放大内镜结合窄带成像技术对慢性胃炎诊断价值的探讨

The value of narrow-band imaging magnification endoscopy for diagnosing chronic gastritis

目的探讨放大内镜结合窄带成像技术(NBI-ME)对慢性胃炎诊断及分型的临床应用价值。方法 41例胃镜检查提示慢性胃炎的患者,对黏膜有可疑病变的区域行NBI-ME观察,对观察区域及相应164例组织标本的病理结果进行分析。幽门螺杆菌(Hp)经13 C呼气试验及快速尿素酶法检测。结果非萎缩炎胃黏膜形态多见于Ⅰ型及Ⅱ型,萎缩炎多见于Ⅲ型、Ⅳ型及Ⅴ型,Ⅰ型与Ⅲ、Ⅳ型相比,Ⅱ型与Ⅲ、Ⅳ型相比,所见非萎缩炎与萎缩炎的发生率差异均有统计学意义(P<0.01);轻度萎缩炎多见于Ⅲ型,中度萎缩炎多见于Ⅳ型,重度萎缩炎及伴肠化或不典型增生多为Ⅴ型及Ⅵ型。Hp感染时,胃窦部主要见于Ⅲ、Ⅳ、Ⅴ1型,Hp阳性率以Ⅳ型最高,与Ⅱ型相比差异有统计学意义(P<0.05),与Ⅲ型、Ⅴ1型相比差异无统计学意义;胃体部多见于Ⅱ型,Ⅰ型与Ⅱ型相比差异有统计学意义(P<0.05)。胃体部集合静脉Ⅰ型Hp阳性率高于R型者,差异有统计学意义(P<0.05);O型Hp阳性率高于R型者,差异有统计学意义(P<0.01)。结论 NBI-ME通过对胃黏膜微细结构及血管形态的观察,对慢性胃炎的诊断和分型与其病理形态学改变具有良好的对应性,对判定Hp感染也有一定的价值。

Objective To explore the clinical value of diagnosing and classifying chronic gastritis by narrow-band imaging magnification endoscopy（NBI-ME）.Methods NBI-ME was used to observe the gastric mucosa area with suspicious lesions in 41 patients with chronic gastritis diagnosed by endoscopy.Totally 164 biopsy samples were obtained and analyzed.Helicopter pylori（Hp） status was determined by 13C-urea breath test and fast urea enzymes test.Results Non-atrophic gastritis was mostly found in gastric mucosa of type Ⅰ and Ⅱ.Atrophic gastritis was seen in type Ⅲ,Ⅳ and Ⅴ.The incidence of non-atrophic gastritis and atrophic gastritis differed significantly between type Ⅰ and type Ⅲ,Ⅳ as well as between type Ⅱ and type Ⅲ,Ⅳ（P0.01）.Mild atrophy was mostly found in type Ⅲ,moderate atrophy was mainly found in type Ⅳ,and severe atrophy with intestinal metaplasia or dysplasia was mostly found in type V and type Ⅵ.Hp infection in gastric antrum mainly appeared in type Ⅲ,Ⅳ and V1.The positive rate of Hp was the highest in type Ⅳ.Type Ⅳ had a significantly different positive rate from that of type Ⅱ（P0.05）,but not from that of type Ⅲ or V1.In gastric body,Hp infection mainly appeared in type Ⅱ,which was significantly different from type Ⅰ（P0.05）.The positive rate of Hp was significantly higher in type Ⅰ and type O of gastric corpus collecting vein than in type R（P0.05,P0.01）.Conclusion Diagnosis and classification of chronic gastritis by NBI-ME through observation of the fine mucosal patterns and vascular morphology of the gastric mucosa closely correspond to histopathology.NBI-ME is also valuable for diagnosing Hp infection.