内镜窄带成像技术诊断胃黏膜肠上皮化生的临床应用价值

The clinical value of narrow band imaging endoscopy in diagnosing intestinal metaplasia

目的确定内镜窄带成像技术（NBI）下胃黏膜肠上皮化生（IM）的形态学特征，并结合组织病理学探讨NBI诊断IM的可行性和准确性。方法应用NBI对80例患者行常规内镜检查，对黏膜有可疑病变的区域行窄带成像联合放大内镜（NBI—ME）观察，分别在浅蓝色的嵴状结构（LBC）阳性和LBC阴性区域取活检标本行病理组织学检查并对其结果进行比较分析。结果80例患者接受了NBI检查，经病理组织学诊断65例患者有IM。65例确诊IM的患者中，有61例患者的胃黏膜中观察到了LBC，LBC对IM的敏感度为85．15％，特异度为91．57％。从61例LBC阳性患者中获取94份活检标本，其中86份显示有组织学上的IM证据，诊断符合率为91．49%，即LBC对IM的阳性预测值为91.49％。在LBC阳性患者的非LBC区及LBC阴性患者中所取的94份活检标本中，79份（84．04％）无IM的证据，LBC对IM的阴性预测值为84．04％。NBI下在LBC阳性黏膜区活检可明显提高IM的检出率（P〈0．05）。结论NBI—ME有助于内镜直视下LBC区域的靶向活检，从而提高胃黏膜IM的检出率，对胃癌的早期发现、早期诊断、及时治疗具有重要的临床意义。

Objective To investigate the morphologic features of gastric intestinal metaplasia （IM） using narrow band imaging （NBI） endoscopy, and its feasibility and accuracy for diagnosis of IM combined with histopathology. Methods The endoscopic examination was performed on 80 patients and suspected lesions associated with IM was further observed by NBI combined with magnifying endoscopy. The biopsy specimens were obtained from regions containing light blue crest （LBC） or non-LBC mucosa for pathological examination, and the results were analyzed. Results In 80 patients examined with NBI, IM was pathologically confirmed in 65 patients. Of which LBC was seen in 61 patients with a sensitivity of 94% and a specificity of 95%. In a total of 94 specimens obtained from LBC region, 86 had histological evidence of IM with a positive predictive value of 91.49 %. There was no evidence of IM in 79 out of 94 specimens obtained from non-LBC region of patients with or without LBC with a negative predictive value of 84.04%. The results indicated that the detective rate of IM could be increased if biopsy specimen was obtained from LBC region with help of NBI endoscopy （P〈0.05）. Conclusions It has been demonstrated that NBI combined with magnifying endoscopy may improve the diagnosis of IM by clearly observing microvasculature and targeted-biopsy in LBC region, which is helpful in early diagnosis of gastric cancer.