探讨感染幽门螺旋杆菌(Hp)及Hp阴性患者胃镜下黏膜表现的差异，旨在为临床诊疗工作提供参考依据。

回顾性分析2017年12月至2019年3月经天津医科大学附属第二医院消化内科门诊收治的14C呼气试验(＋)及14C呼气试验(－)并同时间段行胃镜检查的受检者共1 792例内镜下观察，对胃黏膜表现进行记录，并分析Hp阳性及Hp阴性的胃镜下黏膜差异。

(1)不同Hp感染状态胃镜下黏膜表现差异分析上，单因素分析显示，消化性溃疡、点状发红、斑片状发红、线状红斑、黏膜出血、结节样改变、黏膜水肿、黏膜萎缩、皱襞肿大、增生性息肉在Hp感染者及Hp阴性患者的胃镜下黏膜表现有显著的统计学差异(P<0.05)，且以上表现在Hp感染者中发生率高。反流性食管炎(RE)、规则的集合静脉(RAC)、胃底腺息肉在Hp阴性者中发生率较Hp阳性者高，有明显统计学差异(P<0.05)。黏膜糜烂在Hp阳性者及Hp阴性者中无显著统计意义(P>0.05)，但胃窦部隆起型糜烂在Hp感染者中发生率明显高于未感染Hp患者，差异有统计学意义(P<0.05)。多因素Logistic回归分析显示，RE、RAC、胃底腺息肉在Hp阴性者中发生率高，差异有统计学意义(P<0.05)。消化性溃疡、点状发红、结节样改变、黏膜水肿、黏膜萎缩、线状红斑、斑片状发红、胃窦部隆起型糜烂在Hp感染者中发生率高，差异有统计学意义(P<0.05)。(2)不同胃镜下黏膜表现对于预测Hp感染与否的诊断价值分析上，RAC对预测Hp阴性的AUC、敏感性、特异性、阳性预测值及阴性预测值分别为0.750、65.6%、84.5%、77.8%及74.7%；胃底腺息肉预测Hp阴性的特异性、阳性预测值分别为99.8%、96.4%。RE患者诊断Hp阴性的特异性高达94.7%；黏膜点状发红作为预测Hp阳性的敏感性为80%，特异性为74.9%，AUC为0.774，阳性预测值为79.3%；结节样改变对于预测Hp阳性其特异性可高达99.9%，阳性预测值高达92.3%。消化性溃疡、增生性息肉、黏膜萎缩及线状红斑对于预测Hp感染的特异性分别为90.8%、98.2%、86.3%及85.1%，阳性预测值分别为78.3%、71.4%、80.4%及75%。

(1)RE、RAC、胃底腺息肉为Hp阴性的独立的胃镜下黏膜征象；消化性溃疡、点状发红、结节样改变、黏膜水肿、黏膜萎缩、线状红斑、斑片状发红、胃窦部隆起型糜烂为Hp阳性独立的胃镜下黏膜征象；(2)RAC、黏膜点状发红预测Hp感染与C14呼气试验结果的符合率较高。结节样改变、黏膜萎缩、消化性溃疡、胃窦部隆起型糜烂、线状红斑作为预测Hp感染的表现有较大价值；黏膜水肿、皱襞肿大、增生性息肉、黏膜出血、斑片状发红作为单独诊断Hp阳性的指标不推荐；胃底腺息肉对于预测Hp阴性有较大价值；RE作为单独诊断Hp阴性的指标不推荐。

To investigate the differences of mucosal manifestations between Helicobacter pylori (Hp)-positive and Hp-negative patients, so as to provide reference for clinical work.

A retrospective analysis of the 14C-urea breath test (+ ) and 14C-urea breath test (-) admitted to the Department of Gastroenterology, the Second Hospital of Tianjin Medical University during the period from December 2017 to March 2019, and the subjects who underwent gastroscopy at the same time. A total of 1792 cases were observed under endoscopy, and the gastric mucosal manifestations were recorded and analyzed for Hp(+ )and Hp(-)endoscopic mucosal differences.

(1)In the analysis of the differences of mucosal manifestations under gastroscopy in different Hp infection states, single factor analysis showed that, peptic ulcer, spotted redness, patchy redness, linear erythema, mucosal hemorrhage, nodular changes, mucosal edema, mucosal atrophy, wrinkle enlargement and hyperplastic polyps in Hp-positive and Hp-negative endoscopic mucosa showed a statistically significant difference (P< 0.05), and the above showed high incidences in Hp-positive patients. The incidence of reflux esophagitis (RE), regular collecting vein (RAC) and fundic gland polyps in Hp-negative patients were higher than that in Hp-positive patients, and there was significant statistical difference (P<0.05). Mucosal erosion was not statistically significant in Hp-positive and Hp-negative patients (P>0.05), but the incidence of protruding erosion of gastric antrum in Hp-positive patients was significantly higher than that in Hp-negative patients, the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that RE, RAC and fundus glandular polyps were more in Hp-negative patients than that in Hp-positive patients with statistically significant differences (P<0.05). Peptic ulcer, spotted redness, nodular changes, mucosal edema, mucosal atrophy, linear erythema, patchy redness and protruding erosion of gastric antrum had high incidences in Hp-positive patients, with statistically significant differences (P<0.05). (2) In the analysis of the diagnostic value of mucosal manifestations under different gastroscopes for predicting Hp infection, the AUC, sensitivity, specificity, positive predictive value and negative predictive value of RAC for predicting Hp negative were 0.750, 65.6%, 84.5%, 77.8% and 74.7% respectively, and the specificity and positive predictive value of fundus glandular polyps for predicting Hp negative were 99.8% and 96.4% respectively. The specificity of Hp negative diagnosis in RE patients was 94.7%; the sensitivity of spotted redness as a predictor of Hp positive was 80%, the specificity was 74.9%, AUC was 0.774, and the positive predictive value was 79.3%; the specificity of nodular changes in predicting Hp positive was 99.9%, and the positive predictive value was 92.3%. The specificity of peptic ulcer, hyperplastic polyps, mucosal atrophy and linear erythema were 90.8%, 98.2%, 86.3% and 85.1% respectively. The positive predictive values were 78.3%, 71.4%, 80.4% and 75% respectively.

(1) RE, RAC and fundic gland polyps are Hp negative and independent mucosal signs under gastroscope; peptic ulcer, spotted redness, nodular changes, mucosal edema, mucosal atrophy, linear erythema, patchy redness and protruding erosion of gastric antrum are Hp positive and independent mucosal signs under gastroscope; (2) RAC and spotted redness of mucosa predicting Hp infection in accordance with 14C-urea breath test results , the combination rate is high. Nodular changes, mucosal atrophy, peptic ulcer, antral protuberant erosions and linear erythema are of great value in the prediction of Hp infection; mucosal edema, wrinkle enlargement, hyperplastic polyps , mucosal hemorrhage and patchy redness are not recommended as independent indicators for Hp positive diagnosis; fundic gland polyps are of great value in the prediction of Hp negative; RE as a single indicator for Hp negative diagnosis is not recommended.