胃黄色瘤合并肠上皮化生的临床分析  

Clinical analysis of gastric xanthomas with intestinal metaplasia

作　　者：池添雨[1] 赵曲川[1] Chi Tianyu;Zhao Quchuan(Department of Gastroenterology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院消化科,北京100053

出　　处：《首都医科大学学报》2023年第2期322-327,共6页Journal of Capital Medical University

摘　　要：目的 回顾性分析胃黄色瘤(gastric xanthoma,GX)合并肠上皮化生患者的临床特征。方法 选取2012年1月至2022年1月在首都医科大学宣武医院消化内镜中心初次行胃镜检查的患者共68 391例,诊断GX 1 346例,GX检出率为1.97%,平均年龄为(55.4±12.1)岁。根据有无肠上皮化生(以下简称肠化)将GX分为2组:GX伴肠化组(n=901)和GX不伴肠化组(n=445)。对比两组患者的年龄、性别、幽门螺杆菌(Helicobacter pylori,HP)感染、胃黏膜萎缩程度及是否合并胃癌情况。将GX伴肠化组再根据肠化的程度分为3个亚组:GX伴轻度肠化(n=412)、GX伴中度肠化(n=291)和GX伴重度肠化(n=198),对比分析不同亚组GX伴肠化的临床特征。结果 GX伴肠化与GX不伴肠化组在年龄(P=0.012)、HP感染(P<0.001)和是否合并胃癌(P=0.014)方面差异有统计学意义;GX伴肠化组中年龄≥65岁患者发病率较高、HP感染率高、合并胃癌的检出率较高。单因素及多因素分析显示GX患者中胃癌组和非胃癌组在年龄(P<0.001)、HP感染(P<0.001)、胃黏膜萎缩程度(P<0.001)及GX是否伴有肠化(P=0.014)等方面比较差异有统计学意义。3个亚组在年龄(P<0.001)、性别(P=0.004)、胃黏膜萎缩程度(P<0.001)和胃癌(P<0.001)上均差异均有统计学意义。GX伴中度、重度肠化组中,老年人比例较高(P=0.002,P=0.008),GX伴轻度肠化组中各种程度胃黏膜萎缩均为最轻(P<0.001),GX伴重度肠化组合并重度胃黏膜萎缩程度最高(P<0.001)且合并胃癌比例较高(P<0.001)。结论 GX伴肠化的发生与胃癌、萎缩性胃炎及其严重程度有关,需要多中心、大样本对照研究进一步论证。Objective To retrospectively analyze the clinical characteristics of patients with gastric xanthoma(GX)combined with intestinal metaplasia.Methods Totally 68391 patients who underwent initial gastroscopy in the digestive endoscopy center of Xuanwu Hospital,Capital Medical University between January 2012 and January 2022 were selected and 1346 cases were diagnosed with GX,with a GX detection rate of 1.97%and a mean age of(55.4±12.1)years old.GX cases were divided into two groups according to the presence or absence of intestinal metaplasia:GX with intestinal metaplasia(n=901)and GX without intestinal metaplasia(n=445).The two groups were compared with respect to age,gender,Helicobacter pylori(HP),degree of gastric mucosal atrophy and the presence or absence of concomitant gastric cancer.The GX with intestinal metaplasia group was further divided into three subgroups according to the degree of intestinal metaplasia:GX with mild intestinal metaplasia(n=412),GX with moderate intestinal metaplasia(n=291)and GX with severe intestinal metaplasia(n=198),and the clinical characteristics of different subgroups of GX with intestinal metaplasia were analyzed comparatively.Results There were significant differences between GX with and without intestinal metaplasia in terms of age(P=0.012),HP infection(P<0.001)and gastric cancer(P=0.014);GX with intestinal metaplasia was associated with a higher incidence of elderly patients,a higher HP infection and a higher detection rate of concomitant gastric cancer.Univariate and multivariate analysis showed that there were significant differences in age(P<0.001),HP infection(P<0.001),gastric mucosa atrophy(P<0.001)and intestinal metaplasia(P=0.014)between GX group and non-gastric cancer group.All three subgroups showed significant differences in age(P<0.001),gender(P=0.004),degree of gastric mucosal atrophy(P<0.001)and gastric cancer(P<0.001).The GX group with moderate or severe intestinal metaplasia had a higher proportion of elderly subjects(P=0.002,P=0.008).Gastric mucosal atrophy of

关 键 词：胃黄色瘤 肠上皮化生 萎缩性胃炎 胃肿瘤 

分 类 号：R573[医药卫生—消化系统]