胃粘膜低級別上皮內(nèi)瘤變內(nèi)鏡下特點(diǎn)及相關(guān)因素分析
發(fā)布時(shí)間：2018-08-30 20:32
【摘要】：目的:分析胃粘膜低級別內(nèi)瘤變者臨床特點(diǎn)、內(nèi)鏡下形態(tài)及病理特征,總結(jié)其發(fā)病特點(diǎn),為臨床工作提供參考,以提高其檢出率。方法:回顧性收集2011年1月1日-2013年12月31日在福建省立醫(yī)院內(nèi)鏡中心行病理活檢首次診斷為低級別內(nèi)瘤變或輕-中度不典型增生的患者,排除病理診斷合并高級別內(nèi)瘤變、胃癌及其他胃轉(zhuǎn)移性腫瘤者、ESD(endoscopic submucosal dissection)或ERM(endoscopic mucosal resection)術(shù)后、殘胃患者及資料不全者,共452例LGIN患者納入研究。收集所有患者的臨床資料及內(nèi)鏡下特點(diǎn),其中包括性別、年齡、Hp感染、病變部位、肉眼形態(tài)、胃粘膜腸化及萎縮情況,分析比較它們之間相互關(guān)系,并探討胃粘膜低級別內(nèi)瘤變合并腸化的危險(xiǎn)因素。結(jié)果:452例胃黏膜低級別上皮內(nèi)瘤變患者中男性多于女性,比例1.6:1,年齡以51-60之間最多見(35.6%),各年齡段在性別方面無差異(P0.05);病變好發(fā)于遠(yuǎn)端胃(胃竇、胃角),比例高達(dá)85.2%;肉眼下以粗糙糜爛型最多見(38.7%),病變部位及肉眼形態(tài)在年齡方面存在差異(P0.05);合并腸化368例(81.4%),粗糙糜爛型腸化率最高,占90.3%,病變部位中,胃角腸化率最高,達(dá)95%,不同部位及肉眼形態(tài)在腸化方面差異有統(tǒng)計(jì)學(xué)意義(P0.05);合并萎縮72例(15.9%),其中51-60歲者萎縮率最高(21.1%),部位中賁門胃底陽性率最高(28%),差異有統(tǒng)計(jì)學(xué)意義(P0.05);Hp陽性者321例(71%),不同部位及肉眼形態(tài)中Hp感染率不盡相同,部位中胃體陽性率最高(88.1%),肉眼形態(tài)下以潰瘍凹陷型感染率最高,占81.5%,差異有統(tǒng)計(jì)學(xué)意義(P0.05);合并萎縮和腸化者均比無萎縮和腸化者Hp陽性率要高,分別為91.7%和75.8%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。通過logistic回歸分析發(fā)現(xiàn)年齡、部位、病變形態(tài)及Hp感染是LGIN合并腸化的危險(xiǎn)因素,其中60歲以上者(包括60歲)是50歲以下者腸化風(fēng)險(xiǎn)的2.6倍;肉眼下呈粗糙糜爛型、增生隆起型及潰瘍凹陷型病灶者分別是未見明顯病灶者腸化風(fēng)險(xiǎn)的9.6倍、7.5倍和6.7倍;胃角、胃竇分別是賁門胃底腸化風(fēng)險(xiǎn)的16倍和4.9倍;HP陽性是Hp陰性者的3.6倍。結(jié)論:1.胃粘膜LGIN患者各年齡段在病變部位、肉眼形態(tài)、粘膜萎縮方面存在差異;不同病變部位與肉眼形態(tài)在腸化、萎縮、Hp感染方面存在差異;腸化、萎縮患者在HP感染方面存在差異。2.年齡、病變部位、肉眼形態(tài)、HP感染是LGIN患者合并腸化的危險(xiǎn)因素,其中60歲以上者(包括60歲)比50歲以下者,有病灶者比無明顯病灶者,胃角、胃竇比賁門胃底、HP陽性比Hp陰性患者合并腸化風(fēng)險(xiǎn)更高。因此內(nèi)鏡醫(yī)師注意對這部分患者進(jìn)行活檢,可以提高LGIN及腸化檢出率,及時(shí)隨訪、干預(yù),降低早癌發(fā)生率。
[Abstract]:Objective: to analyze the clinical features, endoscopic morphology and pathological features of patients with low grade gastric mucosal neoplasia, and to summarize the characteristics of gastric mucosal neoplasms, and to provide reference for clinical work in order to improve the detection rate of gastric mucosal neoplasms. Methods: from January 1, 2011 to December 31, 2013, the patients who were first diagnosed as low grade intratumoral neoplasia or mild to moderate atypical hyperplasia in the endoscopic biopsy center of Fujian Provincial Hospital were retrospectively collected, and the pathological diagnosis and high grade intratumoral neoplasia were excluded. Patients with gastric cancer and other metastatic tumors were included in the study after ESD (endoscopic submucosal dissection) or ERM (endoscopic mucosal resection), patients with remnant stomach and incomplete data were included in the study. The clinical data and endoscopic features of all patients were collected, including sex, age, HP infection, lesion location, naked eye shape, intestinal metaplasia and atrophy of gastric mucosa, and the relationship between them was analyzed and compared. To explore the risk factors of low grade gastric mucosal neoplasia associated with intestinal metaplasia. Results among the 452 patients with low grade intraepithelial neoplasia of gastric mucosa, the proportion of male was more than that of female (1.6: 1). The most common age was 51-60 (35.6%), and there was no difference between different age groups (P0.05). The proportion of stomach angle was as high as 85.2%, the gross erosion type was the most common type (38.7%), the pathological position and the naked eye shape had the difference in age (P0.05), 368 cases (81.4%) were associated with intestinal metaplasia, the rate of rough erosive intestinal metaplasia was the highest (90.3%), and the gastric keratosis rate was the highest among