十年间胃镜诊断慢性胃炎差异的临床分析

发布时间：2018-03-30 08:44

本文选题：慢性胃炎　切入点：胃镜　出处：《昆明医科大学》2014年硕士论文

【摘要】：目的：通过分别评估2001年和2011年胃镜和病理组织学对慢性胃炎诊断的差异以及造成两者差异的相关因素,以探讨慢性胃炎胃镜诊断的准确性。方法：分别选取2001和2011年2年中我院消化内镜中心诊断为慢性胃炎的病例,包括胃镜诊断和病理诊断,结合患者性别、年龄及其他实验室检查,分析胃镜与病理诊断的一致性,并分析十年间胃镜和病理诊断慢性胃炎差异的变化。结果： 1.2001年：(1)我院胃镜检查人数5109例,胃镜下诊断慢性胃炎4089例(占胃镜检查总人数的80.04%),其中诊断为慢性非萎缩性胃炎3502例(占慢性胃炎的85.64%),诊断为慢性萎缩性胃炎587例(占慢性胃炎的14.36%)。 (2)胃镜下诊断为慢性非萎缩性胃炎的3502例患者中同时取活组织病理学检查270例(占胃镜下诊断为慢性非萎缩性胃炎的7.71%)：病理诊断为慢性非萎缩性胃炎218例(胃镜与病理诊断慢性非萎缩性胃炎的符合率为80.74%)；诊断为慢性萎缩性胃炎41例；同时存在萎缩和非萎缩者11例,这部分患者诊断为慢性萎缩性胃炎。 (3)胃镜下诊断为慢性萎缩性胃炎的587例患者中同时取活组织病理学检查116例(占胃镜下诊断为慢性萎缩性胃炎的19.76%)：病理诊断为慢性萎缩性胃炎75例；诊断为慢性非萎缩性胃炎34例；同时存在萎缩和非萎缩者7例,这部分患者诊断为慢性萎缩性胃炎(胃镜与病理诊断慢性萎缩性胃炎的符合率为70.69%)。 2011年：(1)我院胃镜检查人数23410例,胃镜下诊断慢性胃炎21100例(占胃镜检查总人数的90.13%),其中诊断为慢性非萎缩性胃炎19324例(占慢性胃炎的91.58%),诊断为慢性萎缩性胃炎1776例(占慢性胃炎的8.42%)。 (2)胃镜下诊断为慢性非萎缩性胃炎患者的19324例患者中同时取活组织病理学检查320例(占胃镜下诊断为慢性非萎缩性胃炎的1.66%)：病理诊断为慢性非萎缩性胃炎289例(胃镜与病理诊断慢性非萎缩性胃炎的符合率为90.31%)；诊断为慢性萎缩性胃炎22例；同时存在萎缩和非萎缩者9例,这部分患者诊断为慢性萎缩性胃炎。 (3)胃镜下诊断为慢性萎缩性胃炎的1776例患者中同时取活组织病理检查256例(占胃镜下诊断为慢性萎缩性胃炎的14.41%)：病理诊断为慢性萎缩性胃炎176例；诊断为慢性非萎缩性胃炎70例；同时存在萎缩和非萎缩者10例,这部分患者诊断为慢性萎缩性胃炎(胃镜与病理诊断慢性萎缩性胃炎的符合率为72.66%)。较十年前：(1)胃镜检查人数明显增多,慢性胃炎的胃镜下诊断率从80.04%增加至90.13%,P0.01。 (2)慢性非萎缩性胃炎的胃镜下诊断率明显增加：由2001年的85.64%增加到2011年的91.58%,P0.01。慢性萎缩性胃炎的胃镜下诊断率较前下降：由2001年的14.36%减少到2011年的8.42%,P0.01。 (3)慢性非萎缩性胃炎的内镜诊断与病理诊断符合率提高了约10%,P0.01,差异有统计学意义,但慢性萎缩性胃炎的内镜诊断与病理诊断符合率无明显变化,P0.05。 (4)胃镜下诊断为慢性非萎缩性胃炎患者取活组织病理检查人数的比例明显降低：由2001年的7.71%(270/3502)降至1.66%(320/19324),P0.01。胃镜下诊断为慢性萎缩性胃炎患者取活组织病理检查人数比例亦明显降低,由2001年的19.76%(116/587)降至14.41%(256/1776),P0.01 2.慢性胃炎诊断率与患者性别及年龄的关系： (1)2001年4089例胃镜诊断为慢性胃炎患者中,患病男女比例为1.67：1,2011年21100例胃镜诊断为慢性胃炎患者中,患病男女比例为1.60：1,两数值比较,差异不明显,P0.05。 (2)在2001年或2011年同一年中,随着年龄增加,慢性萎缩性胃炎胃镜下诊断率逐渐升高,45岁以上者,慢性萎缩性胃炎诊断率升高明显,P0.05。 (3)2011年年龄小于45岁慢性胃炎患者中,慢性萎缩性胃炎的诊断率明显高于2001年,P0.01；大于45岁慢性胃炎患者中,慢性萎缩性胃炎的诊断率明显低于2001年,.P0.01。 3.慢性萎缩性胃炎的发生部位及镜下改变结果分析： (1)2001年或2011年慢性萎缩性胃炎好发部位主要以胃窦为主,分别占71.64%(96/134)和80.65%(175/217)。 (2)2001年或2011年同一年中诊断为慢性萎缩性胃炎的患者中,全胃发生萎缩概率低,,较少见。 (3)2011年诊断为慢性萎缩性胃炎患者胃窦及胃体伴糜烂者较2001年增加,P0.05。 4.病理学改变结果分析 (1)2001年或2011年慢性胃炎的病理特点以炎症活动为主,分别占61.66%(238/386)和54.86%(316/576) (2)2001年或2011年同一年慢性胃炎的患者中病理诊断为肠化生的比例低,分别占3.63%(14/386)和7.47%(43/576),其发生率低。 (3)2011年慢性胃炎的患者中病理诊断为炎症活动性的比例明显低于2001年,P0.05。而病理诊断为肠化生的比例明显高于2001年,P0.05。结论： 1.与十年前比较,慢性胃炎胃镜诊断率明显增加,与性别无关；慢性萎缩性胃炎与患者年龄密切相关,呈正相关变化。 2.十年间胃镜诊断慢性非萎缩性胃炎明显增多,与人们保健意识增强,体检人数增多及胃镜中心总检查病例大幅增加有关。 3.与十年前比较,慢性胃炎胃镜诊断与病理诊断一致性有所提升,尤其在慢性非萎缩性胃炎的诊断方面,两者一致性较好。 4.胃镜发现慢性胃炎伴糜烂者可视为活动性胃炎,应结合临床症状给予治疗。 5.虽然胃镜可准确诊断慢性胃炎,尤其是慢性非萎缩性胃炎,但结合病理诊断仍然十分重要。初诊慢性萎缩性胃炎病例时应结合病理诊断。 6.建议统一使用慢性非萎缩性胃炎和慢性萎缩性胃炎统一命名慢性胃炎。
[Abstract]:Objective : To evaluate the accuracy of the diagnosis of chronic gastritis by evaluating the difference of gastric and pathological histology in the diagnosis of chronic gastritis in 2001 and 2011 , respectively .

