慢性胃炎木村-竹本分类法与OLGA系统相关性研究

Study on the correlation between Kimura-Takemoto classification and OLGA system in chronic gastritis

目的探究木村-竹本分类法与OLGA系统评估慢性胃炎的相关程度及影响其诊断结果一致性的因素,推广内镜下应用木村-竹本分类法对慢性萎缩性胃炎患者进行评价来评估患者背景黏膜发生胃癌的风险。方法选取2017年3~4月行胃镜检查患者230例,依据木村-竹本分类法进行镜下分级,再依据OLGA评估系统,综合胃窦、胃体黏膜萎缩程度评分结果进行分期,分析两评估系统的相关性及诊断结果的一致性。结果木村-竹本分类法与OLGA系统具有高度相关性(r=0.829,P<0.05)。两评估系统对慢性胃炎诊断结果具有高度一致性(Kappa值0.722(P<0.05))。应用多因素Logistic回归分析得出Hp感染(OR=3.113,95%CI:1.71~5.668,P<0.05)、吸烟(OR=3.206,95%CI:1.35~7.611,P<0.05)、服用非甾体抗炎药(OR=5.018,95%CI:1.588~15.861,P<0.05)是影响两系统诊断结果一致性的因素,而饮酒、胆汁反流、年龄、性别等对两评估系统结果影响不大。结论 OLGA系统与木村-竹本分类法有较强的相关性,两系统诊断结果的一致性也比较理想,故在临床中可应用木村-竹本分类法评估患者背景黏膜发生胃癌的风险,快速发现高危背景黏膜,以达到检出早期胃癌的目的。

Objective To explore the relevance between Kimura-Toshimoto classification and OLGA system in evaluat- ing chronic gastritis and the factors influencing the consistency of its diagnosis, and to promote the application of Kimura-Toshimoto classification under endoscopy to evaluate the risk of gastric cancer of gastric mucosa in patients with chronic atrophic gastritis. Methods Totally 230 patients underwent gastroscopy from March to April in 2017 were selected. The patients were classified by endoscopy according to Kimura-Toshimoto classification and then were staged according to OLGA evaluation system combined with gastric mucosal atrophy score of antrum and gastric body. The correlation between the two assessment system and the consistency of diagnostic results were analyzed. Results There was a highly correlation between Kimura-Takemoto classification and OLGA system, with a highly correlation coeffi- cient of 0.829（P〈0.05）. The two assessment systems had a highly agreement in the diagnosis of chronic gastritis with a Kappa value of 0.722（P〈0.05）. Muhivariate logistic regression analysis showed that Hp infection（OR=3.113, 95% CI： 1.71-5.668, P〈0.05）, smoking（OR=3.206, 95%CI： 1.35-7.611, P〈0.05）, taking non-steroidal anti-inflammatory drugs （OR=5.018, 95% CI： 1.588-15.861, P〈0.05） were the factors influencing the consistency of the two system diagnostic results. However, alcohol, bile reflux, age and gender did not affect the results of the two assessment systems apparently. Conclusion There is a strong correlation between the OLGA system and the Kimura-Takemoto classification, and the consistency between the two system diagnostic results is also quite satisfactory. Therefore, in the clinical practice, Kimura-Takemoto classification can be used to assess the risk of gastric cancer in the background mucosa of patients and to quickly find the high-risk background Mucosa, in order to achieve the purpose of detecting early gastric cancer.