放大内镜在早期胃癌及癌前病变诊断中的价值研究
发布时间：2019-06-14 03:39
【摘要】：背景:胃癌是起源于胃黏膜上皮的恶性肿瘤,是最常见的恶性肿瘤之一,据2006年全国肿瘤登记地区统计,我国胃癌的发病率和死亡率分别为35.02/10万和26.08/10万,均位于所有肿瘤的前三位,给人民健康带来严重危害。大量研究表明,早期胃癌及癌前病变内镜诊治是未来肿瘤防治的重要战略措施之一,应引起我们的高度重视。目的:本文旨在探讨靛胭脂联合放大内镜(magnifying endoscopy combined indigo carmine,ME-IDC)、冰醋酸联合放大内镜(magnifying endoscopy combined acetic acid,ME-AA)及窄带成像联合放大内镜(magnifying endoscopy combined narrow-band imaging,ME-NBI),在癌前病变和早期胃癌筛查中的诊断价值。方法:对2014年12月至2016年3在月郑州大学人民医院消化内镜中心就诊人群进行前瞻性病例对照研究,胃镜下或既往检查发现有可疑病灶并自愿同意加入该研究的81例患者,随机分为ME-IDC、ME-AA及ME-NBI三组。术中选择活检部位进行取材送检,由病理科专人统一阅片,比较三组炎症、肠上皮化生、低级别上皮内瘤变、早期胃癌和阳性病变检出率,及依据VS标准的内镜诊断与病理诊断敏感度、特异度和准确度的比较,从而评价其临床应用价值。结果:1、81例患者的胃黏膜病变部位分布,其中18例(22.22%)位于上1/3胃,15例(18.51%)位于中1/3胃,46例(59.26%)位于下1/3胃。2、三组病例的炎症检出率分别为ME-IDC组6例(21.43%)、ME-AA组10例(33.33%)及ME-NBI组10例(43.48%),差异没有统计学意义(χ~2=2.850,P=0.2400.05)。三组病例的肠上皮化生病变检出率分别为ME-IDC组11例(39.29%)、ME-AA组6例(20.00%)及ME-NBI组8例(34.78%),差异没有统计学意义(χ~2=2.124,P=0.3460.05)。三组病例的LGIN病变检出率分别为ME-IDC组5例(17.86%)、ME-AA组6例(20.00%)及ME-NBI组1例(4.34%),差异没有统计学意义(χ~2=3.029,P=0.2200.05)。三组病例的早期胃癌病变检出率分别为ME-IDC组6例(21.43%)、ME-AA组8例(26.67%)及ME-NBI组4例(17.39%),差异没有统计学意义(χ~2=0.664,P=0.7180.05)。本研究将LGIN和早期胃癌纳入阳性病变,三组病例的阳性病变检出率分别为ME-IDC组11例(39.29%)、ME-AA组14例(46.67%)及ME-NBI组5例(21.74%),,差异没有统计学意义(χ~2=3.562,P=0.1680.05)。3、以活检组织的病理结果作为诊断早期胃癌的金标准,分别对ME-IDC、ME-AA和ME-NBI三组内镜下诊断结果进行分析。ME-IDC、ME-AA及ME-NBI内镜下诊断早期胃癌的敏感度分别为50.00%、77.78%、100%,差异没有统计学意义(χ~2=3.242,P=0.2860.05)。ME-IDC、ME-AA及ME-NBI内镜下诊断早期胃癌的特异度分别为59.09%、85.71%、89.47%,差异没有统计学意义(χ~2=6.633,P=0.0540.05)。ME-IDC、ME-AA及ME-NBI内镜下诊断早期胃癌的准确度分别为57.14%、83.33%、91.30%,差异有统计学意义(χ~2=9.473,P=0.0090.05)。进而作三组间的两两比较,ME-AA及ME-NBI对早期胃癌诊断的准确度均高于ME—IDC,差异有统计学意义(χ~2=4.795,P=0.0290.05,χ~2=7.399,P=0.0070.05)。而ME-AA与ME-NBI对早期胃癌诊断的准确度相似(83.33%vs 91.30%),差异没有统计学意义(χ~2=0.722,P=0.6850.05)。结论:1、胃黏膜病变所在部位的比例,下1/3胃较高,内镜医师在胃镜检查操作中应重点观察防止遗漏;2、ME-NBI、ME-IDC和ME-AA均是检出早期胃癌和癌前病变的有效手段,因其对炎症、炎症、肠上皮化生、低级别上皮内瘤变、早期胃癌和阳性病变检出率之间的差异无统计学意义,各地门诊胃镜筛查可据内镜中心实际情况选用检查方法;3、以活检组织的病理结果作为诊断早期胃癌的金标准,分别对ME-IDC、ME-AA和ME-NBI三组内镜下诊断结果进行分析,三组间敏感度和特异度之间的差异无统计学意义。ME-NBI及ME-AA诊断早期胃癌的准确度,两组间无差异,但与ME-IDC相比均显著升高。ME-NBI及ME-AA应用VS诊断标准可以显著提高早期胃癌内镜下诊断的准确性,并引导靶向活检,是一种简便、有效的早期胃癌诊断方法。
[Abstract]:BACKGROUND: Gastric cancer is one of the most common malignant tumors, which is one of the most common malignant tumors. The incidence and mortality of gastric cancer in our country are 35.02/ 100,000 and 26.08/ 100,000 respectively, which are located in the first three positions of all the tumors, according to the 2006 National Cancer Registration Area. And bring serious harm to the people's health. A large number of studies have shown that the diagnosis and treatment of early gastric cancer and precancerous lesions is one of the important strategic measures for the prevention and treatment of the future. Objective: To study the diagnostic value of the combined magnifying endoscopy (ME-IDC), glacial acetic acid combined with endoscopy (ME-AA) and narrow-band imaging combined with endoscopic (ME-NBI) in the screening of precancerous lesions and early gastric cancer. Methods: From December 2014 to March,2016, a prospective case-control study was conducted in the patients of the digestive endoscopy center of the People's Hospital of Zhengzhou University from December 2014 to March,2016, and the patients with suspected lesions and who voluntarily agreed to join the study were randomly divided into three groups: ME-IDC, ME-AA and ME-NBI. During the operation, the biopsy site was selected for sampling, and the pathological department was specially assigned to the examination sheet to compare three groups of inflammation, intestinal metaplasia, low-grade intraepithelial neoplasia, early gastric cancer and positive lesion detection rate, and the diagnostic and pathological diagnosis sensitivity of the endoscope according to the VS standard. The specificity and the accuracy are compared, so that the clinical application value is evaluated. Results:1,81 patients with gastric mucosal lesion,18 (22.22%) were located in 1/3 of the stomach,15 (18.51%) were located in 1/3 of the stomach,46 (59.26%) were located in the lower 1/3 of the stomach, and the rate of inflammation in the three groups was 6 (21.43%) in the ME-IDC group, respectively. 