the pathological sites. There were significant differences in intestinal metaplasia between different parts and naked eyes (P0.05), 72 cases (15.9%) were complicated with atrophy, the rate of atrophy in 51-60 years old was the highest (21.1%), and the positive rate of gastric fundus in cardia was the highest (28%), the difference was statistically significant (P0.05) in 321 cases with HP positive. (71%) the infection rate of Hp was different in different parts and naked eyes. The positive rate of gastric body was the highest (88.1%), and the infection rate of ulcer concave type was the highest in naked eyes (81.5), the difference was statistically significant (P0.05), the positive rate of Hp in patients with atrophy and intestinal metaplasia was higher than that without atrophy and intestinal metaplasia. 91.7% and 75.8%, respectively, the difference was statistically significant (P0.05). By logistic regression analysis, it was found that age, location, pathological morphology and Hp infection were the risk factors of LGIN complicated with intestinal metaplasia. The risk of intestinal metaplasia in patients over 60 years old (including 60 years old) was 2.6 times higher than that in patients under 50 years old. The risk of intestinal metaplasia in hyperplastic protuberance type and ulcer depression type was 9.6 times, 7.5 times and 6.7 times as much as that in patients without obvious lesions, and the gastric angle and antrum were 16 times and 4.9 times higher than those in cardia and stomach fundus intestinal metaplasia respectively, and the positive rate of HP was 3.6 times higher than that of Hp negative. Conclusion 1. There were differences in pathological site, naked form, mucosal atrophy in different age groups of LGIN patients, intestinal metaplasia and atrophy HP infection in different lesion sites and naked eyes, and differences in HP infection in patients with intestinal metaplasia and atrophy. Age, location of lesion, naked eye morphology and HP infection were risk factors of intestinal metaplasia in patients with LGIN, in which patients over 60 years old (including 60 years old) were more than those under 50 years old, those with lesions were more than those with no obvious lesions, gastric horn. Patients with HP positive gastric antrum were more at risk of intestinal metaplasia than those with Hp negative. Therefore, endoscopic biopsy can improve the detection rate of LGIN and intestinal metaplasia, follow up in time, intervene and reduce the incidence of early cancer.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.2
本文編號：2214208
[Abstract]:Objective: to analyze the clinical features, endoscopic morphology and pathological features of patients with low grade gastric mucosal neoplasia, and to summarize the characteristics of gastric mucosal neoplasms, and to provide reference for clinical work in order to improve the detection rate of gastric mucosal neoplasms. Methods: from January 1, 2011 to December 31, 2013, the patients who were first diagnosed as low grade intratumoral neoplasia or mild to moderate atypical hyperplasia in the endoscopic biopsy center of Fujian Provincial Hospital were retrospectively collected, and the pathological diagnosis and high grade intratumoral neoplasia were excluded. Patients with gastric cancer and other metastatic tumors were included in the study after ESD (endoscopic submucosal dissection) or ERM (endoscopic mucosal resection), patients with remnant stomach and incomplete data were included in the study. The clinical data and endoscopic features of all patients