胃黏膜上皮内瘤变患者653例的临床病理特点分析  

Clinicopathological characteristics of gastric intraepithelial neoplasia:Analysis of 653 cases

作　　者：方家恒 周刚[1] 喻玮 陈鑫[1] 孙倚天 李国熊[1] Jia-Heng Fang;Gang Zhou;Wei Yu;Xin Chen;Yi-Tian Sun;Guo-Xiong Li(Department of Gastroenterology,Hangzhou Normal University Affiliated Hospital,Hangzhou 310015,Zhejiang Province,China;State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,National Clinical Research Center for Infectious Diseases,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases,The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310006,Zhejiang Province,China)

机构地区：[1]杭州师范大学附属医院消化内科,浙江省杭州市310015 [2]国家传染病诊疗重点实验室,国家传染病临床研究中心,传染病诊疗协同创新中心,浙江大学医学院第一附属医院,浙江省杭州市310006

出　　处：《世界华人消化杂志》2021年第18期1064-1070,共7页World Chinese Journal of Digestology

摘　　要：背景胃癌(gastric cancer,GC)因其高死亡率已成为世界各国关注的严重健康问题.目前临床上普遍认为胃黏膜上皮内瘤变(gastric intraepithelial neoplasia,GIN)是胃癌的前期阶段.因此,本研究旨在探讨GIN的临床病理特点,探讨影响GIN的相关因素.目的准确诊断和早期干预GIN是GC防治的重要组成部分之一,本文研究并分析了GIN的临床及病理特点,探讨影响GIN的相关因素,以期更好的区分、指导两种GIN的临床诊断、治疗.方法收集2010-06/2020-10在我院内镜中心接受胃镜检查的653例患者.收集所有患者一般情况、内镜下表现和病理学特征等数据,以探索与GIN相关的危险因素.结果653例GIN患者中有胃黏膜上皮低级别内瘤变(low gastric intraepithelial neoplasia,LGIN)536例(82.08%),胃黏膜上皮高级别内瘤变(high gastric intraepithelial neoplasia,HGIN)117例(17.92%).胃窦是GIN病变最常发生的部位,占58.35%(381/653).HGIN组患者中病变大小>2 cm的发生率(27/117,23.08%)是LGIN组(56/536,10.45%)的两倍多.萎缩的发生率在50-79岁年龄组中,肠化的发生率在>60岁年龄组中随年龄增长而提高.此外,LGIN组和HGIN组之间的幽门螺杆菌(Helicobacter pylori,H.pylori)感染率无明显统计学差异(P=0.162).结论当LGIN患者伴随高龄,病变位于胃窦、大于1 cm和(或)伴随胃粘膜萎缩或粘膜肠化时,更易发展为HGIN,应给予更为积极的随访和治疗.此外,H.pylori感染对LGIN、HGIN发生的影响或许有待商榷.BACKGROUND The high mortality rate of gastric carcinoma(GC)is becoming a serious public concern around the world.Gastric intraepithelial neoplasia(GIN)is believed to be the pre-invasive lesions of GC.Therefore,this study aimed to investigate the clinicopathological characteristics of GIN and explore the risk factors for gastric precancerous lesions.AIM To analyze the clinical and pathological characteristics of GIN and identify its risk factors,so as to better guide the clinical diagnosis and treatment of GIN.METHODS A total of 653 Chinese patients undergoing diagnostic gastroscopy at a single center from June 2010 to October 2020 were included.The demographic,endoscopic,and pathological characteristics were collected to identify the risk factors associated with GIN.RESULTS There were 536 cases with low-grade gastric intraepithelial neoplasia(LGIN)(82.08%)and 117 cases with high-grade gastric intraepithelial neoplasia(HGIN)(17.92%).The gastric antrum was the most common location for GIN lesions(58.35%).The incidence of GIN lesions>2 cm in the HGIN group(27/117,23.08%)was twice as high as that of the LGIN group(56/536,10.45%).The positive rate of atrophy and intestinal metaplasia improved as the age increased among patients 50-80 years old and>60 years old,respectively.In addition,no statistical difference was observed in Helicobacter pylori infection rate between the LGIN and HGIN groups(P=0.162).CONCLUSION Advanced age,lesion located at the antrum,lesion size>1 cm,and presence of atrophy or intestinal metaplasia in the gastric mucosa are risk factors for HGIN.LGIN patients with these risk factors are more likely to develop into HGIN.H.pylori infection has no statistical correlations with LGIN and HGIN.

关 键 词：胃黏膜上皮内瘤变 胃癌 萎缩 肠化 幽门螺杆菌感染 

分 类 号：R735.2[医药卫生—肿瘤]