發(fā)布時間：2018-05-04 17:02

  本文選題：慢性胃炎 + 萎縮��； 參考：《青島大學(xué)》2016年博士論文

【摘要】：目的胃癌是我國發(fā)病率僅次于肺癌居第二位的腫瘤,是一項沉重的公共衛(wèi)生負擔(dān),目前我國大多數(shù)胃癌診斷時已是進展期胃癌。早期胃癌大多數(shù)可通過內(nèi)鏡切除得到治愈,使患者的生活質(zhì)量得到大幅度提高,也減輕了醫(yī)療費用。為了人民群眾的健康,消化內(nèi)鏡醫(yī)生應(yīng)該以發(fā)現(xiàn)早期胃癌為目的,提高中國早期胃癌診斷率。早期胃癌的發(fā)現(xiàn)首先要發(fā)現(xiàn)高危的背景粘膜,高危的背景粘膜包括慢性萎縮性胃炎和幽門螺旋桿菌感染。本研究旨在白光內(nèi)鏡下快速的對慢性胃炎進行評估,評價患者慢性萎縮性胃炎的萎縮程度及是否有幽門螺旋桿菌感染。本研究包括三部分,內(nèi)鏡下萎縮程度與組織學(xué)萎縮程度的一致性、幽門螺旋桿菌感染的內(nèi)鏡特征、黃色瘤與胃癌的相關(guān)性。方法選取256名因消化道癥狀行胃鏡檢查的患者,行13C呼氣試驗檢測Hp,檢測血清胃蛋白酶原PGⅠ、PGⅡ。胃鏡檢查過程中根據(jù)內(nèi)鏡下萎縮范圍按木村-竹本分類分級,按新悉尼胃炎分類系統(tǒng)于胃體中部小彎、大彎、胃角、胃竇小彎、大彎取活檢,根據(jù)病理結(jié)果按可操作的與胃癌風(fēng)險聯(lián)系的胃炎評估(operative link for gastritis assessment,OLGA)分期。評價血清學(xué)檢測胃蛋白酶原PGⅠ、PGⅡ與內(nèi)鏡下萎縮程度及OLGA分期的相關(guān)性;評價內(nèi)鏡下萎縮程度分級即木村-竹本分類和組織學(xué)萎縮程度的分期即OLGA分期的相關(guān)性。通過C13呼氣試驗檢測患者是否有幽門螺旋桿菌感染,并通過內(nèi)鏡組織活檢行特殊染色檢測幽門螺旋桿菌感染。內(nèi)鏡下觀察是否有以下內(nèi)鏡表現(xiàn):胃體黏液附著、彌漫性充血、胃體底黏膜斑點樣充血、斑片狀發(fā)紅、皺襞腫脹、粘膜水腫、規(guī)則排列的集合靜脈(regular arrangement of collecting venules,RAC)、紅色縱行條紋、黃色瘤、胃底腺息肉、增生性息肉、胃潰瘍、十二指腸潰瘍、糜爛。分析上述內(nèi)鏡下表現(xiàn)與幽門螺旋桿菌感染的關(guān)系。集合靜脈分為3型即R型、I型及D型,統(tǒng)計分析上述3型集合靜脈與幽門螺旋桿菌的關(guān)系。選取2015年3月至2015年9月在青島大學(xué)附屬醫(yī)院接受胃鏡檢查的患者,排除嚴重心肝腎疾病、長期使用非甾體抗炎藥、胃切除術(shù)以及胃ESD術(shù)后患者,共有8410例入選,所有患者均經(jīng)胃鏡檢查活檢取病理。胃黃色瘤診斷標準以胃鏡加病理組織學(xué)檢查為依據(jù)。檢測出胃黃色瘤患者187例,將所有入組患者分為兩組:胃黃色瘤組、非胃黃色瘤組,回顧性分析兩組患者的性別、年齡、胃萎縮的嚴重程度、胃黃色瘤的存在情況(數(shù)目、大小、位置)、胃癌的存在情況以及各種臨床病理特征(HP、腸化、不典型增生、癌前病變),并探討胃黃色瘤與上述因素之間的關(guān)系。檢測出胃癌患者426例,將所有入組患者分為胃癌組、非胃癌組,回顧性分析兩組患者性別、年齡、HP感染情況、胃黃色瘤存在情況,并探討胃癌與上述因素之間的關(guān)系,尤其是與胃黃色瘤之間的關(guān)系。結(jié)果256名患者中男性123名,女性133名,平均年齡58.0歲,其中幽門螺旋桿菌感染者113名。內(nèi)鏡下萎縮程度評估木村-竹本分類與組織學(xué)萎縮程度OLGA分期有較高的一致性,加權(quán)Kappa系數(shù)為0.82。同時隨著木村-竹本分類萎縮程度的進展PGⅠ/PGⅡ比值明顯下降(R2=0.834,P0.001)。胃體黏液附著、彌漫性充血、胃體底黏膜斑點樣充血、斑片狀發(fā)紅、皺襞腫脹、粘膜水腫及RAC的I型和D型對Hp感染有較高的敏感度、特異度、陽性預(yù)測值和陰性預(yù)測值;RAC的R型、胃底腺息肉對無Hp感染有較高的敏感度、特異度、陽性預(yù)測值和陰性預(yù)測值。在8410例患者中,檢測出胃黃色瘤患者187例(2.2%)。病變可發(fā)生在賁門、胃底、胃體、胃角、胃竇,以胃竇(51.3%)最為多見,可單發(fā)或多發(fā),以單發(fā)(63.1%)更常見。與年齡≥50歲、性別無統(tǒng)計學(xué)差異(P0.05),說明胃黃色瘤與年齡≥50歲無明顯相關(guān)性;與開放型萎縮性胃炎、腸化、不典型增生、HP感染、胃癌的存在呈顯著相關(guān)性(分別為P0.005,P0.005,P0.025,P0.005,P0.005)。在所有入組患者中檢查測出胃癌患者426例,與年齡≥50歲、性別無統(tǒng)計學(xué)差異(P0.05),說明胃癌與年齡≥50歲、性別無明顯相關(guān)性;與HP感染、胃黃色瘤的存在呈顯著相關(guān)性(分別為P0.005,P0.005)。結(jié)論內(nèi)鏡下萎縮程度評估木村-竹本分類與組織學(xué)萎縮程度OLGA分期有較高的一致性,可預(yù)測組織學(xué)萎縮程度。PGⅠ/PGⅡ比值與木村-竹本分類萎縮程度分級有相關(guān)性。胃體黏液附著、彌漫性充血、胃體底黏膜斑點樣充血、斑片狀發(fā)紅、皺襞腫脹、粘膜水腫及集合靜脈的I型和D型提示Hp感染,而集合靜脈的R型、胃底腺息肉則提示無Hp感染。胃黃色瘤發(fā)生在全胃,以胃竇最為多見,可單發(fā)或多發(fā),以單發(fā)更常見,直徑大小不一,多為2~6mm;胃黃色瘤的發(fā)生與開放型萎縮性胃炎、腸化、不典型增生、幽門螺旋桿菌感染、胃癌的存在相關(guān)性,這些因素可能是易發(fā)生本病的危險因素;幽門螺旋桿菌感染陽性為胃黃色瘤發(fā)生的危險因素胃黃色瘤與胃癌存在相關(guān)性,可作為胃癌的存在一個預(yù)警信號。
[Abstract]:Objective gastric cancer is the second highest incidence of lung cancer in China. It is a heavy public health burden. At present, most of the gastric cancer in our country is diagnosed as advanced gastric cancer. Most of the early gastric cancer can be cured by endoscopic excision, so that the quality of life of the patients is greatly improved and the medical cost is reduced. The health of the people, digestive endoscopes should aim at the discovery of early gastric cancer to improve the diagnosis rate of early gastric cancer in China. First of all, the early gastric cancer should find the high-risk background mucosa, and the high-risk background mucosa includes chronic atrophic gastritis and Helicobacter pylori infection. Assessment of the degree