窄带成像和美兰染色在肠上皮化生诊断中的应用价值  

Application value of narrow band imaging and methylene blue staining in diagnosis of intestinal metaplasia

作　　者：杨宪武[1] 杨宏伟[1] 李红玉[1] 赵树巧[1] 刘春[1] 张晓博[1] YANG Xianwu;YANG Hongwei;LI Hongyu(Department of Digestive System Diseases,The First Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第一医院消化内科,050011

出　　处：《河北医药》2018年第5期728-731,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展指导计划项目(编号:141463113)

摘　　要：目的探讨窄带成像技术(NBI)和美兰染色对胃部癌前病变肠上皮化生(IM)诊断的准确性。方法筛选普通白光胃镜检查提示存在可疑胃黏膜肠上皮化生患者112例。112例可疑IM组数字法随机分成AB 2组,每组56例。A组(NBI组):NBI观察发现胃上皮表面浅蓝色的嵴状结构(light blue crest,LBC)为肠上皮化生特征,在LBC处取活检2块,未见LBC在白光内镜观察可疑病变最严重部位活检2块;B组(美兰色素喷洒):美兰喷洒胃黏膜,冲洗后观察可疑部位活检2块,进行病理评价,比较NBI靶向活检与美兰染色诊断IM的准确性。结果 NBI发现LBC诊断IM的敏感性为87.0%,特异性为90.0%,阳性预测值97.7%、阴性预测值60%;内镜下美兰染色诊断IM的敏感性为93.3%,特异性为90.9%,阳性预测值97.6%、阴性预测值76.9%;2组诊断IM的敏感性、特异性比较差异无统计学意义(P>0.05)。结论 NBI电子染色与美兰染色对胃黏膜IM的诊断均有较高的准确性,NBI电子染色操作简单,靶向活检可以部分替代染色内镜的作用,临床应用可以提高IM的检出率。Objective To investigate the accuracy of narrow band imaging(NBI)and methylene blue staining in diagnosis of gastric intestinal metaplasia(IM).Methods A total of 112 patients with suspected gastric IM were enrolled in the study.According to random number table,these patients were divided into group A(NBI group)and group B(methylene blue group),with 56 patients in each group.In group A the light blue crest(LBC)on the surface of gastric epithelium was used as a marker for IM.In group B gastric IM presented with blue coloring after methylene blue spraying on gastric mucosa,the suspected area was biopsied for pathological evaluation.Results The sensitivity,specificity,positive predictive value,negative predictive value of NBI in diagnosis of IM were 87.0%,90.0%,97.7%and 60%,respectively(group A),however,which by methylene blue staining in diagnosis of IM were 93.3%,90.9%,97.6%and 76.9%,respectively(group B).There were no significant differences in sensitivity and specificity between the two detection methods(P>0.05).Conclusion Both NBI electron staining and methylene blue staining have higher accuracy in diagnosis of IM,however,NBI electron staining can partly replace the role of staining endoscopy and can improve the detection rate of gastric IM.

关 键 词：肠上皮化生 美兰 窄带成像技术 

分 类 号：R735.1[医药卫生—肿瘤]