10 (33.33%) of the ME-AA group and 10 (43.48%) of the ME-NBI group were not statistically significant (P = 2.850, P = 0.240.05). The positive rate of intestinal metaplasia in the three groups was 11 (39.29%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 8 (34.78%) in the ME-NBI group (P = 0.3460.05). The positive rate of LGIN in three groups was 5 (17.86%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 1 (4.34%) in the ME-NBI group (P = 0. 2200.05). The positive rate of early gastric cancer in three groups was 6 (21.43%) in the ME-IDC group,8 (26.67%) in the ME-AA group and 4 (17.39%) in the ME-NBI group (P = 0.664, P = 0.71805). In this study, the positive rate of LGIN and early gastric cancer was included in 11 (39.29%) of the ME-IDC group,14 (46.67%) in the ME-AA group and 5 in the ME-NBI group (21.74%), and the difference was not statistically significant (1-2 = 3.562, P = 0.1680.05). The diagnosis results of the three groups of ME-IDC, ME-AA and ME-NBI were analyzed by the pathological results of the biopsy tissue as the gold standard for the diagnosis of early gastric cancer. The sensitivity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 50.00%, 77.78% and 100%, respectively. The specificity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 59.09%, 85.71% and 89.47%, respectively. The accuracy of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 57.14%, 83.33% and 91.30%, respectively (P-2 = 9.473, P = 0.0090.05). In addition, the accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was higher than that of ME-IDC, and the difference was statistically significant (P = 4.795, P = 0.0290.05, HCO3-2 = 7.399, P = 0.0070.05). The accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was similar (83.33% vs 91.30%), and there was no significant difference between ME-AA and ME-NBI (P = 0.722, P = 0.6850.05). Conclusion:1. The proportion of the part where the gastric mucosa lesion is located, the lower 1/3 of the stomach is high, the endoscope doctor should focus on the prevention of the omission in the operation of gastroscopy,2, ME-NBI, ME-IDC and ME-AA are the effective means to detect early gastric cancer and precancerous lesions, because of its effects on inflammation, inflammation, intestinal metaplasia, The difference of the detection rate of the low-grade intraepithelial neoplasia, the early gastric cancer and the positive lesion was not statistically significant, and the screening of the gastroscope in various places can be selected according to the actual condition of the endoscope center; and 3, as a gold standard for the diagnosis of the early gastric cancer, the pathological results of the biopsy tissue are used as the gold standard for the diagnosis of the early gastric cancer, and the ME-IDC is respectively applied to the ME-IDC, The diagnostic results of the three groups of ME-AA and ME-NBI were analyzed, and the difference between the three groups was not statistically significant. The accuracy of ME-NBI and ME-AA in the diagnosis of early gastric cancer, no difference between the two groups, was significantly higher than that of ME-IDC. The application of ME-NBI and ME-AA in the diagnosis of gastric cancer can significantly improve the accuracy of early diagnosis of gastric cancer and guide the target biopsy. It is a simple and effective method of early gastric cancer diagnosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2
[Abstract]:BACKGROUND: Gastric cancer is one of the most common malignant tumors, which is one of the most common malignant tumors. The incidence and mortality of gastric cancer in our country are 35.02/ 100,000 and 26.08/ 100,000 respectively, which are located in the first three positions of all the tumors, according to the 2006 National Cancer Registration Area. And bring serious harm to the people's health. A large number of studies have shown that the diagnosis and treatment of early gastric cancer and precancerous lesions is one of the important strategic measures for the prevention and treatment of the future. Objective: To study the diagnostic value of the combined magnifying endoscopy (ME-IDC), glacial acetic acid combined with endoscopy (ME-AA) and narrow-band imaging combined with endoscopic (ME-NBI) in the screening of precancerous lesions and early gastric cancer. Methods: From December 2014 to March,2016, a prospective case-control study was conducted in the patients of the digestive endoscopy center of the People's Hospital of Zhengzhou University from December 2014 to March,2016, and the patients with suspected lesions and who