胃黏膜上皮细胞异型增生的随访研究

The long term follow-up study on the evolution of gastric epithelial dysplasia

目的 探讨胃黏膜上皮细胞异型增生自然演变的规律及其在胃癌形成中的作用,为临床处理异型增生病灶提供依据和初步方法。方法 回顾性研究16年来50岁以上患者的胃镜检查结果,分析不同程度的异型增生的变化规律和可能的影响因素。结果4354例患者共检出胃黏膜上皮细胞异型增生239例(261个病灶),其中轻度异型增生119例(病灶131个),中度异型增生77例(病灶83个),重度异型增生43例(病灶47个)。异型增生病灶主要沿胃小弯侧分布。异型增生病灶外观各异,以局灶糜烂为最常见,133个(50.96％),其次为局部充血50个(19.16％),溃疡26个(9.96％),正常黏膜外观24个(9.20％)。进行了完整随访的195例患者,轻度异型增生病变消失率最高,达86.36％,但也有8.18％检出胃癌;重度异型增生癌检出率最高,达72.09％,但也有23.26％发生了逆转,中度异型增生的消失率和癌检出率则居于前两者之间。轻度、中度、重度异型增生中癌检出率的相对危险度分别为1.96、3.74、17.25。结论 不同程度的异型增生均有一定的癌变能力,以重度异型增生的癌变率为最高。对不同程度的异型增生的处理上均要积极,同时也要注意区别对待。

Objective To assess the evolution of gastric epithelial dysplasia (GED). Methods We reviewed the history of 239 of patients with gastric dysplasia diagnosed by endoscopic biopsy, and 195 were followed up for 61. 37 months. Results Among 239 cases of dysplasia (261 lesions) , there were 119, with mild dysplasia, 77 with moderate dysplasia, and 43 with severe dysplasia. The gastric dysplasia lesions are mainly in lesser curvature, and its endoscopic appearance mostly is localized erosion. In the follow - up group, regression of dysplasia was demonstrated in 86. 36% , 81. 25% , and 47. 62% of mild, moderate and severe dysplasia respectively. Progression to gastric cancer was detected in 8. 18% , 15. 63% , and 72. 09% of mild, moderate, and severe dysplasia, respectively. The relative risk (RR) of mild, moderate, severe dysplasia was 1. 96, 3. 74, and 17. 25 respectively. Conclusion Carcinomatous evolution of GED increases proportionally with its histological grade. Gastroscopy biopsy follow-up should be held up for all grades of GED, especially, in high grade GED, gastroscopy and biopsy should be taken as soon as possible.