胃炎评价系统及基于肠化的胃炎评价系统对慢性萎缩性胃炎癌变风险的预测价值

Predictive value of operative link on gastritis assessment and operative link on gastritis assessment based on intestinal metaplasia on cancerization risk of patients with chronic atrophic gastritis

目的探讨胃炎评价(operative link on gastritis assessment,OLGA)系统及基于肠化的胃炎评价(operative link on gastritis assessment based on intestinal metaplasia,OLGIM)系统对慢性萎缩性胃炎患者发生癌变的风险预测价值,以及可能的其他胃癌相关危险因素。方法回顾性分析2016年7月-2018年11月在南方医科大学深圳医院经内镜结合病理确诊慢性萎缩性胃炎或肠化的643例患者资料。标准胃镜检查评估有无萎缩及其范围,病理证实并评估萎缩、肠化严重程度,以及有无上皮内瘤变。采用OLGA及OLGIM系统进行萎缩和肠化分期,比较OLGA和OLGIM低分级与高分级患者高级别上皮内瘤变(high-grade intraepithelial neoplasia,HGIN)检出率。结果 OLGA高分级患者HGIN检出率(13.89%,10/72)显著高于低分级患者(3.85%,22/571,χ2=13.618,P<0.001);OLGIM高分级患者HGIN检出率(13.41%,11/82)显著高于低分级患者(3.74%,21/561,χ2=14.150,P<0.001);OLGA与OLGIM均为高分级患者,HGIN检出率进一步升高[21.21%(7/33)比4.10%(25/610),χ2=19.389,P<0.001]。Logistic回归分析显示,OLGA、OLGIM高分级患者发生HGIN的危险度是低分级患者的2.640倍(95%CI:1.083~6.439,P=0.033)及2.747倍(95%CI:1.156~6.528,P=0.022),OLGA与OLGIM均为高分级患者,比值比为6.300(95%CI:2.497~15.897,P<0.001)。结论 OLGA与OLGIM系统对慢性萎缩性胃炎有较好的癌变风险预测价值,是患者进行胃镜精查和制定随访策略的重要参考依据。

Objective To investigate the predictive value of operative link on gastritis assessment(OLGA)and operative link on gastritis assessment based on intestinal metaplasia(OLGIM)on the risks of gastric cancer of patients with chronic atrophic gastritis.Methods Data of 643 patients were collected in the retrospective study,who were diagnosed with chronic atrophic gastritis or intestinal metaplasia by endoscopy and pathology in Shenzhen Hospital of Southern Medical University from July 2016 to November 2018.Standard gastroscopy was performed to assess the presence and extent of atrophy,and the severity of atrophy,intestinal metaplasia,and the presence of intraepithelial neoplasia were confirmed by pathologic diagnosis.Atrophy and intestinal metaplasia were graded according to OLGA and OLGIM systems,and the detection rate of high-grade intraepithelial neoplasia(HGIN)was compared in patients with different grades.Results The detection rate of HGIN in patients with high OLGA grade(13.89%,10/72)was significantly higher than that in patients with low OLGA grade(3.85%,22/571,χ^2=13.618,P<0.001).The detection rate of HGIN in patients with high OLGIM grade(13.41%,11/82)was significantly higher than that in patients with low OLGIM grade(3.74%,21/561,χ^2=14.150,P<0.001).The detection rate of HGIN was further increased in patients with high grade in both OLGA and OLGIM systems[21.21%(7/33)VS 4.10%(25/610),χ^2=19.389,P<0.001].Compared with patients with low grade,the odds ratio of occurrence of HGIN in patients with high grade of OLGA and that with high grade of OLGIM were 2.640(95%CI:1.083-6.439,P=0.033)and 2.747(95%CI:1.156-6.528,P=0.022),respectively,and the odds ratio of patients with high grade in both OLGA and OLGIM was 6.300(95%CI:2.497-15.897,Pv 0.001).Conclusion OLGA and OLGIM systems have a remarkable predictive value for assessment of cancerization risk of chronic atrophic gastritis,and can be used as an important reference for patients to perform magnifying gastroscopy and to make follow-up strategies.