慢性萎缩性胃炎内镜诊断与病理结果对照分析

Contrast analysis of chronic atrophic gastritis under gastroscopy and their pathologic results in 55 cases

目的 探讨胃镜下表现对萎缩性胃炎 (CAG)的诊断价值。方法 对 5 5例内镜诊断的CAG与病理结果进行对照分析 ,分别计算镜下CAG各种表现对病理诊断CAG、肠上皮化生及异型增生的敏感性和特异性。结果 5 5例患者中内镜诊断CAG30例、CAG合并浅表性胃炎 (CSG) 2 5例 ;病理诊断CAG36例、CSG8例、CAG合并CSG1 1例。内镜直视与病理诊断相比较 ,符合率为 85 4 5 %。CAG内镜下的各种表现对病理诊断的敏感性为 1 2 77%～ 5 1 0 6 %。镜下某些表现对CAG的病理诊断有较高的特异性 ,如花斑样改变和扁平隆起分别达 87 5 0 %、75 0 0 % ;白相为主、血管透见伴扁平隆起及花斑样改变伴隆起糜烂的特异性均达 1 0 0 %。镜下粗糙不平、颗粒样改变对诊断肠上皮化生的价值较大 ,其敏感性和特异性分别达 6 6 6 7%、71 74 %。白相为主、血管透见对诊断异型增生的敏感性达 71 74 % ;隆起糜烂对诊断异型增生的特异性达 6 8 89%。结论 胃镜直视下的花斑样改变 ,粗糙不平、颗粒样改变 ,白相为主、血管透见分别对CAG、肠上皮化生、异型增生的病理诊断有较高的价值 。

Objective To study the significances of various gastroscopic findings in chronic atrophic gastritis.Methods To contrastively analyse various findings of CAG under gastroscopic direct vision and their corresponding pathologic diagnosis in 55 cases, and to calculate respectively the sensitivity and specificity of CAG, intestinal metaplasia (IM), atypical hyperplasia (ATP) through various gastroscopic expressions.Results Of the 55 patients CAG 30 cases, CAG and CSG 25 cases were diagnosed by endoscopy; the pathological diagnoses were CAG 36, CSG 8 and CAG plus CSG 11 cases. The coincidence rate of diagnosis between endoscopy and pathology was 85 45%. The sensitivities of gastroscopic findings in CAG to their pathology were about 12 77%～51 06%. Some manifestations in gastroscopy such as piebald change and flat protrusion in CAG have high specificity to pathology about 87 50% and 75 00% respectively. The dominated white phase, prominent vascular pattern with flat protrusion and piebald with erosive protrusion attained the specificity of 100% to the pathology. The asperous and granular changes had higher diagnostic value about IM, its sensitivity and specificity was 66 67% and 71 74% respectively. The dominated white phase and prominent vascular pattern had higher sensitivity, 71 74% in diagnosing ATP. Erosive protrusion had higher specificity, 68 89% in diagnosing ATP.Conclusion Piebald change, asperous and granular changes, dominated white phase and prominent vascular pattern under gastroscopy are highly helpful to the pathological diagnosis of CAG, IM and ATP. But the combination of gastroscopic and pathologic examination is the inevitable procedure in correct diagnosis of CAG, IM, and ATP.