放大内镜在幽门螺杆菌相关性胃炎诊断中的价值

The efficacy of magnifying endoscopy in diagnosis of Helicobacter pylori induced gastritis

目的 研究正常胃黏膜及幽门螺杆菌(Hp)相关性胃炎的放大内镜表现,探讨放大内镜对幽门螺杆菌相关性胃炎的诊断价值。方法66例患者接受电子放大胃镜检查,观察胃体黏膜毛细血管网、胃小凹及集合小静脉,并取活组织行病理检查及进行Hp检测。结果 66例患者中Hp阳性者为36例,阴性者为30例。Hp阳性者中正常胃黏膜者2例,炎症者34例;Hp阴性者中,正常胃黏膜者28例,炎症者2例。Hp阳性者中,Z0型(见集合小静脉、网状真性毛细血管及针眼样的胃小凹)3例,Z1型(集合小静脉消失,毛细血管网正常或失去正常形态,胃小凹可见)8例,Z2型(集合小静脉及真性毛细血管网皆消失,扩张的胃小凹及沟回发白)15例,Z3型(扩张的胃小凹周围发红)10例;Hp阴性者中,Z0为27例,Z1为1例,Z2为2例,Z3为0例。结论 电子放大胃镜下观察到的胃体黏膜集合小静脉、毛细血管网、胃小凹是正常胃黏膜的特征,而它们的消失与变化是Hp相关性胃炎的特征。

Objective To evaluate the efficacy of magnifying endoscopy in diagnosis of Helicobacter pylori induced gastritis. Methods The gastric mucosal capillary networks, gastric pits and collecting venules of the anterior wall or greater curvature of the middle portion stomachs in 66 patients were observed by magnifying endoscopy. Forceps biopsy was taken for histopathological examination and test for Hp. Results Of the 66 patients / Jhe Hp positive and negative cases were 36 and 30 respectively, and normal gastric mucosa was found in 2 and 28 respectively, and the rest cases having mucosal inflammatory lesions. The magnified views of mucosa were classified into 4 types; Z0 collecting venules with true capillary network, and gastric pits resembling pinholes; Z, , gastric pits with irregular true capillaries but no collecting venules observed; Z2 white gastric pits, with neither collecting venules nor true capillaries being seen; Z3 dilated pits with surrounding redness. Of the Hp positive and negative patients cases, the types of Z0 , Z1 , Z2 , and Z3 were 3 , 8 , 15 , 10 and 27, 1,2,0 respectively. Conclusion The magnified feature of collecting venules and true capillaries network with gastric pits in the center (type Z0 ) were the characteristics of the Hp negative normal mucosa, while any changes or disappearance of these feature are the essential feature of Hp related gastritis.