探头式共聚焦激光显微内镜量化指标诊断幽门螺杆菌相关萎缩性胃炎的临床研究  

A clinical study of quantifying index of probe-based confocal laser endomicroscopy for diagnosis of Helicobacter pylori-associated chronic atrophic gastritis

作　　者：陈佳颖 吴迪 党彤[1] 汤泊夫 刘琳[1] 贾语婧 李志伟 Chen Jiaying;Wu Di;Dang Tong;Tang Bofu;Liu Lin;Jia Yujing;Li Zhiwei(Department of Gastroenterology,The Second Affiliated Hospital of Baotou Medical College,Baotou 014030,China;Department of Critical Care Medicine,The First Affiliated Hospital of Baotou Medical College,Baotou 014010,China)

机构地区：[1]包头医学院第二附属医院消化内科,包头014030 [2]包头医学院第一附属医院重症医学科,包头014010

出　　处：《中华消化内镜杂志》2024年第6期465-471,共7页Chinese Journal of Digestive Endoscopy

基　　金：内蒙古自治区自然科学基金(2021MS08125);内蒙古自治区卫生科技计划项目(202201438);包头卫生科技计划项目(wsjkkj018)。

摘　　要：目的量化探头式共聚焦激光显微内镜(probe-based confocal laser endomicroscopy,pCLE)诊断幽门螺杆菌相关萎缩性胃炎(H.pylori-associated chronic atrophic gastritis,HpCAG)的诊断指标,并评价诊断效能。方法研究分为2个阶段:第1阶段前瞻性纳入2021年11月至2022年9月在包头医学院第二附属医院行胃镜检查及内镜下活检并行13C呼气试验的患者作为研究对象,离线视频采用Image J图像分析软件测量pCLE视野中的毛细血管直径(capillary diameter,CD)、细胞间距(cells spacing,CS)、腺体间距(gland spacing,GS)、腺体面积(gland area,GA)这4个指标,通过分析受试者工作特征(receiver operating characteristic,ROC)曲线下面积,建立pCLE下量化指标诊断HpCAG的标准;第2阶段回顾性纳入2021年10月至2022年10月间在包头医学院第二附属医院行pCLE检查及13C呼气试验的病例,剔除与第1阶段数据重合的病例,试验采用单盲法,内镜医师和病理医师对彼此的诊断结果不知情,pCLE的诊断根据第1阶段获得的标准进行,统计分析pCLE诊断与组织病理学+13C呼气试验结果的一致性。结果第1阶段招募到35例患者共计191块标本入组,根据内镜活检病理结果及13C呼气试验结果将患者及胃黏膜标本分为4组,即幽门螺杆菌(Helicobacter pylori,HP)阳性萎缩性胃炎组(n=59)、HP阳性非萎缩性胃炎组(n=52)、HP阴性萎缩性胃炎组(n=40)、HP阴性非萎缩性胃炎组(n=40)。ROC曲线分析结果显示:在HP阳性患者中,GS区分慢性萎缩性胃炎与非萎缩性胃炎胃黏膜的最佳临界值为29.68μm,在4个参数中ROC曲线下面积最大;在HP阴性患者中,GS区分慢性萎缩性胃炎与非萎缩性胃炎胃黏膜的最佳临界值为23.57μm,在4个参数中ROC曲线下面积最大;在非萎缩性胃炎患者中,GS区分HP阳性与HP阴性胃黏膜的最佳临界值为20.57μm,在4个参数中ROC曲线下面积最大;在慢性萎缩性胃炎患者中,CD、CS、GS、GA区分HP阳性与HP阴性�Objective To quantify the diagnostic index of probe-based confocal laser endomicroscopy(pCLE)for diagnosing Helicobacter pylori(HP)-associated chronic atrophic gastritis(HpCAG),and to evaluate the efficacy of the quantified diagnostic index for HpCAG.Methods The study was divided into two stages.The first stage prospectively included patients undergoing gastroscopy,endoscopic biopsy and 13C breath test from November 2021 to September 2022 at the Second Affiliated Hospital of Baotou Medical College.The capillary diameter(CD),cells spacing(CS),gland spacing(GS),and gland area(GA)in the pCLE field of offline video was measured with Image J.The diagnostic criteria of HpCAG by quantitative indicators under pCLE was established by analyzing the area under the receiver operating characteristic(ROC)curve(AUC).In the second stage,the cases with pCLE examination and 13C breath test at the Second Affiliated Hospital of Baotou Medical College from October 2021 to October 2022 were included.The cases that overlapped with the first stage were excluded.The trial was single-blind,with endoscopists and pathologists blind to each other's diagnoses.The diagnosis of pCLE was conducted according to the criteria obtained in the first stage,and the consistency between pCLE diagnosis and the results of histopathology and 13C breath test was analyzed.Results The first stage enrolled 191 specimens from 35 patients.According to the pathological results of endoscopic biopsy and 13C breath test results,patients and gastric mucosa samples were divided into 4 groups,HP-positive CAG group(n=59),HP-positive non-CAG group(n=52),HP-negative CAG group(n=40),and HP-negative non-CAG group(n=40).ROC curve analysis results showed that in HP-positive patients,the optimal critical value of GS to distinguish between CAG and non-CAG gastric mucosa was 29.68μm,and the AUC was the largest among the 4 parameters.In HP-negative patients,the optimal critical value of GS for distinguishing gastric mucosa from CAG and non-CAG was 23.57μm,and the AUC was the lar

关 键 词：胃炎 萎缩性 幽门螺杆菌相关萎缩性胃炎 探头式共聚焦激光显微内镜 量化标准 

分 类 号：R573.3[医药卫生—消化系统]