810例次慢性胃炎内镜与病理检查的对照研究

Gastroscopic and Histopathologic Control Study of 810 Patients with Chronic Gastritis

背景:慢性胃炎是临床常见的消化系统疾病,目前有内镜诊断和病理诊断两种标准,但这两种诊断标准的一致性、存在差异的原因、胃炎胃镜下表现与胃黏膜组织病理学改变的关系等问题均值得进一步探讨。目的:了解慢性胃炎的胃镜和病理诊断情况,探讨慢性胃炎胃镜诊断的主要条件与病理诊断的关系。方法:回顾性分析胃镜检查诊断为慢性胃炎患者的胃镜下表现及其病理检查结果。结果:胃镜与病理检查诊断慢性非萎缩性胃炎(NAG)和慢性萎缩性胃炎(CAG)的符合率为63.0%。NAG胃镜下主要表现对病理NAG的诊断敏感性高于80%,CAG胃镜下主要表现对病理CAG的诊断敏感性低于50%。37.9%胃镜诊断的NAG和76.8%胃镜诊断的CAG在组织病理学上存在萎缩性改变。胃炎样胃癌多可见痘疹和(或)糜烂(85.7%)。519例次慢性胃炎患者行幽门螺杆菌(H.pylori)尿素酶试验,病理NAG的H.pylori阳性率与病理CAG无显著差异。结论:NAG胃镜下主要表现对病理NAG的诊断敏感性较高,CAG胃镜下主要表现对病理CAG的诊断敏感性较低。淋巴细胞性胃炎和胃炎样胃癌并非罕见,应予重视。

Background： Chronic gastritis is a common clinical digestive disease, gastroscopy and histopathology are used for its diagnosis. The consistency and discrepancy of these two diagnostic methods and the relationship between gastroscopic and histopathologic mucosal changes in chronic gastritis are worth of further studies. Aims： To appraise the gastroscopic and histopathologic diagnosis status of chronic gastritis, and to explore their correlations. Methods： Patients with chronic gastritis diagnosed by gastroscopy and histopathology were analyzed retrospectively. Results： The consistency rate of chronic nonatrophic gastritis （NAG） and chronic atrophic gastritis （CAG） diagnosed by gastroscopy and histopathology was 63.0%. For NAG, the sensitivity of the major manifestations under gastroscopy comparing with histopathology was more than 80%; and for CAG, the sensitivity of the major manifestations under gastroscopy was less than 50%. 37.9% of patients with NAG and 76.8% of patients with CAG diagnosed by gastroscopy showed atrophic changes by histopathology. Verruciform erosions were often observed in gastritic type gastric carcinoma （85.7%）. Helicobactorpylori （1t. pylon） urease test was performed in 519 cases, no significant difference was found between the positivity rate of H. pylori in histopathologic NAG and CAG. Conclusions： The sensitivity of major manifestations under gastroscopy comparing with histopathology for NAG is higher, but that for CAG is lower. As lymphocytic gastritis and gastritic type gastric carcinoma being not rare, hence, much attention should be paid.