of atrophy of chronic atrophic gastritis in patients and whether there were Helicobacter pylori infection. This study included three parts, the consistency of the degree of atrophy and the degree of histologic atrophy, the endoscopic characteristics of Helicobacter pylori infection, and the correlation between xanthoma and gastric cancer. Methods 256 patients with digestive tract symptoms were selected for gastroscopy. The patients were examined by 13C breath test to detect Hp and detect serum pepsinogen PG I, PG II. In the process of gastroscopy, the range of atrophy of the gastroscopy was classified according to the wooden village and bamboo classification according to the endoscopic atrophy, according to the new Sydney gastritis classification system at the small bend in the middle of the stomach body, the big bend, the stomach angle, the antrum sinuses, and the large bend, and the operation and the risk of gastric cancer according to the pathological results. The associated gastritis assessment (operative link for gastritis assessment, OLGA) staging. The correlation of serological detection of pepsinogen PG I, PG II to endoscopic atrophy and OLGA staging; evaluation of the degree of atrophy of the endoscopy, namely, the correlation of the wooden village bamboo classification and the histopathological stage of the histologic atrophy, namely, the OLGA staging. The patients were tested for Helicobacter pylori infection and detected Helicobacter pylori infection by endoscopic biopsy. Endoscopic findings were observed under endoscopy: gastric mucous adhesion, diffuse congestion, speckle like congestion, flaky redness, plica swelling, mucous membrane edema, and regular arrangement of the gastric body Regular arrangement of collecting venules (RAC), red longitudinal stripes, xanthoma, gastric fundus adeno polyp, hyperplastic polyp, gastric ulcer, duodenal ulcer, erosion. Analysis of the relationship between the above endoscopy and Helicobacter pylori infection. The collection vein is divided into 3 types, R, I and D, and the 3 types of collecting veins are analyzed and analyzed. The relationship between Helicobacter pylori, selected patients receiving gastroscopy at the Affiliated Hospital of Qiingdao University from March 2015 to September 2015, excluding serious heart and kidney disease, long term use of NSAIDs, gastrectomy and gastric ESD patients, 8410 cases were selected, all patients were examined by gastroscopy and biopsy. 187 patients with gastric xanthoma were detected by gastroscopy and histopathological examination. All the patients were divided into two groups: Gastric xanthoma group and non gastric yellowish tumor group. The sex, age, the severity of gastric atrophy, the presence of gastric yellowish tumor (number, size, location), the existence of gastric cancer, and the existence of gastric cancer in two groups were analyzed. The relationship between the clinicopathological features (HP, intestinal metaplasia, atypical hyperplasia, precancerous lesions) and the relationship between the gastric xanthoma and the above factors was investigated. 