胃粘膜低级别上皮内瘤变内镜下特点及相关因素分析

发布时间：2018-08-30 20:32

【摘要】：目的:分析胃粘膜低级别内瘤变者临床特点、内镜下形态及病理特征,总结其发病特点,为临床工作提供参考,以提高其检出率。方法:回顾性收集2011年1月1日-2013年12月31日在福建省立医院内镜中心行病理活检首次诊断为低级别内瘤变或轻-中度不典型增生的患者,排除病理诊断合并高级别内瘤变、胃癌及其他胃转移性肿瘤者、ESD(endoscopic submucosal dissection)或ERM(endoscopic mucosal resection)术后、残胃患者及资料不全者,共452例LGIN患者纳入研究。收集所有患者的临床资料及内镜下特点,其中包括性别、年龄、Hp感染、病变部位、肉眼形态、胃粘膜肠化及萎缩情况,分析比较它们之间相互关系,并探讨胃粘膜低级别内瘤变合并肠化的危险因素。结果:452例胃黏膜低级别上皮内瘤变患者中男性多于女性,比例1.6:1,年龄以51-60之间最多见(35.6%),各年龄段在性别方面无差异(P0.05);病变好发于远端胃(胃窦、胃角),比例高达85.2%;肉眼下以粗糙糜烂型最多见(38.7%),病变部位及肉眼形态在年龄方面存在差异(P0.05);合并肠化368例(81.4%),粗糙糜烂型肠化率最高,占90.3%,病变部位中,胃角肠化率最高,达95%,不同部位及肉眼形态在肠化方面差异有统计学意义(P0.05);合并萎缩72例(15.9%),其中51-60岁者萎缩率最高(21.1%),部位中贲门胃底阳性率最高(28%),差异有统计学意义(P0.05);Hp阳性者321例(71%),不同部位及肉眼形态中Hp感染率不尽相同,部位中胃体阳性率最高(88.1%),肉眼形态下以溃疡凹陷型感染率最高,占81.5%,差异有统计学意义(P0.05);合并萎缩和肠化者均比无萎缩和肠化者Hp阳性率要高,分别为91.7%和75.8%,差异有统计学意义(P0.05)。通过logistic回归分析发现年龄、部位、病变形态及Hp感染是LGIN合并肠化的危险因素,其中60岁以上者(包括60岁)是50岁以下者肠化风险的2.6倍;肉眼下呈粗糙糜烂型、增生隆起型及溃疡凹陷型病灶者分别是未见明显病灶者肠化风险的9.6倍、7.5倍和6.7倍;胃角、胃窦分别是贲门胃底肠化风险的16倍和4.9倍;HP阳性是Hp阴性者的3.6倍。结论:1.胃粘膜LGIN患者各年龄段在病变部位、肉眼形态、粘膜萎缩方面存在差异;不同病变部位与肉眼形态在肠化、萎缩、Hp感染方面存在差异;肠化、萎缩患者在HP感染方面存在差异。2.年龄、病变部位、肉眼形态、HP感染是LGIN患者合并肠化的危险因素,其中60岁以上者(包括60岁)比50岁以下者,有病灶者比无明显病灶者,胃角、胃窦比贲门胃底、HP阳性比Hp阴性患者合并肠化风险更高。因此内镜医师注意对这部分患者进行活检,可以提高LGIN及肠化检出率,及时随访、干预,降低早癌发生率。
[Abstract]:Objective: to analyze the clinical features, endoscopic morphology and pathological features of patients with low grade gastric mucosal neoplasia, and to summarize the characteristics of gastric mucosal neoplasms, and to provide reference for clinical work in order to improve the detection rate of gastric mucosal neoplasms. Methods: from January 1, 2011 to December 31, 2013, the patients who were first diagnosed as low grade intratumoral neoplasia or mild to moderate atypical hyperplasia in the endoscopic biopsy center of Fujian Provincial Hospital were retrospectively collected, and the pathological diagnosis and high grade intratumoral neoplasia were excluded. Patients with gastric cancer and other metastatic tumors were included in the study after ESD (endoscopic submucosal dissection) or ERM (endoscopic mucosal resection), patients with remnant stomach and incomplete data were included in the study. The clinical data and endoscopic features of all patients were collected, including sex, age, HP infection, lesion location, naked eye shape, intestinal metaplasia and atrophy of gastric mucosa, and the relationship between them was analyzed and compared. To explore the risk factors of low grade gastric mucosal neoplasia associated with intestinal metaplasia. Results among the 452 patients with low grade intraepithelial neoplasia of gastric mucosa, the proportion of male was more than that of female (1.6: 1). The most common age was 51-60 (35.6%), and there was no difference between different age groups (P0.05). The proportion of stomach angle was as high as 85.2%, the gross erosion type was the most common type (38.7%), the pathological position and the naked eye shape had the difference in age (P0.05), 368 cases (81.4%) were associated with intestinal metaplasia, the rate of rough erosive intestinal metaplasia was the highest (90.3%), and the gastric keratosis rate was the highest among the pathological sites. There were significant differences in intestinal metaplasia between different parts and naked eyes (P0.05), 72 cases (15.9%) were complicated with atrophy, the rate of atrophy in 51-60 years old was the highest (21.1%), and the positive rate of gastric fundus in cardia was the highest (28%), the difference was statistically significant (P0.05) in 321 cases with HP positive. (71%) the infection rate of Hp was different in different parts and naked eyes. The positive rate of gastric body was the highest (88.1%), and the infection rate of ulcer concave type was the highest in naked eyes (81.5), the difference was statistically significant (P0.05), the positive rate of Hp in patients with atrophy and intestinal metaplasia was higher than that without atrophy and intestinal metaplasia. 91.7% and 75.8%, respectively, the difference was statistically significant (P0.05). By logistic regression analysis, it was found that age, location, pathological morphology and Hp infection were the risk factors of LGIN complicated with intestinal metaplasia. The risk of intestinal metaplasia in patients over 60 years old (including 60 years old) was 2.6 times higher than that in patients under 50 years old. The risk of intestinal metaplasia in hyperplastic protuberance type and ulcer depression type was 9.6 times, 7.5 times and 6.7 times as much as that in patients without obvious lesions, and the gastric angle and antrum were 16 times and 4.9 times higher than those in cardia and stomach fundus intestinal metaplasia respectively, and the positive rate of HP was 3.6 times higher than that of Hp negative. Conclusion 1. There were differences in pathological site, naked form, mucosal atrophy in different age groups of LGIN patients, intestinal metaplasia and atrophy HP infection in different lesion sites and naked eyes, and differences in HP infection in patients with intestinal metaplasia and atrophy. Age, location of lesion, naked eye morphology and HP infection were risk factors of intestinal metaplasia in patients with LGIN, in which patients over 60 years old (including 60 years old) were more than those under 50 years old, those with lesions were more than those with no obvious lesions, gastric horn. Patients with HP positive gastric antrum were more at risk of intestinal metaplasia than those with Hp negative. Therefore, endoscopic biopsy can improve the detection rate of LGIN and intestinal metaplasia, follow up in time, intervene and reduce the incidence of early cancer.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.2

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