共聚焦激光显微内镜诊断幽门螺杆菌感染患者的价值  

The value of confocal laser endomicroscopy for diagnosis of helicobacter pylori infection

作　　者：王鹏[1] 季锐[1] 于涛[1] 顾晓萌[1] 左秀丽[1] 周成军[1] 李长青[1] 李真[1] 李延青[1] 

机构地区：[1]山东大学齐鲁医院消化科,济南250012

出　　处：《中华消化杂志》2010年第10期754-758,共5页Chinese Journal of Digestion

摘　　要：目的 探讨荧光素染色下共聚焦激光显微内镜（confocal laser endomicroscopy,CLE）对幽门螺杆菌（Hp）感染患者的诊断价值.方法 2009年6月至2009年11月,选择伴有上消化道症状（上腹部不适、腹胀、早饱、反酸、嗳气）及为行胃癌筛查而行胃镜检查的患者纳入研究.通过回顾分析行CLE检查且已确诊为Hp感染的患者20例和10例Hp阴性对照者的胃黏膜CLE图像,并与相应靶向活检的组织学图像相比较,制定出CLE下Hp感染诊断标准.在前瞻性研究中将CLE诊断结果 与Hp最终检测结果 进行比较,分析CLE诊断标准的观察者之间一致性,并将CLE图像与相应组织病理学结果 进行对比分析.结果 72例患者纳入前瞻性研究,Hp阳性34例,CLE正确诊断31例,CLE诊断总准确率、敏感性和特异性分别为88.9%、91.2%和86.8%.荧光素渗出伴细胞脱落诊断特异性最高（97.4%）,荧光素渗出＋胃小凹水肿扭曲敏感性最高（88.2%）.CLE诊断标准具有较高的观察者之间一致性（Kappa值分别=0.72和0.87）.CLE下Hp感染图像与活动性炎症高度相关（P＜0.001）.结论 CLE可在细胞水平准确辨别正常胃黏膜和Hp感染的胃黏膜,对Hp感染有可靠的诊断价值.Objective To investigate the value of fluorescin-aided confocal laser endomicroscopy （CLE） for diagnosis of helicobacter pylori （Hp） infection. Methods From June 2009 to November 2009, patients undergone gastric endoscope examination with upper gastrointestinal symptoms （upper abdominal discomfort, abdominal distension, satiation, acid reflux and eructation） or screened for gastric cancer were enrolled. The gastric mucosa CLE image data of twenty diagnosed Hp positive patients and 10 Hp negative patients was analyzed retrospectively. By comparing with histological image of targeted biopsy tissue, the CLE diagnostic criteria for Hp infection were established. In the prospective study, CLE diagnose result was compared with Hp tested result. The consistency of CLE diagnostic criteria in different observers was also analyzed. The CLE image data with histopathology result were compared accordingly. Results Total 72 patients were enrolled in the prospective study,of 34 Hp positive patients, 31 patients were correctly diagnosed by CLE. The accuracy, sensitivity and specificity of CLE diagnosis were 88.9%, 91.2 and 86.8% respectively. CLE image displaying fluorescin leakage and cell shedding was the highest specificity for Hp infection diagnosis, （97.4 %）;fluorescin leakage plus gastric pits distortion and cell edema was the highest sensitivity （88. 2%）. The consistency of CLE diagnostic criteria in different observers was high （Kappa value 0. 72, 0.87）. The CLE image of Hp infection was highly correlated with inflammation activity （P〈0. 001）. Conclusion CLE can accurately distinguish normal mucosa from Hp infected mucosa at the cellular level. The diagnostic value for Hp infection was reliable.

关 键 词：内镜检查 胃肠道 幽门螺杆菌 病理学 

分 类 号：R686[医药卫生—骨科学]