放大电子色素内镜下急慢性胃炎特点及与幽门螺杆菌感染相关性分析

The correlation between the characteristics of antral gastritis under magnified electronic chromoendoscopy and H.pylori. infection

目的分析放大电子色素内镜下胃窦炎症的微形态特征及其与H.pylori.感染的关系,评价其用于靶向活检的可行性。方法消化内镜室行放大窄带成像内镜检查的连续的患者为研究对象,将内镜下黏膜表面形态分5型,以快速尿素酶试验并病理组织学特殊染色查H.pylori.结果为标准,比较黏膜表面形态和H.pylori.感染的关系。结果最终共有65例患者的159个部位与病理组织学及H.pylori.检测结果进行分析。正常胃窦黏膜以A型(70.8%)多见,慢性炎症和急性炎症以B型形态(82.1%)和C型形态(82.8%)为主。肠上皮化生主要表现为D型和E型形态(77.5%)。H.pylori.感染阳性部位共58个(36.5%),以B型和C型形态为多,分别占B型和C型部位的60.0%和60.7%。B型和C型形态预测H.pylori.感染的敏感度为70.1%(95%CI[58.3,81.9]),特异度为73.3%[64.7,81.9],准确度为72.3%[65.3,79.3]。结论胃窦黏膜H.pylori.感染在放大电子色素内镜下微血管和腺管形态有其特征性,预测H.pylori.感染有较高的诊断价值,可提高靶向活检的阳性率。

【Objective】To analyze the microstructure characterization of antral gastritis and its correlation with H. pylori. infection under magnified electronic chromoendoscopy. 【Methods】Consecutive patients underwent magnified electronic chromoendoscopy were recruited in the study. The gastric mucosa of antrum was observed under magnified electronic chromoendoscopy and the gastric microstructure patterns were classified into five types. M-NBI images were graded according to the changes of patterns and correlated with the conventional histological findings and H.pylori. infection. 【Results】A total of 159 gastric antral sites from 65 patients were examined by magnified electronic chromoendoscopy. A significantly higher proportion of chronic inflammation and active inflammation had shown type B pattern（82.1%） and type C pattern（82.8%） respectively. The sites of positive of H. pylori. infection was 58（36.5%）. Specifically, in the H. pylori. infection lesions, type B（60.0%） and type C（60.7%） were frequently observed. The sensitivity, specificity, accuracy of the type B and type C pattern for predicting H. pylori. infection was 70.1%（95%CI[58.3,81.9]）, 73.3% [64.7,81.9], 72.3% [65.3,79.3], respectively.【Conclusion】The characteristic changes of microarchitecture of gastric antral inflammation and H.pylori. infection could be identified using magnified electronic chromoendoscopy, by which H.pylori. infection could be predicted with a relatively high accuracy.