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。

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.