放大窄带成像胃镜下胃窦炎微形态特征  

Microstructure characteristics of antrum gastritis by using magnified narrow band imaging

作　　者：刘红[1] 高炳霞[1] 林香春[1] 魏南[1] 刘芳勋[1] 吴静[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院消化科,北京100038

出　　处：《中华消化内镜杂志》2012年第5期268-271,共4页Chinese Journal of Digestive Endoscopy

基　　金：北京市优秀人才培养资助（2011D003034000009）

摘　　要：目的分析放大窄带成像内镜（M-NBI）下胃窦炎的微形态特征，评价M—NBI用于胃窦炎靶向活检的可行性。方法以完成M—NBI检查的连续患者69例为研究对象，按NBI内镜下病变黏膜表面形态分型，以M—NBI检查部位活检的组织学结果为金标准，比较黏膜表面形态和组织病理学结果的关系。另取30张图像进行观察者间一致性评价。结果69例患者共有病变173处，与病理组织学结果进行对比分析。A型以正常部位（89．8％，44／49）为多，B型和C型分别以慢性炎症（53．3％，24／45）和活动性炎症（74．3％，26／35）为多。与A型组相比，B型组（P〈0．001）和C型组（P〈0．001）的炎症水平显著增加。B＋C型预测急慢性炎症的敏感度、特异度和准确度分别为87．5％、78．0％和81．5％；D＋E型预测肠上皮化生的敏感度、特异度和准确度分别为83．8％、90．4％和77．5％。观察者间一致性评价结果示Kappa值为0．734[95％a（0．591—0．977）]，提示一致性较好。结论M—NBI下胃黏膜微形态特征与组织学检查结果有较好的相关性，M-NBI检查能够明显地提高对胃窭炎的预测能力。Objective To determine the features of antrum gastritis by magnified narrow band imaging （M-NBI） and to evaluate the feasibility of target biopsy with M-NBI. Methods A total of 69 consecutive patients who underwent M-NBI were recruited in the study. The gastric mucosa of antrum was observed under M-NBI and the gastric microstructure patterns were classified into 5 types. M-NBI findings were compared with the conventional histological findings. In addition, the interobserver agreement was assessed. Resuits A total of 173 gastric antral sites from 69 patients were examined by M-NBI. Type A was mainly normal sites （89. 8% ,44/49 ） , while type B and C were chronic inflammation （53.3% ,24/45 ）and active inflammation （74. 3% ,26/35 ）. Compared with the type A group, the inflammatory degree in type B （P 〈 0. 001 ） group and type C group （P 〈 0. 001 ） was significantly higher. The sensitivity, specificity, accuracy of the type B and type C pattern for predicting antrum gastritis were 87. 5% , 78. 0% and 81.5%. The sensitivity, specificity, accuracy of the type D and type E pattern for predicting intestinal metaplasia of antrum were 83.8% , 90. 4% and 77.5% , respectively. The kappa value for the interobserver agreement was 0. 734 [95% CI（0. 591-0. 977 ）]. Conclusion Microstructure features of antrum gastritis determined by M-NBI are highly correlated with histopathology, and can evidently help diagnosis.

关 键 词：胃炎 组织学 诊断 放大窄带成像内镜 

分 类 号：R573.3[医药卫生—消化系统]