慢性胃炎的胃镜表现与粘膜组织学改变相关性的研究

Investigation on the relationship between endoscopic and histologic mucosal changes in chronic gastritis

目的探讨慢性胃炎胃镜下表现与胃粘膜病理组织学改变的关系。方法对403例慢性胃炎的胃镜所见及其活检组织病理变化进行了相关性的研究。结果(1)403例患者胃镜诊断浅表性胃炎(CSG)380例,萎缩性胃炎(CAG)38例,其中CSG和CAG并存15例。(2)病理结果CSG365例,CAG49例,其中CSG和CAG并存11例,伴肠上皮化生(IM)108例,伴粘膜糜烂59例,伴急性活动性炎症39例,(3)对CSG的诊断,胃镜结果与病理学结果比较,其敏感性为95.3%,阳性预测值为91.6%,特异性和阴性预测值分别为15.8%和26.6%;对CAG的诊断,胃镜结果与病理结果比较,其特异性为96.0%,阴性预测值为93.2%,敏感性和阳性预测值分别为46.2%和63.2%。(4)胃镜下的各种表现与病理结果比较其敏感性均较低,但是胃镜下的某些表现对病理CSG、CAG和IM具有较高的阳性预测值。(5)CAG主要伴随Ⅱ型IM,达85.2%,而Ⅰ型IM主要发生在CSG,占Ⅰ型IM的81.0%。结论单一的胃镜下表现对病理组织学诊断的敏感性均不理想,但是某些特定的胃镜表现对某些病理组织学诊断有较高的阳性预测值。

Objective To study the relationship between endoscopic and histologic mucosal changes in chronic gastritis.Methods All 403 patients with chronic gastritis were examined by endoscopy and two samples of gastric mucosa were examined by the same pathologist.Results (1)Gastroscopic results:there were 380 cases of chronic superficial gastritis(CSG),38 cases of chronic atrophic gastritis(CAG) including 15 cases of coexistence of CSG and CAG.(2)Pathologic results:365 cases of CSG;49 cases of CAG including 11 cases of coexistence of CSG and CAG.Among 403 cases,108 cases with intestinal metaplasia(IM),59 cases with mucosal erosion.39 cases had active chronic gastritis(ACG).(3)For CSG,comparing with pathology,endoscopic results had 95.3% of sensitivity and 91.6% of positive predictive value.In contrast their specific rate and negative predictive value were 15.8% and 26.6%,respectively;for CAG,endoscopy had 96.0% of specific rate and 93.2% of negative predictive value for pathologic diagnosis.Its sensitivity and positive predictive value were 46.2% and 63.2% respectively.(4)Comparing with pathologic results,endoscopic features had less sensitivity(50%),but some had a higher positive predictive value for pathologic CSG,CAG,and IM.(5)CAG was most likely associated with type Ⅱ IM(85.2%).Although most type Ⅰ IM was presented in CSG(81.0%).Conclusion Any single endoscopic finding was nonspecific for pathologic diagnosis;although some charactristical endoscopic findings had a higher positive predictive value. In other words,a single pathologic change may associated with various endoscopic findings, while a single later finding only presented one or two pathologic changes.