胃黏膜低级别上皮内瘤变的临床转归及其进展的相关因素分析

Analysis of clinical outcomes and factors related to progression for gastric mucosa low grade intraepithelial neoplasia

[目的]探讨胃黏膜低级别上皮内瘤变的临床转归及其进展的相关因素,指导胃黏膜低级别上皮内瘤变治疗。[方法]收集经首次病理诊断为胃黏膜低级别上皮内瘤变648例患者病例资料,其中335例获得内镜及活检病理随访,通过Logistic回归分析胃黏膜低级别上皮内瘤变进展的相关因素。[结果]胃黏膜低级别上皮内瘤变内镜下表现以胃黏膜粗糙糜烂型最为多见,主要发生部位在胃窦;合并萎缩、肠化、胃溃疡的患者幽门螺杆菌感染率更高。335例随访患者中,25例进展为高级别上皮内瘤变,22例发生癌变。年龄、幽门螺杆菌感染、萎缩、胃溃疡与胃黏膜低级别上皮内瘤变进展密切相关(均P<0.05)。[结论]胃黏膜低级别上皮内瘤变的进展与年龄、幽门螺杆菌感染、萎缩、胃溃疡密切相关,对于合并上述危险因素的胃黏膜低级别上皮内瘤变,应定期复查内镜及病理活检,必要时早期行内镜下治疗。

[Objective]To investigate the outcomes of gastric mucosa low-grade intraepithelial neoplasia and its factors related to progression,and to guide the treatment of gastric mucosa low-grade intraepithelial neoplasia.[Methods]The data of the patient’s with the first pathological diagnosis of gastric mucosa low-grade intraepithelial neoplasia was collected from the digestive endoscopy center of our hospital during 2011-01-2018-06.Finally,648 patients were included,of which 335 patients obtained endoscopic and biopsy follow-up.Logistic regression was used to analyze the factors related to the progression of gastric mucosa low-grade intraepithelial neoplasia.[Results]Endoscopic findings of gastric mucosa low-grade intraepithelial neoplasia were most common in the endoscopic findings with gastric mucosal rough erosion type,and the main site was in the gastric antrum.In patients with gastric mucosa low-grade intraepithelial neoplasia,the rate of Helicobacter pylori infection was higher in patients with atrophy,intestinal metaplasia,and gastric ulcer.Of the 335 follow-up patients,25 developed high-grade intraepithelial neoplasia and 22 developed cancer.age,Helicobacter pylori infection,atrophy,and gastric ulcer were closely related to the progression of gastric mucosa low-grade intraepithelial neoplasia(all P<0.05).[Conclusion]The progression of gastric mucosa low-grade intraepithelial neoplasia is closely related to age,Helicobacter pylori infection,atrophy,and gastric ulcer.For gastric mucosa low-grade intraepithelial neoplasia with the risk factors,endoscopic and pathological biopsy should be reviewed regularly.,if necessary,early endoscopic treatment should be performed.