Methods : The cases of chronic gastritis diagnosed by the digestive endoscopy center of our hospital in 2001 and 2011 were selected , including the diagnosis of gastroscopic diagnosis and pathological diagnosis , combined with the sex , age and other laboratory tests of the patients , and analyzed the consistency of the gastroscopic and pathological diagnosis , and analyzed the changes of the difference of the gastroscopic and pathological diagnosis of chronic gastritis in ten years .

Results :

1 . In 2001 : ( 1 ) The number of gastroscopic examination in our hospital was 5109 cases , chronic gastritis was 4089 cases ( 80.04 % of the total number of gastroscopes ) in our hospital . Among them , 3502 cases of chronic non - atrophic gastritis ( 85.64 % of chronic gastritis ) were diagnosed , 587 cases of chronic atrophic gastritis ( 14.36 % of chronic gastritis ) were diagnosed .

( 2 ) In 3502 patients with chronic non - atrophic gastritis diagnosed by endoscopy , 270 cases ( 7.71 % of chronic non - atrophic gastritis were diagnosed as chronic non - atrophic gastritis ) were diagnosed as chronic non - atrophic gastritis : the pathological diagnosis was 218 cases of chronic non - atrophic gastritis ( 80 . 74 % of gastroscopic and pathological diagnosis of chronic non - atrophic gastritis ) ;
41 cases of chronic atrophic gastritis were diagnosed ;
There were 11 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis .

( 3 ) Of 587 patients diagnosed with chronic atrophic gastritis , 116 cases ( 19.76 % of chronic atrophic gastritis were diagnosed by endoscopy ) were diagnosed as chronic atrophic gastritis , and 75 cases of chronic atrophic gastritis were diagnosed by pathology .
34 cases of chronic non - atrophic gastritis were diagnosed .
There were 7 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis ( the coincidence rate of gastroscopic and pathological diagnosis of chronic atrophic gastritis was 70.69 % ) .

In 2011 : ( 1 ) The number of gastroscopic examination in our hospital was 23410 cases , and chronic gastritis 21100 cases ( 90.13 % of the total number of gastroscopes ) were diagnosed in our hospital . Among them , 19324 cases of chronic non - atrophic gastritis ( 91.58 % of chronic gastritis ) were diagnosed , and 1776 cases of chronic atrophic gastritis were diagnosed ( 8.42 % of chronic gastritis ) .

( 2 ) In 19324 patients with chronic non - atrophic gastritis diagnosed by endoscopy , 320 cases ( 1 . 66 % of chronic non - atrophic gastritis were diagnosed as chronic non - atrophic gastritis ) were diagnosed as chronic non - atrophic gastritis : 289 cases were diagnosed as chronic non - atrophic gastritis ( the coincidence rate of gastroscopic and pathological diagnosis of chronic non - atrophic gastritis was 90.31 % ) ;
22 cases of chronic atrophic gastritis were diagnosed ;
At the same time , there were 9 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis .

4 . Gastroscopy shows that chronic gastritis with erosion can be regarded as active gastritis and should be treated in combination with clinical symptoms .
70 cases of chronic non - atrophic gastritis were diagnosed .
There were 10 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis ( the coincidence rate of gastroscopic and pathological diagnosis of chronic atrophic gastritis was 72.66 % ) .

Ten years ago : ( 1 ) The number of gastroscopic examination increased significantly , and the diagnostic rate of gastroscopic diagnosis of chronic gastritis increased from 80.04 % to 90.13 % , P0.01 .

( 2 ) The diagnostic rate of gastroscopic diagnosis of chronic atrophic gastritis increased significantly : from 85.64 % in 2001 to 91.58 % in 2011 , P0.01 . The rate of diagnosis of chronic atrophic gastritis decreased from 14.36 % in 2001 to 8.42 % in 2011 , P0.01 .

( 3 ) The coincidence rate of endoscopic diagnosis and pathological diagnosis of chronic atrophic gastritis increased by about 10 % , P0.01 , but there was no significant difference between the endoscopic diagnosis and pathological diagnosis of chronic atrophic gastritis ( P0.05 ) .