426 cases of gastric cancer were detected. All the patients were divided into gastric cancer group and non gastric cancer group. The sex, age, HP infection, the existence of gastric yellowish tumor, and the discussion of gastric cancer and the above mentioned above were reviewed. The relationship between factors, especially the relationship with gastric yellowish tumor. Results 256 of the 256 patients were male 123, female 133, average age 58 years, of which 113 were Helicobacter pylori infection. Endoscopic atrophy assessment of the Kimura bamboo classification and histologic atrophy had a higher consistency, and the weighted Kappa coefficient was 0.82. The PG I /PG II ratio decreased significantly (R2=0.834, P0.001) with the progress of the atrophy of the wooden village and bamboos. The adherence of the gastric body mucus, diffuse hyperemia, speckle pattern of the gastric body, flaky red, folds swelling, mucous membrane edema, and RAC I and D have higher sensitivity, specificity, positive predictive value and negative predictive value for Hp infection. RAC R type, gastric fundus polyp has high sensitivity, specificity, positive predictive value and negative predictive value for no Hp infection. In 8410 patients, 187 cases (2.2%) of gastric xanthoma were detected. The lesions can occur in the cardia, the fundus of the stomach, the body of the stomach, the angle of the stomach, the antrum, and the antrum (51.3%), single or multiple, more common with single hair (63.1%). There was no significant difference in sex between age and age (P0.05), indicating that there was no significant correlation between gastric xanthoma and age over 50 years, and there was a significant correlation with the presence of open atrophic gastritis, intestinal metaplasia, atypical hyperplasia, HP infection and gastric cancer (P0.005, P0.005, P0.025, P0.005, P0.005). 426 cases of gastric cancer were detected in all the patients, and 426 cases of gastric cancer were detected, There was no statistical difference between age and age (P0.05), and there was no significant difference in sex (P0.05). There was no significant correlation between gastric cancer and age 50 years old. There was a significant correlation between the existence of HP infection and the existence of gastric yellowish tumor (P0.005, P0.005). Conclusion the assessment of the degree of atrophy of Kimura - Bamboo under endoscopic atrophy has a high consistency with the degree of histologic atrophy in OLGA staging. The ratio of.PG I /PG II to the degree of atrophy of the weave was correlated with the classification of the atrophy degree of Kimura bamboo classification. The adhesion of gastric body mucus, diffuse congestion, speckle pattern of gastric body fundus, patchy redness, folds swelling, mucous membrane edema and I type and D type of collecting vein suggestive of Hp infection, and R of collecting veins, and gastric fundus gland polyps suggesting no Hp infection. Gastric xanthoma occurs in the whole stomach, most common in the gastric antrum, single or multiple, more common with single hair, different in diameter, and more 2~6mm; the occurrence of gastric yellowish tumor is related to open atrophic gastritis, intestinal metaplasia, atypical hyperplasia, Helicobacter pylori infection, and gastric cancer. These factors may be a risk factor for this disease; pylorus may be a risk factor for this disease; pylorus Helicobacter pylori infection is a risk factor for gastric xanthoma. Gastric xanthoma is associated with gastric cancer. It can be used as an early warning signal for the existence of gastric cancer.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R735.2;R573.3

