慢性萎缩性胃炎胃镜与病理诊断的符合率及与Hp感染的相关性分析

Relationship between gastroscopic diagnosis and pathological changes and Helicobacter pylori infections in patients with chronic atrophic gastritis

目的探讨慢性萎缩性胃炎(CAG)胃镜与病理诊断的符合率及与幽门螺杆菌(Hp)感染的相关性,为提高诊断正确率提供参考依据。方法选择2014年1月至2015年10月经胃镜诊断为CAG的患者118例,对比分析胃镜下直视诊断结果与病理诊断结果的符合率及与Hp感染的相关性。结果胃镜直视下诊断为CAG的118例患者中,经组织病理学诊断为CAG的患者为71例,胃镜诊断与病理诊断的符合率为60.17%(71/118);46例伴肠上皮化生,占38.98%(46/118);16例伴不典型增生,占13.56%(16/118)。胃镜下诊断为CAG的Hp感染阳性率为44.92%(53/118),病理诊断为CAG的Hp感染阳性率为64.79%(46/71),差异有统计学意义(P<0.05)。胃镜下有伴发表现患者的Hp感染阳性率显著高于一种表现者,差异有统计学意义(P<0.05)。随着萎缩程度加重,肠上皮化生程度和不典型增生程度加重,Hp感染程度加重,差异有统计学意义(P<0.05)。结论胃镜检查对慢性萎缩性胃炎的诊断具有一定的应用价值。当胃镜与病理结果不相符时,要反复印证并分析其原因,必要时,可联合三种检查手段,以提高诊断的准确率。

Objective To asses the relationship between gastroscopic diagnosis and pathological changes and Helicobacter pylori infections in patients with chronic atrophic gastritis. Methods A total of 118 patients who were diagnosed with chronic atrophic gastritis by gastroscope from Jan 2014 to Oct 2015 were enrolled into the study,and the relationship between gastroscopic diagnosis and pathological changes and Helicobacter pylori infections was investigated. Results 71 cases were diagnosed with CAG by histopathology,accounting for 60. 17%（ 71 /118）. And 46 cases with intestinal metaplasia,accounting for 38. 98%（ 46 /118）. 16 cases with atypical hyperplasia,accounting for 13. 56%（ 16 /118）. Hp infection positive rate in gastroscopic diagnosis group and pathologic diagnosis group was 44. 92%（ 53 /118） and 64. 79%（ 46 /71）,respectively,the difference was statistically significant（ P〈0. 05）. The Hp infection positive rate was significant higher than one performance under gastroscope（ P〈0. 05）. The intestinal metaplasia and atypical hyperplasia worsen and Hp infection rate increased as atrophy aggravated（ P〈0. 05）.Conclusion Gastroscopy is contributed to the diagnosis of CAG. When the gastroscopic diagnosis was consistent with the pathological results,when necessary,the three inspection methods could be combined,so as to improve the diagnostic accuracy.