京都胃炎评分及其改良预测模型在胃镜下判断中国人群幽门螺杆菌感染状态的价值

doi:10.16150/j.1671-2870.2023.06.007

摘要/Abstract

摘要：

目的： 验证京都胃炎评分在内镜下判断中国人群幽门螺杆菌（Helicobacter pylori, Hp）感染状态的应用价值，并构建改良预测模型以提高对Hp感染的诊断效能。方法： 回顾性收集2021年1月1日至2023年6月1日在上海交通大学医学院附属第九人民医院（北部）消化内镜中心行胃镜检查的749例患者资料。根据组织学活检或¹³C呼气试验结果分为Hp阳性组和Hp阴性组。依据京都胃炎分类，记录患者各项内镜下胃黏膜表现，包括萎缩、肠上皮化生、皱襞增宽、弥漫性发红、结节、规则排列的集合小静脉丛（regular arrangement of collecting venules， RAC）、脊状发红等18项表现，验证京都胃炎评分判断Hp感染的诊断价值。将单因素分析提示差异有显著性的黏膜表现纳入二元Logistic回归，根据回归系数构建改良预测模型，并用受试者操作特征（receiver operator characteristic, ROC）曲线分析改良预测模型判断Hp感染的诊断价值。结果： 本研究中患者Hp感染率为54.47%。各项内镜下黏膜表现中，肠上皮化生、皱襞增宽、结节、弥漫性发红、点状发红和白浊黏液是Hp感染的独立预测因素，而RAC、脊状发红和多发白色扁平隆起是Hp未感染的独立预测因素。京都胃炎评分≥2分判断Hp感染的曲线下面积（area under curve, AUC）为0.861（95%CI为0.835~0.887），准确率为75.2%，灵敏度和特异度分别为88.5%和65.1%。本研究将点状发红、白浊黏液、RAC等黏膜表现纳入改良预测模型，结果显示改良预测模型判断Hp感染的特异度（85.9%）、阳性预测值（88.2%）、阴性预测值（85.4%）和AUC[0.929（95%CI为0.910~0.947）]均高于京都胃炎评分[分别为65.1%、75.2%、82.5%和0.861（95%CI为0.835~0.887）]。结论： 京都胃炎评分预测Hp在中国人群中有一定的应用价值，而本研究建立的改良预测模型对中国人群Hp感染的诊断价值更高。

关键词: 幽门螺杆菌, 黏膜表现, 京都胃炎评分, 预测模型

Abstract:

Objective: To validate the application value of Kyoto gastritis score in diagnosing Helicobacter pylori (Hp) infection status under gastroscopy in Chinses population, and to construct a modified prediction model to improve the diagnostic value of Hp infection. Methods: A total of 749 cases who underwent gastroscopy at the Digestive Endoscopy Center of the Ninth People's Hospital (North), Shanghai Jiao Tong University School of Medicine, from January 1, 2021 to June 1, 2023 were retrospectively collected. Patients were divided into Hp-positive group and Hp-negative group based on histopathological biopsy or ¹³C breath test results. The endoscopic mucosal manifestations were recorded according to the Kyoto classification of gastritis, including atrophy, intestinal metaplasia, fold enlargement, diffuse redness, nodularity, RAC, red streak, and other 18 manifestations to verify the diagnostic value of Kyoto gastritis score for Hp infection. The mucosal manifestations with significant differences in univariate analysis were included in binary Logistic regression, and a modified prediction model was constructed according to the regression coefficients. ROC analysis was used to analyze the diagnostic value of Kyoto gastritis score and the modified prediction model for Hp infection. Results: The Hp infection rate was 54.47%. Intestinal metaplasia, fold enlargement, nodularity, diffuse redness, spotty redness, and sticky mucus were independent predictors of Hp infection. RAC, red streak, white and flat elevated lesion were independent predictors of Hp non-infection. The area under the curve was 0.861 (95%CI was 0.835~0.887), the accuracy was 75.2%, and the sensitivity and specificity were 88.5% and 65.1%. Mucosal manifestations such as spotty redness, sticky mucus, and RAC were incorporated into the modified prediction model. The results showed that the specificity (85.9%), positive predictive value (88.2%), negative predictive value (85.4%) and AUC [0.929 (95%CI was 0.910-0.947)] of the modified prediction model for Hp infection were higher than those of Kyoto gastritis score [65.1%, 75.2%, 82.5% and 0.861 (95%CI was 0.835-0.887), respectively]. Conclusions: Kyoto gastritis score has a certain application value for Hp in the Chinese population, and the modified prediction model has a higher diagnostic value for Hp infection.

Key words: Helicobacter pylori, mucosal manifestations, Kyoto gastritis score, prediction model

中图分类号:

钱丹烨, 孟祥军, 朱黎明. 京都胃炎评分及其改良预测模型在胃镜下判断中国人群幽门螺杆菌感染状态的价值[J]. 诊断学理论与实践, 2023, 22(06): 555-561.

QIAN Danye, MENG Xiangjun, ZHU Liming. Value of Kyoto gastritis score and modified prediction model in diagnosing Helicobacter pylori infection status under gastroscopy in Chinese population[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(06): 555-561.

