内镜下LCPL征象对胃黏膜高危肠上皮化生的诊断价值  

Diagnostic value of endoscopic LCPL sign for high-risk intestinal metaplasia in gastric mucosa

作　　者：郑喜鹏 潘惠琳 吴林育 侯永英 刘琴[1] 马强[2] 秦修远 刘凯军[1] 王斌[1] 陈东风[1] 王涛[1] ZHENG Xipeng;PAN Huilin;WU Linyu;HOU Yongying;LIU Qin;MA Qiang;QIN Xiuyuan;LIU Kaijun;WANG Bin;CHEN Dongfeng;WANG Tao(Department of Gastroenterology,Chongqing Key Laboratory of Precise Prevention and Treatment of Digestive Malignancies,Army Medical Center of PLA/Daping Hospital of Third Military Medical University,Chongqing;Department of Pathology,Army Medical Center of PLA/Daping Hospital of Third Military Medical University,Chongqing;First Clinical College of Chongqing Medical University,Chongqing,China)

机构地区：[1]陆军特色医学中心(第三军医大学大坪医院)消化内科,消化系统肿瘤精准防治重庆市重点实验室 [2]陆军特色医学中心(第三军医大学大坪医院)病理科,重庆 [3]重庆医科大学第一临床学院,重庆

出　　处：《陆军军医大学学报》2025年第5期407-416,共10页Journal of Army Medical University

基　　金：重庆市自然科学基金创新发展联合基金(CSTB2024NSCQ-LZX0015)。

摘　　要：目的探讨内镜下亮蓝嵴(light blue crest,LBC)包绕的乳头状区域(LBC capsuling papillary lesion,LCPL)征象在高危胃黏膜肠上皮化生(intestinal metaplasia,IM,简称“肠化”)中的诊断价值。方法选取2021年1月至2023年6月在陆军特色医学中心消化内科接受内镜检查及活检的314例患者(共352块活检样本)。采用HE染色及高铁二胺-阿尔新蓝(high iron diamine-alcian blue,HID-AB)染色(诊断高危肠化的金标准)检查样本的组织学类型及肠化类型,并据此将样本分为慢性炎症组、低危肠化组、高危肠化组、高-中分化肠型胃癌组、低分化肠型胃癌组。结合活检部位内镜下图像,统计分析LCPL在各组中的阳性率;采用Logistic回归分析LCPL征象与高危肠化的关系,以及与LCPL相关的临床病理特征;采用灵敏度、特异度、约登指数、受试者工作曲线下面积等指标,评价LCPL对高危肠化的诊断效能。结果LCPL征象在高危肠化组的阳性率达75.70%,显著高于其他各组(P均<0.001);Logistic回归分析显示LCPL与高危肠化密切相关(OR=30.286,95%CI:13.528~67.804,P<0.001)。LCPL征象诊断高危肠化的灵敏度为69.84%、特异度为93.75%、约登指数为0.636、曲线下面积为0.818(95%CI:0.773~0.857);除灵敏度指标外,上述各诊断效能参数均显著优于诊断肠化与否的传统内镜下征象LBC(P均<0.001)。并且,LCPL征象的判别不易受到患者年龄(OR=1.130,95%CI:0.709~1.800,P=0.607)、病变部位(胃角:OR=2.360,95%CI:0.732~7.613,P=0.151;胃窦:OR=2.257,95%CI:0.756~6.744,P=0.145)、是否合并消化性溃疡(OR=1.085,95%CI:0.208~5.652,P=0.923)等因素的影响;94.12%的阳性、66.94%的阴性LCPL征象可在3 s内被快速识别(OR=4.536,95%CI:1.372~14.997,P=0.013)。结论内镜下LCPL征象在诊断胃黏膜高危肠化中有较好效能,具有潜在临床应用价值。Objective To investigate the diagnostic value of endoscopic sign of light blue crest(LBC)capsuling papillary lesion(LCPL)for high-risk intestinal metaplasia(IM).Methods A total of 314 patients(352 biopsy specimens)who underwent endoscopic examination and biopsy in Department of Gastroenterology of Army Medical Center of PLA from January 2021 to June 2023 were recruited,and HE and HID-AB staining(the golden standard of high-risk IM)were apllied to detect the histological types and IM types.The samples were subsequently divided into chronic inflammation group,low-risk IM group,high-risk IM group,well-differentiated intestinal-type gastric cancer group,and poorly-differentiated intestinal-type gastric cancer group.The positive rate of LCPL in each group and its diagnostic efficacy were analyzed based on endoscopic images of the biopsy sites.Logistic regression analysis was used to investigate the relationship between LCPL sign and high-risk IM,as well as the clinical and pathological features associated with LCPL sign.Receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic efficacy of LCPL for high-risk IM,using indicators such as sensitivity,specificity,Youden index and area under the curve(AUC).Results The positive rate of the LCPL sign in high-risk IM group was 75.70%,significantly higher than that of the other groups(all P<0.001).Logistic regression analysis showed that LCPL sign was significantly correlated with high-risk IM(OR=30.286,95%CI:13.528~67.804,P<0.001).When the sign was employed in diagnosing high-risk IM,the sensitivity was 69.84%,the specificity was 93.75%,the Youden’s index was 0.636,and the AUC value was 0.818(95%CI:0.773~0.857).Besides sensitivity,all above parameters of LCPL sign showed significantly better diagnostic efficacy than those of traditional LBC sign,which is used as a sign for diagnosing IM(P<0.001).Moreover,recognition of LCPL sign was not easily affected by age(OR=1.130,95%CI:0.709~1.800,P=0.607),lesion site(Angular incisure:OR=2.360,95%CI:0.732~7.613,

关 键 词：肠上皮化生 胃癌 内镜 诊断 

分 类 号：R573[医药卫生—消化系统] R730.49[医药卫生—内科学] R735.2[医药卫生—临床医学]