共聚焦激光显微内镜对萎缩性胃炎诊断价值  

Diagnosis of Atrophy Gastritis and Gastric Intestinal Metaplasia with Confocal Laser Endomicroscopy in Vivo

作　　者：陶克[1] 徐红[1] 张帆[1] 孙岩[1] 王丽波[1] 

机构地区：[1]吉林大学第一医院消化内科,长春130021

出　　处：《中国消化内镜》2009年第4期10-15,共6页Digestive Disease and Endoscopy

摘　　要：目的慢性萎缩性胃炎伴有肠上皮化生是胃腺癌的癌前病变,临床上主要通过内镜检查与病理检查结合对其进行诊断和随访观察。传统方法依赖内镜医师经验发现病变,活检部位随机选取,所以存在局限性。本研究只在评价新型共聚焦激光显微内镜在萎缩性胃炎和胃粘膜肠上皮化生诊断中的应用价值。方法46名经传统内镜检查疑诊为萎缩性胃炎患者经过共聚焦激光显微内镜检查胃粘膜萎缩和肠上皮化生情况,并在共聚焦显微内镜检查同一部位活检病理检查该部位粘膜萎缩和肠上皮化生情况。结果共聚焦激光显微内镜诊断萎缩性胃炎与病理诊断具有较高的一致性(Kappa=0.0.495,0.4<k<0.75),敏感性为83.00%,特异性为67.50%。共聚焦激光显微内镜和病理检查诊断肠上皮化生一致性较高(Kappa=0.557,0.4<k<0.75),敏感性85.98%,特异性70.59%。结论共聚焦激光显微内镜在诊断萎缩性胃炎和肠上皮化生与病理检查相比具有较高的一致性,并且具有无创性实时显示活体胃肠道粘膜光学断层图像的优势,可以反复观察和随访对比。共聚焦激光纤维内镜在诊断消化道疾病方面有着巨大优势和潜力。Objective： atrophy gastritis and gastric intestinal metaplasia（GIM） are risk facters for development of gastric cancer. We aim to assess the usefulness of confocal laser endomicroscopy（CLE） in diagnosing atrophy gastritis and gastric intestinal metaplasia. Methods： 46 patients who were diagnosed atrophy gastritis by conventional endoscope underwent CLE. The agreement of diagonosis of atrophy gastritis and GIM between CLE and histopathology was assessed. Results： in a prospective study 6993 CLE images were obtained from 249 sites. The kappa value for the correlation with histological findings of atrophy gastritis was 0.495 for CLE. The sensitivity and specificity of CLE in diagnosis of atrophy gastritis were 83.00% and 67.50%. The kappa value for the correlation with histological findings of GIM was 0.557 for CLE. The sensitivity and specificity of CLE in diagnosis of GIM were 85.98% and 70.59%. Conclusions： CLE is a useful and potentially important method for the diagnosis of atrophy gastritis and GIM in vivo.

关 键 词：共聚焦激光显微内镜 萎缩性胃炎 肠上皮化生 病理 

分 类 号：R259.733.2[医药卫生—中西医结合] R972[医药卫生—中医内科学]