醋酸染色结合窄带成像放大内镜在胃黏膜肠上皮化生病变诊断中的应用

Application of acetic acid staining combined with narrow-band imaging magnifying endoscopy in diagnosis of intestinal metaplasia of gastric mucosa

目的分析醋酸染色结合窄带成像放大内镜(NBI-ME)在胃黏膜肠上皮化生(IM)病变诊断中的应用价值。方法选择行胃镜检查的患者120例,依次采用普通内镜、NBI-ME、醋酸染色步骤进行观察,评价各检查方法中病变清晰度,在胃窦、胃体及疑似病变部位取活检行病理学检查,评价三种检查方法的诊断效能。结果NBI-ME模式下,IM呈蓝白色线,观察到上皮表面淡蓝色的嵴状结构(LBC),醋酸染色联合NBI-ME模式下,见黏膜白斑;NBI-ME、醋酸染色结合NBI-ME模式下观察病变清晰度分别为96.67%、100%优于普通内镜85.83%,且醋酸染色结合NBI-ME的清晰度最佳(P<0.05);醋酸染色结合NBI-ME诊断IM的灵敏度96.00%、特异度100%、准确度96.67%、阳性预测值100%、阴性预测值83.33%、Kappa值0.889均高于普通内镜、NBI-ME(P<0.05),NBI-ME与普通内镜的诊断效能差异有统计学意义(P<0.05)。结论 LBC可作为醋酸染色结合NBI-ME下诊断肠上皮化生的特征性表现,指导靶向活检,醋酸染色结合NBI-ME可提高诊断灵敏度、特异度、准确度,且能增加病变观察清晰度,值得在临床推广实践。

Objective To analyze the application value of acetic acid staining combined with narrow-band imaging magnifying endoscopy(NBI-ME) in diagnosis of intestinal metaplasia(IM) of gastric mucosa.Methods A total of 120 patients who underwent gastroscopy were observed by common endoscopy, NBI-ME, and visual inspection with acetic acid staining. The lesions displayed by each examination method were evaluated. Pathological examination of biopsy specimens from the gastric antrum, gastric body, and suspected lesions was performed. The diagnostic efficacy of the three examination methods was evaluated. Results Under the NBI-ME mode, IM showed a blue-white line, and the light blue crest(LBC) on the epithelial surface was observed. Under visual inspection with acetate acid combined with NBI-ME mode, mucosal leukoplakia was observed. Under NBI-ME mode and visual inspection with acetic acid staining combined with NBIME mode, the definition of the lesions observed was 96.67% and 100% respectively, which was better than 85.83% by common endoscopy, and the definition displayed by visual inspection with acetic acid staining combined with NBI-ME was the optimal(P<0.05). The sensitivity, specificity and accuracy of acetate staining combined with NBI-ME in diagnosis of IM was 96.00%, 100%, and 96.67%, respectively. In addition, positive and negative predictive value was 100% and 83.33% respectively, and Kappa value was 0.889,and all the indexes were higher than those by ordinary endoscopy(P<0.05). There were significant differences in diagnostic efficacy between NBI-ME and common endoscopy(P<0.05). Conclusion LBC can be used as a characteristic feature of visual inspection with acetic acid staining combined with NBI-ME to diagnose IM, which can guide targeted biopsy. Acetic acid staining combined with NBI-ME can improve the sensitivity, specificity and accuracy of diagnosis, and can increase the definition of lesions. Therefore, it is worthy of popularization and application in clinical practice.