胃黄色瘤与胃癌前期变化相关性的初步研究

发布时间：2018-06-20 03:38

本文选题：胃黄色瘤 + 胃癌　；参考：《浙江大学》2017年硕士论文

【摘要】：背景与目的:胃黄色瘤的临床意义近年来获得越来越多的关注,黄色瘤主要发于胃部,发于食道及十二指肠部相对少见,在胃镜下一般表现为黄色、白色结节样隆起,过去一直认为是一种病因尚不十分明确的胃肠道良性病变。有研究认为胃黄色瘤是预测早期胃癌发展的标志物。本研究目的旨在研究本院近6年来内镜检查中发现胃黄色瘤患者与无胃黄色瘤人群相比,萎缩性胃炎等胃癌前状态及肠上皮化生等胃癌前病变的检出率差异及影响因素,以评估黄色瘤与萎缩性胃炎、肠上皮化生等之间的相关性。方法:选取我院2011年1月1日至2016年11月25日消化内镜下发现胃黄色瘤的患者,其中男性患者448人,女性患者426人。选取同时期来我院行胃镜检查共545名胃镜下未发现黄色瘤患者,其中男性269人,女性276人,记录黄色瘤部位、多发与否、患者年龄、性别等相关变量,比较胃黄色瘤患者与无黄色瘤人群中胃镜活组织病理检查中幽门螺旋杆菌感染、粘膜糜烂、溃疡、萎缩性胃炎、肠上皮化生、上皮内瘤变、胃癌等检出率。相关黏膜损伤诊断均以内镜下活组织检查为准。结果:胃黄色瘤组幽门螺旋杆菌检出率较对照组未见明显升高,两者胃癌检出率亦无明显统计学差异,黄色瘤组与对照组之间性别无明显统计学差异。黄色瘤组年龄显著高于对照组。黄色瘤组与对照组的肠上皮化生发生率存在显著差异。且较于无黄色瘤的对照组,黄色瘤患者发生肠上皮化生的严重程度更高。类似的,黄色瘤患者中萎缩性胃炎的发生率与对照组有显著差异,且萎缩严重程度更高。黄色瘤患者中,黄色瘤以单发于胃窦为主,位于不同部位黄色瘤组间胃癌检出率无明显差异。黄色瘤多发患者肠上皮化生及萎缩性胃炎的发生率与黄色瘤单发患者发生率无显著差异,但是多发患者肠上皮化生及萎缩性胃炎的严重程度均较单发患者更高。结论:黄色瘤患者组幽门螺旋杆菌感染、胃癌等的检出率与正常人群相比并无显著性差异。在进一步的分析中,黄色瘤患者肠上皮化生和萎缩性胃炎的比例及其严重程度都显著高于对照组。黄色瘤患者中,与单发黄色瘤患者相比,多个部位发现黄色瘤的患者中重度肠化比例更高。考虑到肠上皮化生为公认胃癌前病变,而萎缩性胃炎是公认胃癌前状态,内镜下检出胃黄色瘤或可以作为评估病情严重程度的指标,内镜下发现黄色瘤的患者或许更需要行内镜下活检以排除胃癌的可能。
[Abstract]:Background & objective: in recent years, more and more attention has been paid to the clinical significance of gastric xanthoma. Xanthoma mainly occurs in the stomach and is relatively rare in the esophagus and duodenum. It has long been thought of as a benign gastrointestinal disease that is not yet well-defined. Some studies suggest that xanthoma is a marker for early gastric cancer. The purpose of this study was to investigate the differences and influencing factors of gastric precancerous status such as atrophic gastritis and intestinal metaplasia in patients with gastric xanthoma in our hospital during the past 6 years. To assess the correlation between xanthoma and atrophic gastritis, intestinal metaplasia, etc. Methods: from January 1, 2011 to November 25, 2016, we selected 448 male patients and 426 female patients. A total of 545 patients (269 males and 276 females) with xanthoma, including 269 males and 276 females, were examined by gastroscopy in the same period. The location of xanthoma, multiple tumor sites, patient age, sex and other related variables were recorded. To compare the detection rates of helicobacter pylori infection, mucosal erosion, ulcer, atrophic gastritis, intestinal metaplasia, intraepithelial neoplasia and gastric cancer in patients with gastric xanthoma and those without xanthoma. The diagnosis of mucosal injury was based on endoscopic biopsy. Results: the detection rate of Helicobacter pylori in the xanthoma group was not significantly higher than that in the control group, and there was no significant difference in the detection rate of gastric cancer between the two groups, and there was no significant difference in sex between the xanthoma group and the control group. The age of xanthoma group was significantly higher than that of control group. There was significant difference in the incidence of intestinal metaplasia between the xanthoma group and the control group. The severity of intestinal metaplasia in xanthoma patients was higher than that in controls without xanthoma. Similarly, the incidence of atrophic gastritis in xanthoma patients was significantly different from that in the control group, and the severity of atrophy was higher. In xanthoma patients, xanthoma mainly occurred in the antrum, but there was no significant difference in the detection rate of gastric cancer among the xanthoma groups. There was no significant difference in the incidence of intestinal metaplasia and atrophic gastritis between multiple xanthoma patients and single xanthoma patients, but the severity of intestinal metaplasia and atrophic gastritis in multiple cases was higher than that in single cases. Conclusion: the detection rate of Helicobacter pylori infection and gastric cancer in xanthoma patients was not significantly different from that in normal controls. In further analysis, the proportion and severity of intestinal metaplasia and atrophic gastritis in xanthoma patients were significantly higher than those in the control group. In xanthoma patients, the proportion of moderate and severe intestinal metaplasia was higher in patients with xanthoma than in patients with single xanthoma. Considering that intestinal metaplasia is a recognized precancerous lesion and that atrophic gastritis is an accepted pregastric cancer condition, and that the detection of xanthoma by endoscopy may serve as an indicator of the severity of the disease, Patients with endoscopic xanthoma may be more likely to have endoscopic biopsies to rule out stomach cancer.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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