木村-竹本分型与可操作的胃炎评价系统在幽门螺杆菌根除后胃癌风险分层中的一致性评价  

Consistency evaluation of the Kimura-Takemoto classification and operative link for gastritis assessment in risk stratification of gastric cancer after Helicobacter pylori eradication

作　　者：王程瑶 邵琳琳[1] 李文坤 程芮[1] 张希 张政[1] 李鹏[1] 张澍田[1] 吴静[1] Wang Chengyao;Shao Linlin;Li Wenkun;Cheng Rui;Zhang Xi;Zhang Zheng;Li Peng;Zhang Shutian;Wu Jing(Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科,北京100050

出　　处：《中华消化杂志》2024年第5期308-313,共6页Chinese Journal of Digestion

基　　金：首都医科大学导师专项科研基金(YYDSZX201901);北京市科技计划(Z211100002921028);北京市健康促进与研究基金(首发H2022-2-2025、2020-4-2085);国家重点研发计划(2022YFC3602104)。

摘　　要：目的探讨以癌症风险为导向的内镜下木村-竹本分型与可操作的胃炎评价系统(OLGA)在幽门螺杆菌(H.pylori)根除后慢性胃炎患者胃癌风险分层中的相关性和一致性。方法选择2018年1月1日至2021年10月31日在首都医科大学附属北京友谊医院就诊并成功根除H.pylori的97例慢性胃炎患者。随访期间对患者进行统一放大内镜检查,应用木村-竹本分型法判断胃黏膜萎缩范围,分为无或轻度萎缩、中度萎缩和重度萎缩。根据新悉尼系统,对内镜下5个部位行活体组织检查的病例进行OLGA分期,分为0、Ⅰ、Ⅱ、Ⅲ和Ⅳ期。分别采用Spearman秩相关分析和Kappa一致性检验评估两种分级系统间的相关性和一致性。采用受试者操作特征曲线的曲线下面积(AUC)计算胃镜下胃黏膜萎缩分级对高风险组织学分期的预测能力。应用多因素logistic回归分析评估影响两种分级系统一致性的因素。统计学方法采用卡方检验或Fisher确切概率法。结果最终完成随访的病例共97例,H.pylori根除后随访时间为(37.38±13.18)个月。无或轻度萎缩患者OLGAⅢ~Ⅳ期比例低于中、重度萎缩患者[21.7%(10/46)比63.0%(29/46)、5/5],差异均有统计学意义(χ^(2)=16.07、13.30,均P<0.001)。中度与重度萎缩患者的OLGA分期分布比较,差异均无统计学意义(均P>0.05)。两种分级系统胃癌高风险评估的一致率为73.2%(71/97)。木村-竹本分型与OLGA分期的相关性中等(r=0.47),95%置信区间(95%CI)为0.30~0.61(P<0.001)。一致性检验结果显示,两种分级系统具有中等一致性,Kappa值为0.46(95%CI 0.29~0.64,P<0.001)。对于H.pylori根除后的慢性胃炎患者,使用木村-竹本分型的中、重度内镜萎缩分级识别OLGA分期高风险的灵敏度为77.21%(95%CI 62.16%~88.53%),特异度为69.81%(95%CI 55.66%~81.66%),AUC为0.735(95%CI 0.636~0.820,P<0.01)。随着H.pylori根除时间的延长(H.pylori根除后<18、18~36、>36个月),木村-竹本分型与OObjective To assess the correlation and consistency between the cancer risk-oriented endoscopic Kimura-Takemoto classification and the operative link for gastritis assessment(OLGA)in risk stratification of gastric cancer in patients with chronic gastritis after Helicobacter pylori(H.pylori)eradication.Methods From January 1,2018 to October 31,2021,97 patients with chronic gastritis who successfully underwent H.pylori eradication at Beijing Friendship Hospital affiliated to Capital Medical University were selected.During the follow-up period,all patients underwent standardized magnifying endoscopy to assess gastric mucosal atrophy with the Kimura-Takemoto classification,which was classified as no or mild atrophy,moderate atrophy,and severe atrophy.Additionally,according to the new Sydney staging system,endoscopic biopsies were conducted at 5 sites of the patients to classify into OLGA stages 0,Ⅰ,Ⅱ,Ⅲ,orⅣ.Spearman rank correlation analysis and Kappa consistency test were performed to evaluate the correlation and consistency between the 2 evaluation systems,respectively.Area under the curve(AUC)of the receiver operating characteristic curve was used to calculate the predictive ability of the grading of gastric mucosal atrophy under endoscopy in high-risk histological staging.Furthermore,multivariate logistic regression analysis was used to assess factors influencing the consistency of the 2 evaluation systems.Chi-square test or Fisher′s exact test were used for statistical analysis.Results Longitudinal follow-up was completed in 97 cases,with a follow-up time of(37.38±13.18)months after H.pylori eradication.The proportion of OLGA stageⅢtoⅣin patients with no or mild atrophy(21.7%,10/46)was lower than that in patients with moderate and severe atrophy(63.0%,29/46 and 5/5,respectively),and the differences were statistically significant(χ^(2)=16.07 and 13.30,both P<0.001).However,there was no significant difference in distribution of OLGA staging between patients with moderate atrophy and patients with se

关 键 词：慢性胃炎 胃黏膜萎缩 木村-竹本分类法 OLGA系统 胃癌风险分层 

分 类 号：R735.2[医药卫生—肿瘤] R573.3[医药卫生—临床医学]