nodules or bulges, congestion, erosions and ulcers were independent risk factors for Hp-negative EGC and precancerous lesions, while the presence of nodules or bulges, erosions and ulcers were independent risk factors for Hp-positive EGC and precancerous lesions, as observed by WLE. Although ulcers were the strongest risk factor for early gastric cancer and precancerous lesions, the OR＾ for the Hp-negative group was 26.86 higher than the 14.43 for the Hp-positive group. Further analysis of the effect of Hp infection on the diagnosis of EGC and precancerous lesions showed that the sensitivity of 78.13% and specificity of 82.99% in the Hp-positive group, which were lower than those of 80.95% and 87.91% in the Hp-negative group. The receiver operating characteristic (ROC) curve for the diagnosis of EGC and precancerous lesions with different Hp status by WLE were also plotted, and the area under curve (AUC) value of the Hp-negative group was 0.79, which was higher than the 0.74 of the Hp-positive group.Conclusion Hp infection not only changes the site of EGC and precancerous lesions, but also affects the mucosal manifestation of lesions under WLE, thus making the diagnosis of EGC and precancerous lesions more difficult.