内镜窄带成像结合放大技术应用VS分类标准对胃早期癌性病变的诊断价值研究  

The diagnostic value of NBI combined with magnifying endoscopy using VS classification standard for early gastric carcinoma lesions

作　　者：汤瑜[1] 刘鹏飞[2] 王芳军[2] 邱全兴[3] 徐威[3] 胡学军[3] 姚平[3] 李葵芳[3] 刘烨[3] 陈洪[1] 

机构地区：[1]江苏南京东南大学医学院,210009 [2]东南大学附属江阴医院消化科 [3]南京中医药大学附属江阴医院消化科

出　　处：《中华消化内镜杂志》2015年第9期595-599,共5页Chinese Journal of Digestive Endoscopy

基　　金：江苏省自然科学基金资助（BK2012561）

摘　　要：目的探讨内镜窄带成像（NBI）结合高清放大内镜（ME）应用VS分类标准对胃早期癌性病变的诊断价值。方法选取2013年1月-2014年6月行普通白光胃镜检查提示存在胃黏膜粗糙、糜烂、色泽异常、隆起或浅溃疡等疑似早期癌病例100例，采用自身对照法，对病例先行普通白光内镜观察并活检，2周后对同一病例再进行NBI—ME观察并活检，均以病理诊断为标准；A组采用NBI—ME，应用VS分类标准作出内镜下诊断；B组采用白光内镜技术诊断。比较两组的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果普通白光胃镜诊断胃早期癌性病变的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为76．19％（16／21）、45．57％（36／79）、27．12％（16／59）、87．80％（36／41）、52．00％（52／100）；NBI—ME诊断胃早期癌性病变的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为95．24％（20／21）、97．47％（77／79）、90．91％（20／22）、98．72％（77／78）、97．00％（97／100）。两组准确度相比差异存在统计学意义（x^2=53．30，P〈0．01）。结论NBI—ME应用VS分类标准具有简洁、实用，与病理符合率高的特点，在胃早期癌性病变的诊断中有良好的临床应用价值。Objective To study the diagnostic value of NBI combined with magnification endoscopy using VS classification standard for early gastric carcinoma lesions. Methods A total of 100 patients with suspected early gastric cancer whose gastric mucosa showed roughness, erosion, abnormal colour or ulcer were collected from January 2013 to June 2014. The lesions were observed under white light endoscopy and then underwent biopsy. Observation and biopsy were conducted in the same location by NBI-ME with self contrast method 2 weeks later. Patients in group A underwent NBI-ME, then were diagnosed by VS classification standard. Patients in group B were diagnosed with white light endoscopy. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy between group A and group B were com- pared. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of white light endoscopy in the diagnosis of early gastric carcinoma lesions were 76. 19% （ 16/21 ）, 45.57% （36/79）, 27.12% （16/59）, 87.80% （36/41） and 52. 00% （52/100）, respectively; while the these variables of NBI-ME for early gastric carcinoma lesions were 95.24% （20/21）, 97. 47% （77/79）, 90.91% （20/22）, 98.72% （77/78） and 97.00% （97/100）, respectively. The accuracy of NBI-ME for early gastric carcinoma lesions was significantly higher than that of white light endoscopy （x^2 = 53.30, P 〈 0. 01 ）. Conclusion NBI-ME is convenient and effective in the diagnosis of early gastric carcinoma lesions with high consistency of pathology and good clinical application value.

关 键 词：胃镜检查 癌前状态 早期胃癌 VS分类标准 

分 类 号：R735.2[医药卫生—肿瘤]