OLGA分期、分级评估系统在胃镜活检组织病理学评价中的应用  

Pathological assessment of gastric mucosa using OLGA system

作　　者：张贺军[1] 金珠[1] 崔荣丽[1] 韩亚京[1] 尚惠茹[1] 张颖[1] 

机构地区：[1]北京大学第三医院消化科,北京100191

出　　处：《中华消化内镜杂志》2014年第3期121-125,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评估慢性胃炎OLGA分期、分级评估系统在国人胃黏膜活检组织病理学评价中的应用价值。方法回顾性总结2007年至2012年在北京大学第三医院消化科行上消化道内镜检查的108例患者的内镜及病理资料，依据慢性胃炎OLGA评估系统标准，对人组病例胃黏膜腺体萎缩程度进行分期，对炎症程度进行分级，分析慢性胃炎OLGA分期、分级与胃黏膜异型增生和／或癌的发生以及与幽门螺杆菌（H.pylori）感染的关系。结果检出的2例早期腺癌分别位于OLGAⅢ期和Ⅳ期；高OLGA分期（OLGAⅢ-Ⅳ期）患者的胃黏膜癌前病变（肠化生、异型增生）的检出率显著高于低OLGA分期（OLGA0～Ⅱ期）患者（肠化生：100．O％比65．3％，P〈0．001；异型增生：77．8％比13．9％，P〈0．001），且OLGA分期与检出异型增生的程度呈显著正相关（r=0．671，P〈0．001）；低OLGA分期患者仅检出10例（13．9％）异型增生病例，且均为轻度异型增生。不同OLGA分级病例之间Hpylon现症感染率差异具有统计学意义（P〈0．001），且OLGA分级与Hpylori现症感染程度呈显著正相关（r=0．586，P〈0．001）。结论高OLGA分期患者更易检出异型增生及腺癌，慢性胃炎OLGA分期能有效地根据胃癌风险性将胃炎病例进行分层，而慢性胃炎OLGA分级与Hpylori现症感染密切相关。Objective To evaluate the clinical value of OLGA （Operative Link on Gastritis Assess- ment） system in pathological assessment of gastric mucosa from Chinese patients. Methods Endoscopic and pathological data of patients, who underwent the endoscopic examination of upper gastrointestinal tract from 2007 to 2012, were analyzed. Using the Sydney protocol, we graded atrophy and staged the Helicobacter pylori infection status in gastric biopsies from 108 patients with dyspepsia. We applied the OLGA system to assess the relationship between OLGA staging and grading and dysplasia/cancer, and the relationship be- tween OLGA grading and Helicobacter pylori infection. Results Two cases of early gastric adenocareinoma were detected at stage 111 and IV, respectively. The detection rates of precancerous lesions （ including intes- tinal metaplasia and dysplasia） in cases clustered in stages IH-1V were significantly higher than those in sta- ges 0- Ⅱ （ intestinal metaplasia： 100.0% VS 65.3 % , P 〈 0. 001 ; dysplasia： 77. 8 % VS 13.9 %, P 〈 O. 001, respectively） , and there were significant differences between OLGA staging and the degree of dysplasia （r = 0. 671, P 〈0. 001 ）. In the subjects at stage 0- Ⅱ, we observed only 10 cases （ 13.9% ） of mild dysplasia. The difference in rate of Helicobacter pylori infection was significant at different OLGA grade （ P 〈 O. 001 ）, and the correlation between OLGA grading and infection degree of Helicobacter pylori was significant （ r = 0. 586, P 〈 0. 001 ）. Conclusion Precancerous lesions and gastric adenocarcinoma tend to be discovered in patients clustered at high-risk （ Ⅲ -IV ） OLGA stages. OLGA staging of dysplasia can effectively differentiate the risks of gastric cancer. The OLGA grading system is consistently associated with the Helicobacter pyloriinfection.

关 键 词：胃炎 萎缩性 螺杆菌 幽门 OLGA系统 异型增生 胃癌 

分 类 号：R573[医药卫生—消化系统]