放大內(nèi)鏡在早期胃癌及癌前病變診斷中的價值研究
發(fā)布時間：2019-06-14 03:39
【摘要】：背景:胃癌是起源于胃黏膜上皮的惡性腫瘤,是最常見的惡性腫瘤之一,據(jù)2006年全國腫瘤登記地區(qū)統(tǒng)計,我國胃癌的發(fā)病率和死亡率分別為35.02/10萬和26.08/10萬,均位于所有腫瘤的前三位,給人民健康帶來嚴(yán)重危害。大量研究表明,早期胃癌及癌前病變內(nèi)鏡診治是未來腫瘤防治的重要戰(zhàn)略措施之一,應(yīng)引起我們的高度重視。目的:本文旨在探討靛胭脂聯(lián)合放大內(nèi)鏡(magnifying endoscopy combined indigo carmine,ME-IDC)、冰醋酸聯(lián)合放大內(nèi)鏡(magnifying endoscopy combined acetic acid,ME-AA)及窄帶成像聯(lián)合放大內(nèi)鏡(magnifying endoscopy combined narrow-band imaging,ME-NBI),在癌前病變和早期胃癌篩查中的診斷價值。方法:對2014年12月至2016年3在月鄭州大學(xué)人民醫(yī)院消化內(nèi)鏡中心就診人群進行前瞻性病例對照研究,胃鏡下或既往檢查發(fā)現(xiàn)有可疑病灶并自愿同意加入該研究的81例患者,隨機分為ME-IDC、ME-AA及ME-NBI三組。術(shù)中選擇活檢部位進行取材送檢,由病理科專人統(tǒng)一閱片,比較三組炎癥、腸上皮化生、低級別上皮內(nèi)瘤變、早期胃癌和陽性病變檢出率,及依據(jù)VS標(biāo)準(zhǔn)的內(nèi)鏡診斷與病理診斷敏感度、特異度和準(zhǔn)確度的比較,從而評價其臨床應(yīng)用價值。結(jié)果:1、81例患者的胃黏膜病變部位分布,其中18例(22.22%)位于上1/3胃,15例(18.51%)位于中1/3胃,46例(59.26%)位于下1/3胃。2、三組病例的炎癥檢出率分別為ME-IDC組6例(21.43%)、ME-AA組10例(33.33%)及ME-NBI組10例(43.48%),差異沒有統(tǒng)計學(xué)意義(χ~2=2.850,P=0.2400.05)。三組病例的腸上皮化生病變檢出率分別為ME-IDC組11例(39.29%)、ME-AA組6例(20.00%)及ME-NBI組8例(34.78%),差異沒有統(tǒng)計學(xué)意義(χ~2=2.124,P=0.3460.05)。三組病例的LGIN病變檢出率分別為ME-IDC組5例(17.86%)、ME-AA組6例(20.00%)及ME-NBI組1例(4.34%),差異沒有統(tǒng)計學(xué)意義(χ~2=3.029,P=0.2200.05)。三組病例的早期胃癌病變檢出率分別為ME-IDC組6例(21.43%)、ME-AA組8例(26.67%)及ME-NBI組4例(17.39%),差異沒有統(tǒng)計學(xué)意義(χ~2=0.664,P=0.7180.05)。本研究將LGIN和早期胃癌納入陽性病變,三組病例的陽性病變檢出率分別為ME-IDC組11例(39.29%)、ME-AA組14例(46.67%)及ME-NBI組5例(21.74%),,差異沒有統(tǒng)計學(xué)意義(χ~2=3.562,P=0.1680.05)。3、以活檢組織的病理結(jié)果作為診斷早期胃癌的金標(biāo)準(zhǔn),分別對ME-IDC、ME-AA和ME-NBI三組內(nèi)鏡下診斷結(jié)果進行分析。ME-IDC、ME-AA及ME-NBI內(nèi)鏡下診斷早期胃癌的敏感度分別為50.00%、77.78%、100%,差異沒有統(tǒng)計學(xué)意義(χ~2=3.242,P=0.2860.05)。ME-IDC、ME-AA及ME-NBI內(nèi)鏡下診斷早期胃癌的特異度分別為59.09%、85.71%、89.47%,差異沒有統(tǒng)計學(xué)意義(χ~2=6.633,P=0.0540.05)。ME-IDC、ME-AA及ME-NBI內(nèi)鏡下診斷早期胃癌的準(zhǔn)確度分別為57.14%、83.33%、91.30%,差異有統(tǒng)計學(xué)意義(χ~2=9.473,P=0.0090.05)。進而作三組間的兩兩比較,ME-AA及ME-NBI對早期胃癌診斷的準(zhǔn)確度均高于ME—IDC,差異有統(tǒng)計學(xué)意義(χ~2=4.795,P=0.0290.05,χ~2=7.399,P=0.0070.05)。而ME-AA與ME-NBI對早期胃癌診斷的準(zhǔn)確度相似(83.33%vs 91.30%),差異沒有統(tǒng)計學(xué)意義(χ~2=0.722,P=0.6850.05)。結(jié)論:1、胃黏膜病變所在部位的比例,下1/3胃較高,內(nèi)鏡醫(yī)師在胃鏡檢查操作中應(yīng)重點觀察防止遺漏;2、ME-NBI、ME-IDC和ME-AA均是檢出早期胃癌和癌前病變的有效手段,因其對炎癥、炎癥、腸上皮化生、低級別上皮內(nèi)瘤變、早期胃癌和陽性病變檢出率之間的差異無統(tǒng)計學(xué)意義,各地門診胃鏡篩查可據(jù)內(nèi)鏡中心實際情況選用檢查方法;3、以活檢組織的病理結(jié)果作為診斷早期胃癌的金標(biāo)準(zhǔn),分別對ME-IDC、ME-AA和ME-NBI三組內(nèi)鏡下診斷結(jié)果進行分析,三組間敏感度和特異度之間的差異無統(tǒng)計學(xué)意義。ME-NBI及ME-AA診斷早期胃癌的準(zhǔn)確度,兩組間無差異,但與ME-IDC相比均顯著升高。ME-NBI及ME-AA應(yīng)用VS診斷標(biāo)準(zhǔn)可以顯著提高早期胃癌內(nèi)鏡下診斷的準(zhǔn)確性,并引導(dǎo)靶向活檢,是一種簡便、有效的早期胃癌診斷方法。
[Abstract]:BACKGROUND: Gastric cancer is one of the most common malignant tumors, which is one of the most common malignant tumors. The incidence and mortality of gastric cancer in our country are 35.02/ 100,000 and 26.08/ 100,000 respectively, which are located in the first three positions of all the tumors, according to the 2006 National Cancer Registration Area. And bring serious harm to the people's health. A large number of studies have shown that the diagnosis and treatment of early gastric cancer and precancerous lesions is one of the important strategic measures for the prevention and treatment of the future. Objective: To study the diagnostic value of the combined magnifying endoscopy (ME-IDC), glacial acetic acid combined with endoscopy (ME-AA) and narrow-band imaging combined with endoscopic (ME-NBI) in the screening of precancerous lesions and early gastric cancer. Methods: From December 2014 to March,2016, a prospective case-control study was conducted in the patients of the digestive endoscopy center of the People's Hospital