慢性胃炎的临床与病理学诊断进展

Advances in Clinical and Pathological Diagnosis of Chronic Gastritis

慢性胃炎在中国相当普遍,其中绝大多数源自胃幽门螺杆菌(Hp)感染,如不及时治疗,将导致胃黏膜肠上皮化生、萎缩、异型增生和癌变。近来大量临床和病理学研究结果提示,不完全性肠上皮化生和多灶性胃上皮萎缩具有较高致癌潜能。这些癌前病变多始于胃角和胃窦,沿胃小弯发展至全胃窦,然后扩展至胃体和贲门,伴功能性胃泌酸细胞萎缩、血清胃蛋白酶原Ⅰ水平下降、胃泌素-17水平上升。随着广泛胃上皮萎缩的发生,胃上皮细胞发生异型增生,直至癌变。及时阻断这些癌前病变环节,能从源头遏制、防止胃癌的发生。因此,应对所有行胃镜检查的患者作系统性活检和详尽的组织病理学分析,以得出准确的诊断和分期,这是成功治疗慢性胃炎,防止胃癌发展的有效措施之一。

Chronic gastritis is very common in Chinese population, primarily as a result of widespread infection with Helicobacter pylori, leading to intestinal metaplasia, atrophy, dysplasia and malignancy if not treated effectively. A growing body of evidence derived from recent clinicopathologic research suggests that incomplete intestinal metaplasia and multifocal atrophy are associated with a greater potential for malignant progression. These premalignant lesions usually start at the incisura-antrum, and spread, mainly along the lesser curvature, to the body, cardia and fundus, together with parietal cell atrophy, decreased serum level of pepsinogen I , and increased level of gastrin-17. As the loss of functional gastric glands intensifies and expands, dysplasia in epithelial cells emerges, which may progress to malignancy. Effective treatment of chronic gastritis to prevent development or alleviate progression of intestinal metaplasia and atrophy holds the key to defend against malignant progression. Therefore, it is essential that meticulous examination of gastric mucosa at gastroscopy and comprehensive histopathologic evaluation of biopsy tissues should be carried out in every patient for an accurate diagnosis and staging of the lesion to be served as the foundation for effective therapy of chronic gastritis and prevention of gastric malignancy.