放大胃镜联合窄带成像观察胃黏膜集合小静脉诊断幽门螺杆菌感染的临床研究

摘要

目的 研究放大胃镜观察胃黏膜微血管形态诊断幽门螺旋杆菌(HP)感染的临床价值.方法 对符合入选标准的69例行无痛胃镜检查患者,放大胃镜窄带成像模式观察胃黏膜集合小静脉(RAC),进行分类并作出有无HP感染的内镜诊断;对观察区域,胃黏膜组织切片进行HP的HE染色和免疫组化染色,判断有无HP感染.结果 参照Nakagawa分型,不规则型和模糊型的HP感染率分别为73.1％、83.3％,高于规则型6.5％(P＜0.01).进行胃黏膜RAC分型与HP的HE染色和免疫组化染色进行比较,结果显示69例放大胃镜检查观察RAC形态诊断HP感染灵敏度为93.55％,特异度为76.32％,符合率为55.07％,阳性预测值为93.55％,阴性预测值为76.32％,Kappa值为0.84.结论 放大胃镜联合窄带成像观察胃黏膜RAC诊断幽门螺杆菌感染简便、安全、阳性预测性好.%Objective To observe the morphology of regular arrangement of collecting venules (RAC) by narrow band imaging system with magnifying endoscopy (ME-NBI),combined with the HP histologic HE and Rabbit Polyclonal staining and to explore the diagnostic value of ME-NBI in HP infection.Methods 69 patients who underwent painless gastroendoscopy were enrolled in our study.The RAC was observed by ME-NBI.The different RAC morphology was classified and an endoscopic diagnosis of HP infection was made.Simultaneously,we made an endoscopic biopsy on the observed area to the HP histologic HE and Rabbit Polyclonal staining.Results According to the Nakagawa classification,the rates of HP infection in irregular and dim RAC were significantly higher than that in the regular group(73.1％ and 83.3％ vs 6.5％,P＜0.01).By observing the form of regular arrangement of collecting venules through gastroscope,the sensitivity of HP infection was 93.55％,the specificity was 76.32％,the coincidence was 55.07％,the positive predictive value was 93.55％,the negative predictive value was 76.32％,Kappa value was 0.84.Conclusion RAC observation by narrowband imaging system with magnifyingendoscopy is an simple,safe and high positive predictive method in diagnosis of HP infection.