醋酸靛胭脂染色在根除幽门螺杆菌前后辅助诊断早期胃癌效果的比较

Comparative study of chromoendoscopy with the indigo carmine dye added to acetic acid in the diagnosis of early gastric cancer before and after Helicobacter pylori eradication

目的 探讨根除幽门螺杆菌(Helicobacter pylori, H.pylori )对传统白光胃镜(white light endoscopy, WLE)及醋酸靛胭脂(acetic acid,AI)染色诊断早期胃癌准确率的影响。方法收集80例成功根除 H.pylori 的早期胃癌患者( H.pylori 根除组)及80例感染 H.pylori 的早期胃癌患者(对照组),分别行WLE检查及AI染色检查,比较两组间不同检查方法诊断准确率的差异。结果 WLE在 H.pylori 根除组及对照组中诊断的准确率分别为66.25%(53/80)和81.25%(65/80),两者比较差异有统计学意义(χ^2=4.649,P= 0.031);AI染色在 H.pylori 根除组及对照组中诊断的准确率分别为57.50%(46/80)和93.75%(75/80),两者比较差异有统计学意义(χ^2=28.515,P <0.001);此外在对照组中,AI染色诊断早期胃癌的准确率(93.75%)要明显高于WLE(81.25%)(χ^2= 5.714 ,P =0.017),而在 H.pylori 根除组中,AI染色诊断早期胃癌的准确率(57.50%)对比WLE(66.25%)并无明显优势(χ^2= 1.298 ,P =0.255),且AI染色诊断早期胃癌的不确定性与早期胃癌的表面出现非肿瘤上皮或分化型肿瘤上皮的覆盖密切相关(χ^2= 12.890 ,P <0.001)。结论根治 H.pylori 可明显影响WLE及AI染色诊断早期胃癌的准确率,且对AI染色诊断早期胃癌的准确率影响更明显,可能与肿瘤表面出现非肿瘤上皮或分化型肿瘤上皮的覆盖密切相关。

Objective To investigate the diagnostic reliability of early gastric cancer by conventional white light endoscopy(WLE) and chromoendoscopy with the indigo carmine dye added to acetic acid(AI) in patients with or without history of prior Helicobacter pylori(H.pylori) eradication therapy. Methods Eighty early gastric cancer patients with successful H.pylori eradication(eradication group) and 80 early gastric cancer patients with current H.pylori infection(control group) were collected. The differences of diagnostic reliability of early gastric cancer were compared by the WLE and AI between two groups. Results Diagnostic reliability of early gastric cancer by the WLE in the eradication group and the control group were 66.25%(53/80) and 81.25%(65/80), respectively, and the statistical significance was found between two groups(χ^2=4.649, P=0.031). Diagnostic reliability of early gastric cancer by the AI in the eradication group and the control group were 57.50%(46/80) and 93.75%(75/80), respectively, and the statistical significance was found between two groups(χ^2=28.515, P<0.001). And then, in the control group, diagnostic reliability of early gastric cancer by the AI(93.75%) was higher than the WLE(81.25%)(χ^2=5.714, P=0.017). However, in the eradication group, the accurary of AI staining in the diagnosis of early gastric cancer was not superior to WLE staining(χ^2=1.298, P=0.255). On the other hand, uncertainty of AI staining in the diagnosis of early gastric cancer were associated with the presence of histological changes such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors(χ^2=12.890,P<0.001). Conclusion Successful H.pylori eradication can influence the diagnostic reliability of early gastric cancer by WLE and AI, and more obvious influence on diagnostic reliability of early gastric cancer by AI. The reason is possible associated with the presence of histological changes such as non-tumorous epithelium on the tumor and/or surface differentiation of tumors.