were collected, including sex, age, HP infection, lesion location, naked eye shape, intestinal metaplasia and atrophy of gastric mucosa, and the relationship between them was analyzed and compared. To explore the risk factors of low grade gastric mucosal neoplasia associated with intestinal metaplasia. Results among the 452 patients with low grade intraepithelial neoplasia of gastric mucosa, the proportion of male was more than that of female (1.6: 1). The most common age was 51-60 (35.6%), and there was no difference between different age groups (P0.05). The proportion of stomach angle was as high as 85.2%, the gross erosion type was the most common type (38.7%), the pathological position and the naked eye shape had the difference in age (P0.05), 368 cases (81.4%) were associated with intestinal metaplasia, the rate of rough erosive intestinal metaplasia was the highest (90.3%), and the gastric keratosis rate was the highest among the pathological sites. There were significant differences in intestinal metaplasia between different parts and naked eyes (P0.05), 72 cases (15.9%) were complicated with atrophy, the rate of atrophy in 51-60 years old was the highest (21.1%), and the positive rate of gastric fundus in cardia was the highest (28%), the difference was statistically significant (P0.05) in 321 cases with HP positive. (71%) the infection rate of Hp was different in different parts and naked eyes. The positive rate of gastric body was the highest (88.1%), and the infection rate of ulcer concave type was the highest in naked eyes (81.5), the difference was statistically significant (P0.05), the positive rate of Hp in patients with atrophy and intestinal metaplasia was higher than that without atrophy and intestinal metaplasia. 91.7% and 75.8%, respectively, the difference was statistically significant (P0.05). By logistic regression analysis, it was found that age, location, pathological morphology and Hp infection were the risk factors of LGIN complicated with intestinal metaplasia. The risk of intestinal metaplasia in patients over 60 years old (including 60 years old) was 2.6 times higher than that in patients under 50 years old. The risk of intestinal metaplasia in hyperplastic protuberance type and ulcer depression type was 9.6 times, 7.5 times and 6.7 times as much as that in patients without obvious lesions, and the gastric angle and antrum were 16 times and 4.9 times higher than those in cardia and stomach fundus intestinal metaplasia respectively, and the positive rate of HP was 3.6 times higher than that of Hp negative. Conclusion 1. There were differences in pathological site, naked form, mucosal atrophy in different age groups of LGIN patients, intestinal metaplasia and atrophy HP infection in different lesion sites and naked eyes, and differences in HP infection in patients with intestinal metaplasia and atrophy. Age, location of lesion, naked eye morphology and HP infection were risk factors of intestinal metaplasia in patients with LGIN, in which patients over 60 years old (including 60 years old) were more than those under 50 years old, those with lesions were more than those with no obvious lesions, gastric horn. Patients with HP positive gastric antrum were more at risk of intestinal metaplasia than those with Hp negative. Therefore, endoscopic biopsy can improve the detection rate of LGIN and intestinal metaplasia, follow up in time, intervene and reduce the incidence of early cancer.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.2
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