基于早期诊断胃癌目的的慢性胃炎评估

发布时间：2018-05-04 17:02

本文选题：慢性胃炎 + 萎缩　；参考：《青岛大学》2016年博士论文

【摘要】：目的胃癌是我国发病率仅次于肺癌居第二位的肿瘤,是一项沉重的公共卫生负担,目前我国大多数胃癌诊断时已是进展期胃癌。早期胃癌大多数可通过内镜切除得到治愈,使患者的生活质量得到大幅度提高,也减轻了医疗费用。为了人民群众的健康,消化内镜医生应该以发现早期胃癌为目的,提高中国早期胃癌诊断率。早期胃癌的发现首先要发现高危的背景粘膜,高危的背景粘膜包括慢性萎缩性胃炎和幽门螺旋杆菌感染。本研究旨在白光内镜下快速的对慢性胃炎进行评估,评价患者慢性萎缩性胃炎的萎缩程度及是否有幽门螺旋杆菌感染。本研究包括三部分,内镜下萎缩程度与组织学萎缩程度的一致性、幽门螺旋杆菌感染的内镜特征、黄色瘤与胃癌的相关性。方法选取256名因消化道症状行胃镜检查的患者,行13C呼气试验检测Hp,检测血清胃蛋白酶原PGⅠ、PGⅡ。胃镜检查过程中根据内镜下萎缩范围按木村-竹本分类分级,按新悉尼胃炎分类系统于胃体中部小弯、大弯、胃角、胃窦小弯、大弯取活检,根据病理结果按可操作的与胃癌风险联系的胃炎评估(operative link for gastritis assessment,OLGA)分期。评价血清学检测胃蛋白酶原PGⅠ、PGⅡ与内镜下萎缩程度及OLGA分期的相关性;评价内镜下萎缩程度分级即木村-竹本分类和组织学萎缩程度的分期即OLGA分期的相关性。通过C13呼气试验检测患者是否有幽门螺旋杆菌感染,并通过内镜组织活检行特殊染色检测幽门螺旋杆菌感染。内镜下观察是否有以下内镜表现:胃体黏液附着、弥漫性充血、胃体底黏膜斑点样充血、斑片状发红、皱襞肿胀、粘膜水肿、规则排列的集合静脉(regular arrangement of collecting venules,RAC)、红色纵行条纹、黄色瘤、胃底腺息肉、增生性息肉、胃溃疡、十二指肠溃疡、糜烂。分析上述内镜下表现与幽门螺旋杆菌感染的关系。集合静脉分为3型即R型、I型及D型,统计分析上述3型集合静脉与幽门螺旋杆菌的关系。选取2015年3月至2015年9月在青岛大学附属医院接受胃镜检查的患者,排除严重心肝肾疾病、长期使用非甾体抗炎药、胃切除术以及胃ESD术后患者,共有8410例入选,所有患者均经胃镜检查活检取病理。胃黄色瘤诊断标准以胃镜加病理组织学检查为依据。检测出胃黄色瘤患者187例,将所有入组患者分为两组:胃黄色瘤组、非胃黄色瘤组,回顾性分析两组患者的性别、年龄、胃萎缩的严重程度、胃黄色瘤的存在情况(数目、大小、位置)、胃癌的存在情况以及各种临床病理特征(HP、肠化、不典型增生、癌前病变),并探讨胃黄色瘤与上述因素之间的关系。检测出胃癌患者426例,将所有入组患者分为胃癌组、非胃癌组,回顾性分析两组患者性别、年龄、HP感染情况、胃黄色瘤存在情况,并探讨胃癌与上述因素之间的关系,尤其是与胃黄色瘤之间的关系。结果256名患者中男性123名,女性133名,平均年龄58.0岁,其中幽门螺旋杆菌感染者113名。内镜下萎缩程度评估木村-竹本分类与组织学萎缩程度OLGA分期有较高的一致性,加权Kappa系数为0.82。同时随着木村-竹本分类萎缩程度的进展PGⅠ/PGⅡ比值明显下降(R2=0.834,P0.001)。胃体黏液附着、弥漫性充血、胃体底黏膜斑点样充血、斑片状发红、皱襞肿胀、粘膜水肿及RAC的I型和D型对Hp感染有较高的敏感度、特异度、阳性预测值和阴性预测值;RAC的R型、胃底腺息肉对无Hp感染有较高的敏感度、特异度、阳性预测值和阴性预测值。在8410例患者中,检测出胃黄色瘤患者187例(2.2%)。病变可发生在贲门、胃底、胃体、胃角、胃窦,以胃窦(51.3%)最为多见,可单发或多发,以单发(63.1%)更常见。与年龄≥50岁、性别无统计学差异(P0.05),说明胃黄色瘤与年龄≥50岁无明显相关性;与开放型萎缩性胃炎、肠化、不典型增生、HP感染、胃癌的存在呈显著相关性(分别为P0.005,P0.005,P0.025,P0.005,P0.005)。在所有入组患者中检查测出胃癌患者426例,与年龄≥50岁、性别无统计学差异(P0.05),说明胃癌与年龄≥50岁、性别无明显相关性;与HP感染、胃黄色瘤的存在呈显著相关性(分别为P0.005,P0.005)。结论内镜下萎缩程度评估木村-竹本分类与组织学萎缩程度OLGA分期有较高的一致性,可预测组织学萎缩程度。PGⅠ/PGⅡ比值与木村-竹本分类萎缩程度分级有相关性。胃体黏液附着、弥漫性充血、胃体底黏膜斑点样充血、斑片状发红、皱襞肿胀、粘膜水肿及集合静脉的I型和D型提示Hp感染,而集合静脉的R型、胃底腺息肉则提示无Hp感染。胃黄色瘤发生在全胃,以胃窦最为多见,可单发或多发,以单发更常见,直径大小不一,多为2~6mm;胃黄色瘤的发生与开放型萎缩性胃炎、肠化、不典型增生、幽门螺旋杆菌感染、胃癌的存在相关性,这些因素可能是易发生本病的危险因素;幽门螺旋杆菌感染阳性为胃黄色瘤发生的危险因素胃黄色瘤与胃癌存在相关性,可作为胃癌的存在一个预警信号。
[Abstract]:Objective gastric cancer is the second highest incidence of lung cancer in China. It is a heavy public health burden. At present, most of the gastric cancer in our country is diagnosed as advanced gastric cancer. Most of the early gastric cancer can be cured by endoscopic excision, so that the quality of life of the patients is greatly improved and the medical cost is reduced. The health of the people, digestive endoscopes should aim at the discovery of early gastric cancer to improve the diagnosis rate of early gastric cancer in China. First of all, the early gastric cancer should find the high-risk background mucosa, and the high-risk background mucosa includes chronic atrophic gastritis and Helicobacter pylori infection. Assessment of the degree of atrophy of chronic atrophic gastritis in patients and whether there were Helicobacter pylori infection. This study included three parts, the consistency of the degree of atrophy and the degree of histologic atrophy, the endoscopic characteristics of Helicobacter pylori infection, and the correlation between xanthoma and gastric