胃低级别上皮内瘤变的内镜随访及转归影响因素分析  

Endoscopic follow-up of gastric low-grade intraepithelial neoplasia and influencing factors for outcome

作　　者：邓万银[1] 林瀛[2] 林晓露 郑金辉[1] 郑晓玲[1] 杨士杰[1] 郭仙斌[1] 梁玮[1] Deng Wanyin;Lin Ying;Lift Xiaolu;Zheng Jinhui;Zheng Xiaoling;Yang Shijie;Guo Xianbin;Liang Wei(Digestive Endoscopy Center,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院消化内镜中心,福州350001 [2]福建省立医院病理科,福州350001

出　　处：《中华消化内镜杂志》2018年第12期890-894,共5页Chinese Journal of Digestive Endoscopy

基　　金：福建省卫计委中青年骨干项目(重点类2015一ZQN-ZD-5);福建省科技厅引导性项目(2015Y0006,2017Y0017).

摘　　要：目的 探讨影响胃低级别上皮内瘤变(LGIN)转归的因素,为指导LGIN治疗方案的选择提供依据.方法 采用放大内镜结合窄带成像技术(ME-NBI)的随访策略,前瞻性对福建省立医院消化内镜中心收治的47例LGIN患者的病灶位置、大小、病灶表面情况、分界线、腺管及微血管等进行观察,分析LGIN转归的影响因素.结果 35例LGIN的活检及ME-NBI表现无进展(稳定型LGIN组),随访时间(20.7±6.9)个月;12例病理较前有进展(进展型LGIN组),其中4例为高级别上皮内瘤变、8例为中度不典型增生,随访时间(16.3±11.8)个月.2组在患者性别构成(P=0.33)、年龄分布(P=0.13)以及病灶分布(P=0.70)、病灶形态构成(P=0.97)方面差异均无统计学意义.稳定型LGIN组病灶大小以<20 mm为主(71.4%,25/35),进展型LGIN组病灶以≥20 mm为主(66.7%,8/12),2组间差异有统计学意义(P=0.02).病灶表面不均匀表现占比,进展组明显高于稳定组[75.0%(9/12)比34.3%(12/35),P=0.01];ME-NBI下阳性表现占比,进展组亦明显高于稳定组[83.3%(10/12)比8.6%(3/35),P=0.00].结论 病灶大小≥20 mm、表面不均匀表现及ME-NBI下阳性表现为影响LGIN转归的重要因素,结合ME-NBI观察对LGIN治疗方案的选择具有重要指导意义.Objective To study the influencing factors for outcomes of gastric low-grade intraepitbelial neoplasia (LGIN)for better LGIN treatment regimen.Methods Using magnifying endoscopy combined with narrow-band imaging (ME-NBI)follow-up strategy,the endoscopic features of 47 cases of LGIN in Fujian Provincial Hospital,including location,size,surface situation,demarcation line, microvascular pattern and microsurface pattern,were prospectively observed,then the factors influencing the outcome were analyzed.Results Among the 47 cases of LGIN,there were 35 eases in stable condition,whose results of biopsy and ME-NBI had no changes (stable LGIN),and the mean follow-up time was 20.7±6.9 months.The remaining 12 patients had progressive dysplasia (progressive LGIN),including 4 cases of high- grade intraepithelial neoplasia,and 8 cases of moderate dysplasia.The mean follow-up time was 16.3±11.8 months.There were no significant differences between the two groups in gender (P =0.33),mean age (P = 0.13),lesion distribution (P =0.70),and lesion morphology (P =0.97).The lesion size was less than 20mm in the stable group (71.4%,25/35),and over 20mm in the progressive group (66.7%,8/12),and the difference was statistically significant (P=0.02).The proportion of the lesion surface heterogeneity in the progressive group was significantly higher than that in the stable group[75.0%(9/12)VS 34.3%(12/35),P=0.01].The proportion of positive manifestations under ME-NBI in the progressive group was also significantly higher than that in the stable group [83.3%(10/12) VS 8.6%(3/35),P =0.00]. Conclusion The size of lesions over 20 mm,the uneven surface and positive ME-NBI are the important factors influencing the outcome of LGIN,which are of significance for ,the diagnosis and treatment of LGIN.

关 键 词：随访研究 放大内镜结合窄带成像技术 低级别上皮内瘤变 早期胃癌 

分 类 号：R735.2[医药卫生—肿瘤]