Clinical Study On Regular Arrangement Of Venules In Gastric Mucosa For Negative Diagnosis Of Helicobacter Pylori Infection

Background: Among the global malignant tumors,the incidence and mortality of gastric cancer ranked in the top five in 2018,and the country with the highest incidence of gastric cancer in the world is located in East Asia,and China is among them.The World Health Organization(WHO)classifies Helicobacter pylori(Hp)as a class I carcinogen of gastric cancer.It has been reported that eradication of Helicobacter pylori can reduce the risk of gastric cancer by 46%.At present,the detection methods for the diagnosis of Helicobacter pylori infection mainly include endoscopic invasive detection and non-invasive detection.With the development of high-definition endoscope,the microvessels and microglandular tubules of gastric mucosa can be observed and judged clearly in real time.The regular arrangement of collecting venules(RAC)is considered to be highly related to the negative state of Helicobacter pylori infection.The purpose of this study was to investigate the accuracy and influencing factors of gastric mucosal RAC in the diagnosis of negative Helicobacter pylori infection.Methods: This study included 243 patients who underwent upper gastrointestinal endoscopy in a single center of the digestive endoscope room in our hospital from June2019 to October 2019.At least one of the following three positive items was defined as the gold standard of Helicobacter pylori infection: histopathological HE staining positive,urea breath test positive,serological antibody positive but never treated.The gastric mucosa was observed by high-definition endoscope,standard 1: RAC was defined as RAC positive in any part of gastric mucosa,and standard 2: RAC was defined as RAC positive in single part of gastric horn mucosa.The sensitivity,specificity and accuracy of the two RAC criteria for negative diagnosis of Helicobacter pylori infection were analyzed,and the covariates such as age,atrophic gastritis and esophagitis were included for correlation analysis.The paired chi-square test was used to compare the accuracy of RAC in the diagnosis of negative Helicobacter pylori infection under the two criteria,and the Kappa test was used to calculate the consistency between the two criteria.Chi-square test was used for univariate analysis.Factors with statistical significance and related factors with clinical significance were selected for logistic multivariate regression analysis.The research program is implemented with the approval of the Ethics Committee of our hospital.Results: 243 cases were included.Standard 1 was used to diagnose the sensitivity of negative Helicobacter pylori infection,and the specificity and accuracy were 75.19%,71.93% and 73.66%,respectively.The sensitivity,specificity and accuracy of standard 2for the diagnosis of negative Helicobacter pylori infection were 48.84%,86.84% and66.67%,respectively.Under the two criteria,the accuracy of RAC in the diagnosis of negative Helicobacter pylori infection was statistically different(P < 0.024),and the consistency was general(Kappa=0.502,P < 0.001).According to standard 1,logistic multivariate regression analysis showed that no esophagitis and previous Helicobacter pylori infection were independent risk factors for decreased diagnostic accuracy.According to standard 2,logistic multivariate regression analysis showed that no esophagitis,atrophic gastritis,aging and previous Helicobacter pylori infection were independent risk factors for the decrease of diagnostic accuracy.Conclusion: The identification of RAC under high-definition endoscope has a certain diagnostic efficacy for negative Helicobacter pylori infection,and the diagnostic accuracy of RAC is different in different parts.This accuracy may be affected by the presence of atrophic gastritis,esophagitis,age and previous infection of Helicobacter pylori.