cancer. Methods 256 patients with digestive tract symptoms were selected for gastroscopy. The patients were examined by 13C breath test to detect Hp and detect serum pepsinogen PG I, PG II. In the process of gastroscopy, the range of atrophy of the gastroscopy was classified according to the wooden village and bamboo classification according to the endoscopic atrophy, according to the new Sydney gastritis classification system at the small bend in the middle of the stomach body, the big bend, the stomach angle, the antrum sinuses, and the large bend, and the operation and the risk of gastric cancer according to the pathological results. The associated gastritis assessment (operative link for gastritis assessment, OLGA) staging. The correlation of serological detection of pepsinogen PG I, PG II to endoscopic atrophy and OLGA staging; evaluation of the degree of atrophy of the endoscopy, namely, the correlation of the wooden village bamboo classification and the histopathological stage of the histologic atrophy, namely, the OLGA staging. The patients were tested for Helicobacter pylori infection and detected Helicobacter pylori infection by endoscopic biopsy. Endoscopic findings were observed under endoscopy: gastric mucous adhesion, diffuse congestion, speckle like congestion, flaky redness, plica swelling, mucous membrane edema, and regular arrangement of the gastric body Regular arrangement of collecting venules (RAC), red longitudinal stripes, xanthoma, gastric fundus adeno polyp, hyperplastic polyp, gastric ulcer, duodenal ulcer, erosion. Analysis of the relationship between the above endoscopy and Helicobacter pylori infection. The collection vein is divided into 3 types, R, I and D, and the 3 types of collecting veins are analyzed and analyzed. The relationship between Helicobacter pylori, selected patients receiving gastroscopy at the Affiliated Hospital of Qiingdao University from March 2015 to September 2015, excluding serious heart and kidney disease, long term use of NSAIDs, gastrectomy and gastric ESD patients, 8410 cases were selected, all patients were examined by gastroscopy and biopsy. 187 patients with gastric xanthoma were detected by gastroscopy and histopathological examination. All the patients were divided into two groups: Gastric xanthoma group and non gastric yellowish tumor group. The sex, age, the severity of gastric atrophy, the presence of gastric yellowish tumor (number, size, location), the existence of gastric cancer, and the existence of gastric cancer in two groups were analyzed. The relationship between the clinicopathological features (HP, intestinal metaplasia, atypical hyperplasia, precancerous lesions) and the relationship between the gastric xanthoma and the above factors was investigated. 