背景:休斯顿共识会议和美国胃肠病学会(ACG)建议在具有特定危险因素的美国人群中进行幽门螺杆菌筛查。然而,这些指南在临床实践中的表现尚不清楚.
方法:我们确定了在休斯顿的一家安全网医院接受上消化道活检的连续患者是否有适应症,2015年1月至2016年12月期间的TX。我们测试了幽门螺杆菌(组织病理学,粪便抗原,尿素呼气试验,免疫球蛋白G血清学,或先前治疗)和使用逻辑回归模型的幽门螺杆菌风险因素,报告为比值比和95%置信区间(CI)。我们评估了由休斯顿共识会议和ACG确定的个体风险因素的预测能力的接收器工作特征(AUROC)曲线下面积。
结果:在942名患者中,幽门螺杆菌感染率为51.5%。具有最高预测性能的风险因素包括第一代移民(AUROC,0.59)和西班牙裔或黑人种族/种族(AUROC,0.57),而其余7个危险因素/陈述的预测价值较低.结合第一代移民身份的模型,黑人或西班牙裔种族/种族,消化不良,反流对幽门螺杆菌感染有更高的预测能力(AUROC,0.64;95%CI,0.61-0.68)比任何个体风险因素。
结论:在这个当代美国队列中,除了黑人或西班牙裔种族/族裔和第一代移民身份外,休斯顿共识会议和ACG确定的个体风险因素在预测幽门螺杆菌感染方面的表现普遍较低.结合多个风险因素的风险预测模型改善了诊断性能,应在未来的研究中进行验证。
BACKGROUND: The Houston
Consensus Conference and American College of Gastroenterology (ACG) have recommended Helicobacter pylori screening in United States populations with specific risk factors. However, the performance of these
guidelines in clinical practice is not known.
METHODS: We identified consecutive patients undergoing upper endoscopy with gastric biopsies for any indication in a safety-net hospital in Houston, TX during January 2015-December 2016. We tested the association between the presence of H pylori (histopathology, stool antigen, urea breath test, immunoglobulin G serology, or prior treatment) and H pylori risk factors using logistic regression models, reported as odds ratios and 95% confidence intervals (CIs). We evaluated the area under the receiver operating characteristic (AUROC) curve for predictive ability of individual risk factors identified by the Houston
Consensus Conference and ACG.
RESULTS: Of 942 patients, the prevalence of H pylori infection was 51.5%. The risk factors with the highest predictive performance included first-generation immigrant (AUROC, 0.59) and Hispanic or black race/ethnicity (AUROC, 0.57), whereas the remaining 7 risk factors/statements had low predictive value. A model that combined first-generation immigrant status, black or Hispanic race/ethnicity,
dyspepsia, and reflux had higher predictive ability for H pylori infection (AUROC, 0.64; 95% CI, 0.61-0.68) than any individual risk factor.
CONCLUSIONS: In this contemporary U.S. cohort, the performance of individual risk factors identified by the Houston
Consensus Conference and ACG was generally low for predicting H pylori infection except for black or Hispanic race/ethnicity and first-generation immigrant status. A risk prediction model combining several risk factors had improved diagnostic performance and should be validated in future studies.