( 4 ) The proportion of pathological examination of biopsy in patients with chronic non - atrophic gastritis decreased significantly from 7.71 % ( 270 / 3502 ) in 2001 to 1.66 % ( 320 / 19324 ) , P0.01 . The proportion of pathological examination of biopsy in patients with chronic atrophic gastritis decreased significantly from 19.76 % ( 116 / 587 ) in 2001 to 14.41 % ( 256 / 1776 ) , P0.01 .

2 . The relationship between the diagnosis rate of chronic gastritis and the sex and age of the patient :

( 1 ) In 2001 , 4089 cases of gastroscopic diagnosis were diagnosed as chronic gastritis , the proportion of men and women was 1.67 : 1 . In 21100 cases of chronic gastritis in 2011 , the proportion of male and female was 1.60 : 1 , the difference was not obvious , P0.05 .

( 2 ) In the same year of 2001 or 2011 , with the increase of age , the diagnostic rate of chronic atrophic gastritis increased gradually , and the diagnostic rate of chronic atrophic gastritis increased obviously after 45 years of age , and the diagnosis rate of chronic atrophic gastritis increased obviously , P0.05 .

( 3 ) In patients with chronic gastritis aged less than 45 years of age in 2011 , the diagnosis rate of chronic atrophic gastritis was significantly higher than that in 2001 , P0.01 ;
In patients with chronic gastritis over 45 years of age , the diagnosis rate of chronic atrophic gastritis was significantly lower than that in 2001 . P0.01.

3 . Analysis of the incidence part of chronic atrophic gastritis and the results of the change in the mirror :

( 1 ) The incidence of chronic atrophic gastritis in 2001 or 2011 was mainly by gastric antrum , accounting for 71.64 % ( 96 / 134 ) and 80.65 % ( 175 / 217 ) , respectively .

( 2 ) In the patients diagnosed as chronic atrophic gastritis in the same year of 2001 or 2011 , the incidence of gastric atrophy in the whole stomach was low , and it was rare .

( 3 ) In 2011 , the diagnosis of chronic atrophic gastritis with gastric antrum and gastric body with erosion increased in 2001 , P0.05 .

4 . Analysis of pathological changes

( 1 ) The pathological characteristics of chronic gastritis in 2001 or 2011 were mainly inflammatory activities , accounting for 61.66 % ( 238 / 386 ) and 54.86 % ( 316 / 576 ) , respectively .

( 2 ) In the patients with chronic gastritis in 2001 or 2011 , the proportion of the patients with chronic gastritis was low , accounting for 3.63 % ( 14 / 386 ) and 7.47 % ( 43 / 576 ) , respectively .

( 3 ) The proportion of pathological diagnosis in patients with chronic gastritis in 2011 was significantly lower than that in 2001 ( P0.05 ) .

CsA could cause PLT to decrease ;

1 . Compared with ten years ago , the diagnostic rate of gastroscopic diagnosis of chronic gastritis increased significantly , which was not related to sex ;
Chronic atrophic gastritis is closely related to the age of the patient and is positively correlated .

2 . Chronic non - atrophic gastritis was significantly increased in 10 years , which was related to the increasing awareness of health care , the increase of physical examination and the increase of total examination cases in the center of the gastroscopic examination .

3 . Compared with ten years ago , the diagnosis and pathological diagnosis of chronic gastritis were improved , especially in the diagnosis of chronic non - atrophic gastritis .

( 3 ) In 1776 patients with chronic atrophic gastritis , 256 cases ( 14.41 % of chronic atrophic gastritis were diagnosed by endoscopy ) were diagnosed as chronic atrophic gastritis , 176 cases of chronic atrophic gastritis were diagnosed by pathology .

5 . Although the gastric mirror can accurately diagnose chronic gastritis , especially chronic non - atrophic gastritis , it is still very important in combination with pathological diagnosis . It should be combined with pathological diagnosis in case of chronic atrophic gastritis .

6 . It is recommended to use the unified nomenclature of chronic atrophic gastritis and chronic atrophic gastritis to name chronic gastritis .

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573.3

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