426 cases of gastric cancer were detected. All the patients were divided into gastric cancer group and non gastric cancer group. The sex, age, HP infection, the existence of gastric yellowish tumor, and the discussion of gastric cancer and the above mentioned above were reviewed. The relationship between factors, especially the relationship with gastric yellowish tumor. Results 256 of the 256 patients were male 123, female 133, average age 58 years, of which 113 were Helicobacter pylori infection. Endoscopic atrophy assessment of the Kimura bamboo classification and histologic atrophy had a higher consistency, and the weighted Kappa coefficient was 0.82. The PG I /PG II ratio decreased significantly (R2=0.834, P0.001) with the progress of the atrophy of the wooden village and bamboos. The adherence of the gastric body mucus, diffuse hyperemia, speckle pattern of the gastric body, flaky red, folds swelling, mucous membrane edema, and RAC I and D have higher sensitivity, specificity, positive predictive value and negative predictive value for Hp infection. RAC R type, gastric fundus polyp has high sensitivity, specificity, positive predictive value and negative predictive value for no Hp infection. In 8410 patients, 187 cases (2.2%) of gastric xanthoma were detected. The lesions can occur in the cardia, the fundus of the stomach, the body of the stomach, the angle of the stomach, the antrum, and the antrum (51.3%), single or multiple, more common with single hair (63.1%). There was no significant difference in sex between age and age (P0.05), indicating that there was no significant correlation between gastric xanthoma and age over 50 years, and there was a significant correlation with the presence of open atrophic gastritis, intestinal metaplasia, atypical hyperplasia, HP infection and gastric cancer (P0.005, P0.005, P0.025, P0.005, P0.005). 426 cases of gastric cancer were detected in all the patients, and 426 cases of gastric cancer were detected, There was no statistical difference between age and age (P0.05), and there was no significant difference in sex (P0.05). There was no significant correlation between gastric cancer and age 50 years old. There was a significant correlation between the existence of HP infection and the existence of gastric yellowish tumor (P0.005, P0.005). Conclusion the assessment of the degree of atrophy of Kimura - Bamboo under endoscopic atrophy has a high consistency with the degree of histologic atrophy in OLGA staging. The ratio of.PG I /PG II to the degree of atrophy of the weave was correlated with the classification of the atrophy degree of Kimura bamboo classification. The adhesion of gastric body mucus, diffuse congestion, speckle pattern of gastric body fundus, patchy redness, folds swelling, mucous membrane edema and I type and D type of collecting vein suggestive of Hp infection, and R of collecting veins, and gastric fundus gland polyps suggesting no Hp infection. Gastric xanthoma occurs in the whole stomach, most common in the gastric antrum, single or multiple, more common with single hair, different in diameter, and more 2~6mm; the occurrence of gastric yellowish tumor is related to open atrophic gastritis, intestinal metaplasia, atypical hyperplasia, Helicobacter pylori infection, and gastric cancer. These factors may be a risk factor for this disease; pylorus may be a risk factor for this disease; pylorus Helicobacter pylori infection is a risk factor for gastric xanthoma. Gastric xanthoma is associated with gastric cancer. It can be used as an early warning signal for the existence of gastric cancer.

【学位授予单位】：青岛大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R735.2;R573.3

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