胃窦部幽门螺杆菌活检检测情况的临床分析

Clinical analysis of helicobacter pylori biopsy in gastric antrum

摘要:

目的 分析胃窦部不同部位幽门螺杆菌（Hp）检测情况，为寻找Hp最佳活检部位提供临床指导依据。方法 回顾性分析2020年1月－2022年12月承德市中心医院行¹³C尿素呼气试验并行电子胃镜检查，于胃窦部位取活检的患者的临床资料，按超基准值（DOB）分为：¹³C尿素呼气试验阳性组（DOB ≥ 4）和¹³C尿素呼气试验阴性组（DOB < 4），收集患者的胃镜报告和病理资料。根据患者胃窦部不同活检部位，分为：常规活检部位组、隆起糜烂部位组和平坦糜烂部位组，比较不同活检部位Hp的检出率。将¹³C尿素呼气试验阳性组按DOB值的情况，分为：A组（4 < DOB ≤ 16）、B组（16 < DOB ≤ 35）和C组（DOB > 35），并分类统计每组患者胃窦部活检及病理情况。结合患者内镜报告和病理资料，分为：萎缩性胃炎组和非萎缩性胃炎组，分类统计胃窦部活检及病理情况。结果 ¹³C尿素呼气试验阳性组中，隆起糜烂部位组Hp检出率（96.4%）高于常规活检部位组（92.7%）和平坦糜烂部位组（93.9%），差异有统计学意义（P = 0.036）；DOB值方面，A组中，隆起糜烂部位组Hp检出率最高，常规活检部位组Hp检出率最低，3个活检部位Hp检出率比较，差异有统计学意义（P = 0.016）；B组和C组3个活检部位Hp检出率比较，差异均无统计学意义（P = 0.622；P = 0.721）；非萎缩性胃炎组中，隆起糜烂部位组Hp检出率（96.5%）高于常规活检部位组（91.2%）和平坦糜烂部位组（92.0%），3个活检部位组Hp检出率比较，差异有统计学意义（P = 0.043）；萎缩性胃炎组中，3个活检部位组Hp检出率比较，差异无统计学意义（P = 0.614）。¹³C尿素呼气试验阴性组中，3个活检部位Hp检出率比较，差异无统计学意义（P = 0.255）。结论 对于¹³C尿素呼气试验阳性但DOB值较低的患者，隆起糜烂部位Hp的阳性率更高。对于非萎缩性胃炎患者而言，与常规活检部位相比，隆起糜烂部位Hp的检出率更高；但对于萎缩性胃炎患者而言，胃窦部不同部位的Hp检出率差异不大。对于¹³C尿素呼气试验阴性患者而言，3个活检部位Hp检出率无明显差异。临床工作中，对于类似的患者，可以精准活检，以提高Hp的检出率。

Abstract:

Objective To analyze the detection of helicobacter pylori (Hp) in different parts of gastric antrum, and to provide clinical guidance for finding the best biopsy site for Hp.Methods Patients who underwent ¹³C urea breath test and electronic gastroscopy from January 2020 to December 2022 were retrospectively analyzed and divided into ¹³C urea breath test positive group [delta over baseline (DOB) ≥ 4] and ¹³C urea breath test negative group (DOB < 4) according to DOB value. Gastroscopy reports and pathological data of patients were collected. According to different biopsy sites in gastric antrum, patients were divided into conventional biopsy site group, elevated erosive site group and flat erosive site group, and the detection rate of Hp in different biopsy sites was compared. ¹³C urea breath test positive group was divided into group A (4 < DOB ≤ 16), group B (16 < DOB ≤ 35) and group C (DOB > 35) according to DOB value, and the gastric antral biopsy and pathology of each group were classified and analyzed. Combined with endoscopic reports and pathological data, patients were divided into atrophic gastritis group and non-atrophic gastritis group.Results In the ¹³C urea breath test positive group, the detection rate of Hp in the elevated erosive site group (96.4%) was higher than that in the conventional biopsy site group (92.7%) and the flat erosive site group (93.9%), and the difference was statistically significant (P = 0.036). In DOB group A, the detection rate of Hp was the highest at the site of elevated erosive and the lowest at the site of conventional biopsy, and the detection rate of Hp at the three biopsy sites was compared, the difference was statistically significant (P = 0.016); There was no significant difference in the detection rate of Hp at three biopsy sites between group B and group C (P = 0.622; P = 0.721); the non-atrophic gastritis group, the detection rate of Hp at the elevated erosive site (96.5%) was higher than that at the conventional biopsy site (91.2%) and the flat erosive site (92.0%), and the difference was statistically significant (P = 0.043). There was no significant difference in the detection rate of Hp at three biopsy sites in the atrophic gastritis group (P = 0.614). ¹³C urea breath test negative group: There was no significant difference in Hp detection rate among the three biopsy sites (P = 0.255).Conclusion For patients with positive ¹³C urea breath test but low DOB value, the positive rate of Hp in the elevated erosive site is higher. For non-atrophic gastritis patients, the detection rate of Hp was higher in the elevated erosive sites than in the conventional biopsy sites. But for patients with atrophic gastritis, there was little difference in the detection rate of Hp in different parts of antrum. For patients with negative ¹³C urea breath test, there was no significant difference in Hp detection rate among the three biopsy sites. In future clinical work, for similar patients, precise biopsy can be performed to improve the detection rate of Hp.