本文選題：慢性胃炎　切入點(diǎn)：胃鏡　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過(guò)分別評(píng)估2001年和2011年胃鏡和病理組織學(xué)對(duì)慢性胃炎診斷的差異以及造成兩者差異的相關(guān)因素,以探討慢性胃炎胃鏡診斷的準(zhǔn)確性。 方法：分別選取2001和2011年2年中我院消化內(nèi)鏡中心診斷為慢性胃炎的病例,包括胃鏡診斷和病理診斷,結(jié)合患者性別、年齡及其他實(shí)驗(yàn)室檢查,分析胃鏡與病理診斷的一致性,并分析十年間胃鏡和病理診斷慢性胃炎差異的變化。 結(jié)果： 1.2001年：(1)我院胃鏡檢查人數(shù)5109例,胃鏡下診斷慢性胃炎4089例(占胃鏡檢查總?cè)藬?shù)的80.04%),其中診斷為慢性非萎縮性胃炎3502例(占慢性胃炎的85.64%),診斷為慢性萎縮性胃炎587例(占慢性胃炎的14.36%)。 (2)胃鏡下診斷為慢性非萎縮性胃炎的3502例患者中同時(shí)取活組織病理學(xué)檢查270例(占胃鏡下診斷為慢性非萎縮性胃炎的7.71%)：病理診斷為慢性非萎縮性胃炎218例(胃鏡與病理診斷慢性非萎縮性胃炎的符合率為80.74%)；診斷為慢性萎縮性胃炎41例；同時(shí)存在萎縮和非萎縮者11例,這部分患者診斷為慢性萎縮性胃炎。 (3)胃鏡下診斷為慢性萎縮性胃炎的587例患者中同時(shí)取活組織病理學(xué)檢查116例(占胃鏡下診斷為慢性萎縮性胃炎的19.76%)：病理診斷為慢性萎縮性胃炎75例；診斷為慢性非萎縮性胃炎34例；同時(shí)存在萎縮和非萎縮者7例,這部分患者診斷為慢性萎縮性胃炎(胃鏡與病理診斷慢性萎縮性胃炎的符合率為70.69%)。 2011年：(1)我院胃鏡檢查人數(shù)23410例,胃鏡下診斷慢性胃炎21100例(占胃鏡檢查總?cè)藬?shù)的90.13%),其中診斷為慢性非萎縮性胃炎19324例(占慢性胃炎的91.58%),診斷為慢性萎縮性胃炎1776例(占慢性胃炎的8.42%)。 (2)胃鏡下診斷為慢性非萎縮性胃炎患者的19324例患者中同時(shí)取活組織病理學(xué)檢查320例(占胃鏡下診斷為慢性非萎縮性胃炎的1.66%)：病理診斷為慢性非萎縮性胃炎289例(胃鏡與病理診斷慢性非萎縮性胃炎的符合率為90.31%)；診斷為慢性萎縮性胃炎22例；同時(shí)存在萎縮和非萎縮者9例,這部分患者診斷為慢性萎縮性胃炎。 (3)胃鏡下診斷為慢性萎縮性胃炎的1776例患者中同時(shí)取活組織病理檢查256例(占胃鏡下診斷為慢性萎縮性胃炎的14.41%)：病理診斷為慢性萎縮性胃炎176例；診斷為慢性非萎縮性胃炎70例；同時(shí)存在萎縮和非萎縮者10例,這部分患者診斷為慢性萎縮性胃炎(胃鏡與病理診斷慢性萎縮性胃炎的符合率為72.66%)。 較十年前：(1)胃鏡檢查人數(shù)明顯增多,慢性胃炎的胃鏡下診斷率從80.04%增加至90.13%,P0.01。 (2)慢性非萎縮性胃炎的胃鏡下診斷率明顯增加：由2001年的85.64%增加到2011年的91.58%,P0.01。慢性萎縮性胃炎的胃鏡下診斷率較前下降：由2001年的14.36%減少到2011年的8.42%,P0.01。 (3)慢性非萎縮性胃炎的內(nèi)鏡診斷與病理診斷符合率提高了約10%,P0.01,差異有統(tǒng)計(jì)學(xué)意義,但慢性萎縮性胃炎的內(nèi)鏡診斷與病理診斷符合率無(wú)明顯變化,P0.05。 (4)胃鏡下診斷為慢性非萎縮性胃炎患者取活組織病理檢查人數(shù)的比例明顯降低：由2001年的7.71%(270/3502)降至1.66%(320/19324),P0.01。胃鏡下診斷為慢性萎縮性胃炎患者取活組織病理檢查人數(shù)比例亦明顯降低,由2001年的19.76%(116/587)降至14.41%(256/1776),P0.01 2.慢性胃炎診斷率與患者性別及年齡的關(guān)系： (1)2001年4089例胃鏡診斷為慢性胃炎患者中,患病男女比例為1.67：1,2011年21100例胃鏡診斷為慢性胃炎患者中,患病男女比例為1.60：1,兩數(shù)值比較,差異不明顯,P0.05。 (2)在2001年或2011年同一年中,隨著年齡增加,慢性萎縮性胃炎胃鏡下診斷率逐漸升高,45歲以上者,慢性萎縮性胃炎診斷率升高明顯,P0.05。 (3)2011年年齡小于45歲慢性胃炎患者中,慢性萎縮性胃炎的診斷率明顯高于2001年,P0.01；大于45歲慢性胃炎患者中,慢性萎縮性胃炎的診斷率明顯低于2001年,.P0.01。 3.慢性萎縮性胃炎的發(fā)生部位及鏡下改變結(jié)果分析： (1)2001年或2011年慢性萎縮性胃炎好發(fā)部位主要以胃竇為主,分別占71.64%(96/134)和80.65%(175/217)。 (2)2001年或2011年同一年中診斷為慢性萎縮性胃炎的患者中,全胃發(fā)生萎縮概率低,,較少見(jiàn)。 (3)2011年診斷為慢性萎縮性胃炎患者胃竇及胃體伴糜爛者較2001年增加,P0.05。 4.病理學(xué)改變結(jié)果分析 (1)2001年或2011年慢性胃炎的病理特點(diǎn)以炎癥活動(dòng)為主,分別占61.66%(238/386)和54.86%(316/576) (2)2001年或2011年同一年慢性胃炎的患者中病理診斷為腸化生的比例低,分別占3.63%(14/386)和7.47%(43/576),其發(fā)生率低。 (3)2011年慢性胃炎的患者中病理診斷為炎癥活動(dòng)性的比例明顯低于2001年,P0.05。而病理診斷為腸化生的比例明顯高于2001年,P0.05。 結(jié)論： 1.與十年前比較,慢性胃炎胃鏡診斷率明顯增加,與性別無(wú)關(guān)；慢性萎縮性胃炎與患者年齡密切相關(guān),呈正相關(guān)變化。 2.十年間胃鏡診斷慢性非萎縮性胃炎明顯增多,與人們保健意識(shí)增強(qiáng),體檢人數(shù)增多及胃鏡中心總檢查病例大幅增加有關(guān)。 3.與十年前比較,慢性胃炎胃鏡診斷與病理診斷一致性有所提升,尤其在慢性非萎縮性胃炎的診斷方面,兩者一致性較好。 4.胃鏡發(fā)現(xiàn)慢性胃炎伴糜爛者可視為活動(dòng)性胃炎,應(yīng)結(jié)合臨床癥狀給予治療。 5.雖然胃鏡可準(zhǔn)確診斷慢性胃炎,尤其是慢性非萎縮性胃炎,但結(jié)合病理診斷仍然十分重要。初診慢性萎縮性胃炎病例時(shí)應(yīng)結(jié)合病理診斷。 6.建議統(tǒng)一使用慢性非萎縮性胃炎和慢性萎縮性胃炎統(tǒng)一命名慢性胃炎。
[Abstract]:Objective : To evaluate the accuracy of the diagnosis of chronic gastritis by evaluating the difference of gastric and pathological histology in the diagnosis of chronic gastritis in 2001 and 2011 , respectively .