voluntarily agreed to join the study were randomly divided into three groups: ME-IDC, ME-AA and ME-NBI. During the operation, the biopsy site was selected for sampling, and the pathological department was specially assigned to the examination sheet to compare three groups of inflammation, intestinal metaplasia, low-grade intraepithelial neoplasia, early gastric cancer and positive lesion detection rate, and the diagnostic and pathological diagnosis sensitivity of the endoscope according to the VS standard. The specificity and the accuracy are compared, so that the clinical application value is evaluated. Results:1,81 patients with gastric mucosal lesion,18 (22.22%) were located in 1/3 of the stomach,15 (18.51%) were located in 1/3 of the stomach,46 (59.26%) were located in the lower 1/3 of the stomach, and the rate of inflammation in the three groups was 6 (21.43%) in the ME-IDC group, respectively. 10 (33.33%) of the ME-AA group and 10 (43.48%) of the ME-NBI group were not statistically significant (P = 2.850, P = 0.240.05). The positive rate of intestinal metaplasia in the three groups was 11 (39.29%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 8 (34.78%) in the ME-NBI group (P = 0.3460.05). The positive rate of LGIN in three groups was 5 (17.86%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 1 (4.34%) in the ME-NBI group (P = 0. 2200.05). The positive rate of early gastric cancer in three groups was 6 (21.43%) in the ME-IDC group,8 (26.67%) in the ME-AA group and 4 (17.39%) in the ME-NBI group (P = 0.664, P = 0.71805). In this study, the positive rate of LGIN and early gastric cancer was included in 11 (39.29%) of the ME-IDC group,14 (46.67%) in the ME-AA group and 5 in the ME-NBI group (21.74%), and the difference was not statistically significant (1-2 = 3.562, P = 0.1680.05). The diagnosis results of the three groups of ME-IDC, ME-AA and ME-NBI were analyzed by the pathological results of the biopsy tissue as the gold standard for the diagnosis of early gastric cancer. The sensitivity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 50.00%, 77.78% and 100%, respectively. The specificity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 59.09%, 85.71% and 89.47%, respectively. The accuracy of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 57.14%, 83.33% and 91.30%, respectively (P-2 = 9.473, P = 0.0090.05). In addition, the accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was higher than that of ME-IDC, and the difference was statistically significant (P = 4.795, P = 0.0290.05, HCO3-2 = 7.399, P = 0.0070.05). The accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was similar (83.33% vs 91.30%), and there was no significant difference between ME-AA and ME-NBI (P = 0.722, P = 0.6850.05). Conclusion:1. The proportion of the part where the gastric mucosa lesion is located, the lower 1/3 of the stomach is high, the endoscope doctor should focus on the prevention of the omission in the operation of gastroscopy,2, ME-NBI, ME-IDC and ME-AA are the effective means to detect early gastric cancer and precancerous lesions, because of its effects on inflammation, inflammation, intestinal metaplasia, The difference of the detection rate of the low-grade intraepithelial neoplasia, the early gastric cancer and the positive lesion was not statistically significant, and the screening of the gastroscope in various places can be selected according to the actual condition of the endoscope center; and 3, as a gold standard for the diagnosis of the early gastric cancer, the pathological results of the biopsy tissue are used as the gold standard for the diagnosis of the early gastric cancer, and the ME-IDC is respectively applied to the ME-IDC, The diagnostic results of the three groups of ME-AA and ME-NBI were analyzed, and the difference between the three groups was not statistically significant. The accuracy of ME-NBI and ME-AA in the diagnosis of early gastric cancer, no difference between the two groups, was significantly higher than that of ME-IDC. The application of ME-NBI and ME-AA in the diagnosis of gastric cancer can significantly improve the accuracy of early diagnosis of gastric cancer and guide the target biopsy. It is a simple and effective method of early gastric cancer diagnosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2
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