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参考文献 22

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Mucosal manifestations	Hp(+) [n(%)]	Hp(-) [n(%)]	χ²	P value	OR (95%CI)
Number	408	341
Atrophy	263 (64.5)	146 (42.8)	35.110	<0.001	2.423 (1.803-3.254)
Intestinal metaplasia	223 (54.7)	104 (30.5)	44.073	<0.001	2.747 (2.031-3.715)
Fold enlargement	324 (79.4)	84 (24.6)	224.750	<0.001	11.801 (8.367-6.645)
Nodularity	148 (36.3)	30 (8.8)	77.406	<0.001	5.901 (3.856-9.032)
Diffuse redness	266 (65.2)	49 (14.4)	196.915	<0.001	11.163 (7.751-16.077)
Spotty redness	266 (65.2)	56 (16.4)	180.296	<0.001	9.533 (6.708-13.549)
Sticky mucus	204 (50.0)	83 (24.3)	51.746	<0.001	3.108 (2.270-4.257)
Hyperplastic polyp	35 (8.6)	5 (1.5)	18.586	<0.001	6.306 (2.442-16.281)
Xanthoma	23 (5.6)	18 (5.3)	0.046	0.830	1.072 (0.569-2.021)
Patchy redness	66 (16.2)	74 (21.7)	3.730	0.053	0.696 (0.482-1.006)
Depressed erosion	35 (8.6)	26 (7.6)	0.226	0.635	1.137 (0.670-1.930)
RAC	24 (5.9)	140 (41.1)	134.377	<0.001	11.144 (6.997-17.749)
Fundic gland polyp	5 (1.2)	27 (7.9)	20.342	<0.001	6.931 (2.639-18.202)
Red streak	20 (4.9)	60 (17.6)	31.371	<0.001	4.142 (2.441-7.029)
Hematin	30 (7.4)	57 (16.7)	15.860	<0.001	2.529 (1.584-4.039)
Elevated erosion	19 (4.7)	25 (7.3)	2.403	0.121	0.617 (0.334-1.142)
Map-like redness	2 (0.5)	13 (3.8)	10.446	0.001	8.046 (1.803-35.907)
White and flat elevated lesion	6 (1.5)	29 (8.5)	20.631	<0.001	6.228 (2.554-15.186)

Mucosal manifestations	β	SE	Wald χ²	OR	95%CI	P value
Atrophy	0.506	0.281	3.251	1.659	0.957-2.878	0.071
Intestinal metaplasia	0.712	0.283	6.306	2.037	1.169-3.550	0.012
Fold enlargement	1.647	0.238	47.802	5.189	3.254-8.276	<0.001
Nodularity	1.607	0.308	27.235	4.990	2.729-9.127	<0.001
Diffuse redness	1.167	0.253	21.269	3.211	1.956-5.272	<0.001
Spotty redness	1.323	0.250	28.058	3.755	2.301-6.126	<0.001
Sticky mucus	0.816	0.250	10.664	2.262	1.386-3.691	0.001
Hyperplastic polyp	1.005	0.619	2.635	2.732	0.812-9.191	0.105
RAC	-1.936	0.324	35.667	0.144	0.076-0.272	<0.001
Fundic gland polyp	-0.358	0.783	0.209	0.699	0.151-3.244	0.648
Red streak	-1.079	0.427	6.379	0.340	0.147-0.785	0.012
Hematin	-0.096	0.371	0.067	0.909	0.439-1.881	0.796
Map-like redness	-1.036	1.029	1.013	0.355	0.047-2.668	0.314
White and flat elevated lesion	-1.371	0.611	5.035	0.254	0.077-0.841	0.025

Mucosal manifestations	AUC	SE	P value	95%CI
Atrophy	0.615	0.02	<0.001	0.575-0.655
Intestinal metaplasia	0.637	0.02	<0.001	0.597-0.676
Fold enlargement	0.774	0.018	<0.001	0.739-0.809
Nodularity	0.637	0.02	<0.001	0.598-0.677
Diffuse redness	0.770	0.017	<0.001	0.736-0.804
Kyoto gastritis score	0.861	0.013	<0.001	0.835-0.877

	β	SE	Wald χ²	P value	OR	95%CI
Intestinal metaplasia			15.846	<0.001
IM (1)^*	0.472	0.255	3.427	0.064	1.603	0.973-2.641
IM (2)^*	1.632	0.423	14.867	<0.001	5.116	2.231-11.731
Fold enlargement	1.714	0.237	52.205	<0.001	5.549	3.486-8.832
Nodularity	1.771	0.303	34.22	<0.001	5.879	3.247-10.642
Diffuse redness			24.688	<0.001
Diffuse redness (1)^*	0.955	0.256	13.859	<0.001	2.598	1.572-4.296
Diffuse redness (2)^*	3.805	1.046	13.239	<0.001	44.926	5.786-348.858
Spotty redness	1.217	0.252	23.331	<0.001	3.377	2.061-5.532
Sticky mucus	0.838	0.246	11.642	0.001	2.312	1.429-3.743
RAC	-1.860	0.317	34.339	<0.001	0.156	0.084-0.290
Red streak	-1.067	0.425	6.301	0.012	0.344	0.150-0.791
White and flat elevated lesion	-1.462	0.614	5.673	0.017	0.232	0.070-0.772
Constant	-2.195	0.268	66.964	<0.001	0.111	/

Mucosal manifestations	Score
Intestinal metaplasia
None	0
Antrum	1
Corpus and antrum	3
Fold enlargement
Absence	0
Presence	4
Nodularity
Absence	0
Presence	4
Diffuse redness
Absence	0
Mild (with RAC)	2
Severe	8
Spotty redness
Absence	0
Presence	3
Sticky mucus
Absence	0
Presence	2
RAC
Absence	0
Presence	-4
Red streak
Absence	0
Presence	-2
White and flat elevated lesion
Absence	0
Presence	-3
Modified Score	(-9)-24