慢性萎缩性胃炎内镜与病理诊断的相关性研究

The correlativity between endoscopic and pathologic diagnosis of chronic atrophic gastritis

目的 探讨中重度慢性萎缩性胃炎 (CAG)的胃镜下表现与病理结果的关系。方法 对4 9例中重度CAG的胃镜下诊断及表现与病理学结果进行相关性研究。结果 病理诊断中重度CAG33例 ,轻度CAG1 0例 ,正常 6例。肠上皮化生 (IM) 2 7例 ,异型增生 30例。中重度CAG的胃镜诊断与病理结果比较肉眼符合率为 6 7 35 %。其中 2 0例患者胃镜下美蓝染色后 ,诊断符合率为80 %。胃镜下表现与病理结果比较 ,胃黏膜的各种表现对CAG的阳性预测值均达到 80 %以上 ,多种表现同时存在对CAG阳性预测值可达 90 %以上 ,其阳性率之间比较无显著差异。各种胃镜下表现的灵敏度及特异度均在 95 %以上。黏膜变薄等表现对IM及异型增生的阳性预测值均较低在 70 %以下 ,灵敏度及特异度在 30 %以下。黏膜粗糙不平对IM及异型增生诊断的灵敏度分别为 92 85 %和83 33% ,特异度也均在 70 %左右。结论 中重度CAG的胃镜下诊断符合率较低 ,但是通过对胃镜下表现的认识以及染色技术的应用 。

Objective To study the endoscopic manifestations of moderate or severe chronic atrophic gastritis (CAG) related to their pathologic diagnosis.Methods The correlation analysis was done between gastroscopic manifestations and pathologic diagnosis of 49 patients with moderate to severe atrophic gastritis.Results Pathologic diagnosis of moderate to severe CAG and mild CAG were conducted in 33 and 10 cases respectively, among them, 27 cases with intestinal metaplasia (IM) and 30 cases with atypical hyperplasia. For moderate to severe CAG under gastroscopy compared with their pathologic diagnosis, the coincidence rate was 67 35%; 20 cases out of them, stained in vivo with methylene blue under gastroscopy, the coincidence rate of diagnosis was 80%. Compared with pathologic diagnosis, the gastroscopic manifestations of gastric mucosa have positive prediction rate more than 80%, when several alterations coexisted, positive prediction rate raised to more than 90%, but for every individual alteration, incidence of positive prediction was not significant. Both sensitivity and specificity of each manifestation under endoscopy were more than 95%. Other manifestations such as gastric mucosa thinning, their positive prediction rates of IM and atypical hyperplasia were less than 70%; their sensitivity and specificity were less than 30%. In using coarse and uneven lumped mucosa as the criteria in diagnosing IM and atypical hyperplasia, the sensitivity was 92 85% and 83 33% respectively, and the specificity was the same (about 70%).Conclusion Coincidence rate of diagnosis under gastroscopy and pathology is quite low in moderate to severe CAG, but the knowledge of gastroscopic manifestation and the staining technique might raise this coincidence rate.