窄带成像放大内镜分级系统在慢性萎缩性胃炎实时诊断及危险分层中的价值研究

Establishment of real-time evaluation and risk stratification method of chronic atrophic gastritis based on narrow band imaging magnifying endoscopy scoring system

目的探讨窄带成像放大内镜(narrow band imaging magnification endoscopy,NBI-ME)分级系统在慢性萎缩性胃炎(chronic atrophic gastritis,CAG)实时诊断及危险分层中的价值。方法收集40岁以上接受NBI-ME检查患者的内镜和病理资料,评估NBI-ME分级系统和组织病理学金标准—OLGA/OLGIM(operative link for gastritis assessment/operative link for gastric intestinal metaplasia assessment)分期系统的相关性及一致性。结果共纳入63例患者,男41例,女22例,胃窦和胃体部的NBI-ME评分和组织学评分的一致性均为73.0%,总体一致性显著(Kappa=0.695,P<0.05;加权Kappa=0.907,P<0.05),其中胃窦的一致性良好(Kappa=0.604,P<0.05),胃体的一致性中等(Kappa=0.487,P<0.05);Cochran-Mantel-Haenszel分析表明,高危NBI-ME分级(Ⅱ~Ⅳ级)的患者诊断为高危OLGA/OLGIM分期的可能性更高(P<0.0001),NBI-ME分级诊断高危CAG/GIM的敏感性为81.8%(95%CI:59.7%~94.8%),特异性为95.1%(95%CI:83.5%~99.4%)。结论NBI-ME评分与组织病理学评分具有较高一致性,它是一种简便、经济并实时诊断CAG及识别胃癌高危人群的检查及随访方式。

Objective To investigate the value of narrow band imaging magnification endoscopy(NBI-ME)staging system in real-time diagnosis and risk stratification of chronic atrophic gastritis(CAG).Methods Patients over 40-year-old,who received NBI-ME were enrolled in this study.The correlation and consistency between the NBI-ME staging system and the tissue pathology gold standard OLGA/OLGIM staging system were evaluated.Results Totally 63 patients(41 male and 22 female)were enrolled in this study.The consistency between NBI-ME scores and histology scores was 73.0%,both in antrum and corpus.The agreement was substantial in the antrum(Kappa=0.604,P<0.05)and was moderate reliability in the corpus(Kappa=0.487,P<0.05).The overall agreement was substantial between NBI-ME stages and OLGA/OLGIM stages(Kappa=0.695,P<0.05;weighted Kappa=0.907,P<0.05).Cochran-Mantel-Haenszel analysis demonstrated that patients with high-risk NBI-ME stages(Ⅱ-Ⅳ)may more likely diagnosed as high-risk OLGA/OLGIM stages(P<0.0001).When considering NBI-ME stage as a continuous variable,the sensitivity was 81.8%(95%CI:59.7%-94.8%)and specificity was 95.1%(95%CI:83.5%-99.4%)for CAG/GIM diagnosis.Conclusion NBI-ME score has a high consistency with histopathological score.It is a simple,economical and real-time diagnosis of CAG and identification of high-risk groups of gastric cancer.