幽门螺杆菌根除后发生胃癌的内镜征象及相关危险因素分析

Analysis of endoscopic manifestations and associated risk factors for gastric cancer after helicobacter pylori eradication

摘要:

目的 采用白光成像技术（WLI）和联动成像技术（LCI）来研究根除幽门螺杆菌（HP）后发生胃癌的内镜征象及相关危险因素。方法 回顾性分析2017年1月－2021年12月该院138例成功根除HP后至少1年，使用WLI和LCI模式行食管胃十二指肠镜检查（EGD）患者的临床资料。分为CA组（检测出胃癌，n = 62）和NC组（未检测出胃癌，n = 76）。观察两组患者分别在WLI和LCI模式下的8种内镜表现征象，通过多因素Logistic回归模型，分析根除HP后发生胃癌的相关危险因素。结果 在WLI和LCI模式下行内镜检查，CA组出现中-重度胃黏膜萎缩和地图样发红的概率明显高于NC组（WLI：77.4%和60.5%，P = 0.034；67.7%和36.8%，P = 0.000；LCI：79.0%和60.5%，P = 0.020；79.0%和43.4%，P = 0.000），CA组出现胃内规则排列的集合小静脉（RAC）的概率明显低于NC组（WLI：45.2%和84.2%，P = 0.000；LCI：40.3%和82.9%，P = 0.000），两组其他5种内镜征象的出现概率比较，差异均无统计学意义（P > 0.05）。多因素Logistic回归分析发现，地图样发红是根除HP后发生胃癌的独立危险因素（WLI：OR＾ = 2.96，95%CI：1.36～6.45，P = 0.006；LCI：OR＾ = 4.87，95%CI：2.04～11.62，P = 0.000），而RAC是根除HP后发生胃癌的保护性因素（WLI：OR＾ = 0.16，95%CI：0.07～0.38，P = 0.000；LCI：OR＾ = 0.13，95%CI：0.06～0.32，P = 0.000）。结论 出现地图样发红和RAC缺失是根除HP后发生胃癌的独立危险因素。

Abstract:

Objective White light imaging (WLI) and linked color imaging (LCI) were used to study the endoscopic manifestations and associated risk factors for gastric cancer after eradication of helicobacter pylori (HP).Methods Clinical data of 138 patients who underwent esophagogastroduodenoscopy (EGD) using WLI and LCI at least 1 year after successful HP eradication from January 2017 to December 2021 at this institution were retrospectively analyzed. They were categorized into CA group (gastric cancer detected, n = 62) and NC group (gastric cancer not detected, n = 76). Eight endoscopic manifestations of the two groups in WLI and LCI modes, respectively, were observed, and the risk factors associated with the development of gastric cancer after HP eradication were analyzed by multivariate Logistic regression modeling.Results The frequency of moderate-to-severe gastric mucosal atrophy and map-like redness were significantly higher than those in the CA group compared to the NC group when endoscopy was performed in both WLI and LCI modes (WLI: 77.4% vs 60.5%, P = 0.034; 67.7% vs 36.8%, P = 0.000, respectively; LCI: 79.0% vs 60.5%, P = 0.020; 79.0% vs 43.4%, P = 0.000, respectively), and the frequency of regular arrangement of collecting venules (RAC) was significantly lower in the CA group compared to the NC group (WLI: 45.2% vs 84.2%, P = 0.000; LCI: 40.3% vs 82.9%, P = 0.000). In contrast, the frequency of the other five endoscopic manifestations was not statistically significant. Multivariate Logistic regression analysis revealed that map-like redness was an independent risk factor for gastric cancer after HP eradication (WLI: OR＾ = 2.96, 95%CI: 1.36 ~ 6.45, P = 0.006; LCI: OR＾ = 4.87, 95%CI: 2.04 ~ 11.62, P = 0.000), while RAC was a protective factor (WLI: OR＾ = 0.16, 95%CI: 0.07 ~ 0.38, P = 0.000; LCI: OR＾ = 0.13, 95%CI: 0.06 ~ 0.32, P = 0.000).Conclusion The presence of map-like redness and the absence of RAC were independent risk factors for gastric cancer detected after successful HP eradication.