Methods : The cases of chronic gastritis diagnosed by the digestive endoscopy center of our hospital in 2001 and 2011 were selected , including the diagnosis of gastroscopic diagnosis and pathological diagnosis , combined with the sex , age and other laboratory tests of the patients , and analyzed the consistency of the gastroscopic and pathological diagnosis , and analyzed the changes of the difference of the gastroscopic and pathological diagnosis of chronic gastritis in ten years .

Results :

1 . In 2001 : ( 1 ) The number of gastroscopic examination in our hospital was 5109 cases , chronic gastritis was 4089 cases ( 80.04 % of the total number of gastroscopes ) in our hospital . Among them , 3502 cases of chronic non - atrophic gastritis ( 85.64 % of chronic gastritis ) were diagnosed , 587 cases of chronic atrophic gastritis ( 14.36 % of chronic gastritis ) were diagnosed .

( 2 ) In 3502 patients with chronic non - atrophic gastritis diagnosed by endoscopy , 270 cases ( 7.71 % of chronic non - atrophic gastritis were diagnosed as chronic non - atrophic gastritis ) were diagnosed as chronic non - atrophic gastritis : the pathological diagnosis was 218 cases of chronic non - atrophic gastritis ( 80 . 74 % of gastroscopic and pathological diagnosis of chronic non - atrophic gastritis ) ;
41 cases of chronic atrophic gastritis were diagnosed ;
There were 11 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis .

( 3 ) Of 587 patients diagnosed with chronic atrophic gastritis , 116 cases ( 19.76 % of chronic atrophic gastritis were diagnosed by endoscopy ) were diagnosed as chronic atrophic gastritis , and 75 cases of chronic atrophic gastritis were diagnosed by pathology .
34 cases of chronic non - atrophic gastritis were diagnosed .
There were 7 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis ( the coincidence rate of gastroscopic and pathological diagnosis of chronic atrophic gastritis was 70.69 % ) .

In 2011 : ( 1 ) The number of gastroscopic examination in our hospital was 23410 cases , and chronic gastritis 21100 cases ( 90.13 % of the total number of gastroscopes ) were diagnosed in our hospital . Among them , 19324 cases of chronic non - atrophic gastritis ( 91.58 % of chronic gastritis ) were diagnosed , and 1776 cases of chronic atrophic gastritis were diagnosed ( 8.42 % of chronic gastritis ) .

( 2 ) In 19324 patients with chronic non - atrophic gastritis diagnosed by endoscopy , 320 cases ( 1 . 66 % of chronic non - atrophic gastritis were diagnosed as chronic non - atrophic gastritis ) were diagnosed as chronic non - atrophic gastritis : 289 cases were diagnosed as chronic non - atrophic gastritis ( the coincidence rate of gastroscopic and pathological diagnosis of chronic non - atrophic gastritis was 90.31 % ) ;
22 cases of chronic atrophic gastritis were diagnosed ;
At the same time , there were 9 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis .

4 . Gastroscopy shows that chronic gastritis with erosion can be regarded as active gastritis and should be treated in combination with clinical symptoms .
70 cases of chronic non - atrophic gastritis were diagnosed .
There were 10 cases of atrophy and non - atrophy , which was diagnosed as chronic atrophic gastritis ( the coincidence rate of gastroscopic and pathological diagnosis of chronic atrophic gastritis was 72.66 % ) .

Ten years ago : ( 1 ) The number of gastroscopic examination increased significantly , and the diagnostic rate of gastroscopic diagnosis of chronic gastritis increased from 80.04 % to 90.13 % , P0.01 .

( 2 ) The diagnostic rate of gastroscopic diagnosis of chronic atrophic gastritis increased significantly : from 85.64 % in 2001 to 91.58 % in 2011 , P0.01 . The rate of diagnosis of chronic atrophic gastritis decreased from 14.36 % in 2001 to 8.42 % in 2011 , P0.01 .

( 3 ) The coincidence rate of endoscopic diagnosis and pathological diagnosis of chronic atrophic gastritis increased by about 10 % , P0.01 , but there was no significant difference between the endoscopic diagnosis and pathological diagnosis of chronic atrophic gastritis ( P0.05 ) .

