胃蛋白酶原联合窄带成像放大内镜指导靶向活检对胃黏膜萎缩、异型增生及早癌的诊断价值  

Diagnostic value of pepsinogen combined with narrowband imaging and magnifying endoscopy guided targeted biopsy in the diagnosis of gastric mucosal atrophy,dysplasia and early cancer

作　　者：苏振华[1] 王亮[1] 魏思忱[1] 王卫卫[1] 孔郁[1] 魏新亮[1] 田树英[1] 郭瑞雪 史晓盟 SU Zhenhua;WANG Liang;WEI Sichen;WANG Weiwei;KONG Yu;WEI Xinliang;TIAN Shuying;GUO Ruixue;SHI Xiaomeng(Department of Gastroenterology,Cangzhou Central Hospital in Hebei Province,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院消化科,河北沧州061000

出　　处：《中国现代医生》2018年第22期1-3,7,169,共5页China Modern Doctor

基　　金：河北省沧州市科技计划项目(151302139)

摘　　要：目的评估窄带成像放大内镜(NBI-ME)在胃黏膜萎缩、异型增生及早癌中指导靶向活检的价值。方法收集2015年8月~2017年5月于我院行普通胃镜(C-WLI)检查可见萎缩、糜烂及凹陷性病变需要内镜随访的患者200例,随机分为两组复查,即C-WLI组(n=100)和NBI-ME组(n=100),均行病理活检,以病理学检查结果为金标准,检测两种检查方法的准确性。完善胃蛋白酶原化验,检验其对胃黏膜萎缩及早癌筛查的价值。结果 (1)CWLI和NBI-ME诊断萎缩性胃炎及肠化生的敏感度分别是70.73%和89.41%(P<0.05),特异度分别是55.38%和67.27%(P<0.05),准确度分别是63.90%和78.57%(P<0.05),差异均有统计学意义,对萎缩性胃炎及肠化生的诊断NBI-ME优于C-WLI。(2)C-WLI和NBI-ME诊断异型增生及早癌病变的敏感度分别是70.58%和90.58%(P<0.05),特异度分别是53.84%和77.55%(P<0.05),准确度分别是56.67%和79.86%(P<0.05),差异均有统计学意义,对异型增生及早癌的诊断NBI-ME优于C-WLI。(3)入选病例诊断萎缩性胃炎及肠化生的患者PGI水平(69.2±9.2)μg/L,PGR值(3.1±1.8),诊断异型增生及早癌的患者PGI水平(65.6±7.6)μg/L,PGR值(3.2±1.2)。结论 (1)胃蛋白酶原筛查有助于提高对萎缩及早癌的诊断;(2)对于胃黏膜萎缩、异型增生及早癌的诊断,NBI-ME优于C-WLI,可用于内镜精查。Objective To evaluate the value of NBI-ME in the guidance of targeted biopsy in gastric mucosa atrophy,dysplasia and early cancer.Methods 200 patients who were given routine gastroscopy（C-WLI） to detect atrophic,erosive and sulcus lesions and were in need of endoscopic follow-up from August 2015 to May 2017 in our hospital were collected.They were randomly divided into two groups for review,namely C-WLI group（n=100） and NBI-ME group（n=100）.All were given pathological biopsy.The results of the pathological examination were taken as the gold standard to test the accuracy of the two examination methods.The pepsinogen assay was improved,and the value for gastric mucosal atrophy and early cancer screening was tested.Results 1）The sensitivity of C-WLI and NBI-ME in the diagnosis of atrophic gastritis and intestinal metaplasia were 70.73% and 89.41% respectively（P0.05）.The specificity was 55.38% and 67.27% respectively（P0.05）.The accuracy was 63.90% and 78.57% respectively（P0.05）.The difference was statistically significant.For the diagnosis of atrophic gastritis and intestinal metaplasia,NBI-ME was superior to C-WLI.2） The sensitivity of C-WLI and NBI-ME in the diagnosis of dysplasia and early cancer lesions was70.58% and 90.58% respectively（P0.05）.The specificity was 53.84% and 77.55% respectively（P0.05）.The accuracy was 56.67% and 79.86% respectively（P0.05）.The difference was statistically significant.For the diagnosis of dysplasia and early cancer,C-WLI was superior to NBI-ME.3）For the selected cases of patients who were diagnosed as atrophic gastritis and intestinal metaplasia,PGI level was（69.2±9.2） μg/L,and PGR value was（3.1±1.8）.For the patients diagnosed as dysplasia and early cancer,the PGI level was（65.6±7.6） μg/L,and PGR value was（3.2±1.2）.Conclusion 1） The screening of pepsinogen is beneficial to improving the diagnosis of atrophy and early cancer;2） for the diagnosis of gastric mucosal atrophy,dysplasia,and early cancer,NBI-ME is superior

关 键 词：胃蛋白酶原 窄带成像放大内镜 靶向活检 胃黏膜萎缩 异型增生 

分 类 号：R735.2[医药卫生—肿瘤]