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3 殷繼鵬;腫瘤血管靶向肽GX1用于胃癌的分子影像研究[D];第四軍醫(yī)大學(xué);2015年

4 蔡習(xí)強;TFEB介導(dǎo)的自噬在胃癌耐藥中的作用及其機制研究[D];第四軍醫(yī)大學(xué);2015年

5 趙曉迪;microRNA-7調(diào)控胃癌惡性生物學(xué)行為的功能與分子機制研究[D];第四軍醫(yī)大學(xué);2015年

6 尚華;MicroRNA-125a在胃癌中表達水平的研究及其臨床意義[D];山東大學(xué);2015年

7 關(guān)中正;TGF-β在胃癌免疫逃逸中作用及機制研究[D];山東大學(xué);2015年

8 黃勇;AEG-1/MT qDH、NF-κB、MMP-9在胃癌中的表達及相關(guān)性的研究[D];山東大學(xué);2015年

9 謝黎明;胃癌中miR-124表達的意義及作用機制研究[D];南華大學(xué);2015年

10 劉佳寧;SOX9和CEACAM1在胃癌組織中表達及其對胃癌細胞增殖和轉(zhuǎn)移的影響[D];山東大學(xué);2015年

相關(guān)碩士學(xué)位論文 前10條

1 徐海蓉;胃癌危險因素的流行病學(xué)研究[D];南京醫(yī)科大學(xué);2002年

2 張軍利;p27、PTEN與VEGF蛋白在胃癌組織中的表達及其意義[D];泰山醫(yī)學(xué)院;2014年

3 馬春婷;胃癌與幽門螺桿菌的相關(guān)性研究[D];石河子大學(xué);2015年

4 王士杰;腹腔鏡手術(shù)治療進展期遠端胃癌的臨床療效及患者術(shù)后隨訪生存質(zhì)量研究[D];中國人民解放軍醫(yī)學(xué)院;2015年

5 李浩;胃癌血清蛋白標記物的篩選與鑒定[D];鄭州大學(xué);2015年

6 王巍;胃癌患者血液樣品的光譜分析[D];鄭州大學(xué);2015年

7 李玉博;高場磁共振在胃癌術(shù)前T分期與分級的價值[D];鄭州大學(xué);2015年

8 張?zhí)K鈺;SOX4和P53蛋白在胃癌組織中的表達及貞芪扶正膠囊對胃癌術(shù)后輔助治療作用的觀察[D];蘭州大學(xué);2015年

9 馬來陽;能譜CT成像在胃癌術(shù)前分期及分化程度評價中的應(yīng)用研究[D];蘭州大學(xué);2015年

10 侯向紅;HORMAD2在胃癌中的表達及對胃癌細胞增殖和凋亡的影響[D];蘭州大學(xué);2015年

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