( 4 ) The proportion of pathological examination of biopsy in patients with chronic non - atrophic gastritis decreased significantly from 7.71 % ( 270 / 3502 ) in 2001 to 1.66 % ( 320 / 19324 ) , P0.01 . The proportion of pathological examination of biopsy in patients with chronic atrophic gastritis decreased significantly from 19.76 % ( 116 / 587 ) in 2001 to 14.41 % ( 256 / 1776 ) , P0.01 .

2 . The relationship between the diagnosis rate of chronic gastritis and the sex and age of the patient :

( 1 ) In 2001 , 4089 cases of gastroscopic diagnosis were diagnosed as chronic gastritis , the proportion of men and women was 1.67 : 1 . In 21100 cases of chronic gastritis in 2011 , the proportion of male and female was 1.60 : 1 , the difference was not obvious , P0.05 .

( 2 ) In the same year of 2001 or 2011 , with the increase of age , the diagnostic rate of chronic atrophic gastritis increased gradually , and the diagnostic rate of chronic atrophic gastritis increased obviously after 45 years of age , and the diagnosis rate of chronic atrophic gastritis increased obviously , P0.05 .

( 3 ) In patients with chronic gastritis aged less than 45 years of age in 2011 , the diagnosis rate of chronic atrophic gastritis was significantly higher than that in 2001 , P0.01 ;
In patients with chronic gastritis over 45 years of age , the diagnosis rate of chronic atrophic gastritis was significantly lower than that in 2001 . P0.01.


3 . Analysis of the incidence part of chronic atrophic gastritis and the results of the change in the mirror :

( 1 ) The incidence of chronic atrophic gastritis in 2001 or 2011 was mainly by gastric antrum , accounting for 71.64 % ( 96 / 134 ) and 80.65 % ( 175 / 217 ) , respectively .

( 2 ) In the patients diagnosed as chronic atrophic gastritis in the same year of 2001 or 2011 , the incidence of gastric atrophy in the whole stomach was low , and it was rare .

( 3 ) In 2011 , the diagnosis of chronic atrophic gastritis with gastric antrum and gastric body with erosion increased in 2001 , P0.05 .

4 . Analysis of pathological changes

( 1 ) The pathological characteristics of chronic gastritis in 2001 or 2011 were mainly inflammatory activities , accounting for 61.66 % ( 238 / 386 ) and 54.86 % ( 316 / 576 ) , respectively .

( 2 ) In the patients with chronic gastritis in 2001 or 2011 , the proportion of the patients with chronic gastritis was low , accounting for 3.63 % ( 14 / 386 ) and 7.47 % ( 43 / 576 ) , respectively .

( 3 ) The proportion of pathological diagnosis in patients with chronic gastritis in 2011 was significantly lower than that in 2001 ( P0.05 ) .

CsA could cause PLT to decrease ;

1 . Compared with ten years ago , the diagnostic rate of gastroscopic diagnosis of chronic gastritis increased significantly , which was not related to sex ;
Chronic atrophic gastritis is closely related to the age of the patient and is positively correlated .

2 . Chronic non - atrophic gastritis was significantly increased in 10 years , which was related to the increasing awareness of health care , the increase of physical examination and the increase of total examination cases in the center of the gastroscopic examination .

3 . Compared with ten years ago , the diagnosis and pathological diagnosis of chronic gastritis were improved , especially in the diagnosis of chronic non - atrophic gastritis .

( 3 ) In 1776 patients with chronic atrophic gastritis , 256 cases ( 14.41 % of chronic atrophic gastritis were diagnosed by endoscopy ) were diagnosed as chronic atrophic gastritis , 176 cases of chronic atrophic gastritis were diagnosed by pathology .

5 . Although the gastric mirror can accurately diagnose chronic gastritis , especially chronic non - atrophic gastritis , it is still very important in combination with pathological diagnosis . It should be combined with pathological diagnosis in case of chronic atrophic gastritis .

6 . It is recommended to use the unified nomenclature of chronic atrophic gastritis and chronic atrophic gastritis to name chronic gastritis .

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R573.3

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