of Zhengzhou University from December 2014 to March,2016, and the patients with suspected lesions and who voluntarily agreed to join the study were randomly divided into three groups: ME-IDC, ME-AA and ME-NBI. During the operation, the biopsy site was selected for sampling, and the pathological department was specially assigned to the examination sheet to compare three groups of inflammation, intestinal metaplasia, low-grade intraepithelial neoplasia, early gastric cancer and positive lesion detection rate, and the diagnostic and pathological diagnosis sensitivity of the endoscope according to the VS standard. The specificity and the accuracy are compared, so that the clinical application value is evaluated. Results:1,81 patients with gastric mucosal lesion,18 (22.22%) were located in 1/3 of the stomach,15 (18.51%) were located in 1/3 of the stomach,46 (59.26%) were located in the lower 1/3 of the stomach, and the rate of inflammation in the three groups was 6 (21.43%) in the ME-IDC group, respectively. 10 (33.33%) of the ME-AA group and 10 (43.48%) of the ME-NBI group were not statistically significant (P = 2.850, P = 0.240.05). The positive rate of intestinal metaplasia in the three groups was 11 (39.29%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 8 (34.78%) in the ME-NBI group (P = 0.3460.05). The positive rate of LGIN in three groups was 5 (17.86%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 1 (4.34%) in the ME-NBI group (P = 0. 2200.05). The positive rate of early gastric cancer in three groups was 6 (21.43%) in the ME-IDC group,8 (26.67%) in the ME-AA group and 4 (17.39%) in the ME-NBI group (P = 0.664, P = 0.71805). In this study, the positive rate of LGIN and early gastric cancer was included in 11 (39.29%) of the ME-IDC group,14 (46.67%) in the ME-AA group and 5 in the ME-NBI group (21.74%), and the difference was not statistically significant (1-2 = 3.562, P = 0.1680.05). The diagnosis results of the three groups of ME-IDC, ME-AA and ME-NBI were analyzed by the pathological results of the biopsy tissue as the gold standard for the diagnosis of early gastric cancer. The sensitivity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 50.00%, 77.78% and 100%, respectively. The specificity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 59.09%, 85.71% and 89.47%, respectively. The accuracy of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 57.14%, 83.33% and 91.30%, respectively (P-2 = 9.473, P = 0.0090.05). In addition, the accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was higher than that of ME-IDC, and the difference was statistically significant (P = 4.795, P = 0.0290.05, HCO3-2 = 7.399, P = 0.0070.05). The accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was similar (83.33% vs 91.30%), and there was no significant difference between ME-AA and ME-NBI (P = 0.722, P = 0.6850.05). Conclusion:1. The proportion of the part where the gastric mucosa lesion is located, the lower 1/3 of the stomach is high, the endoscope doctor should focus on the prevention of the omission in the operation of gastroscopy,2, ME-NBI, ME-IDC and ME-AA are the effective means to detect early gastric cancer and precancerous lesions, because of its effects on inflammation, inflammation, intestinal metaplasia, The difference of the detection rate of the low-grade intraepithelial neoplasia, the early gastric cancer and the positive lesion was not statistically significant, and the screening of the gastroscope in various places can be selected according to the actual condition of the endoscope center; and 3, as a gold standard for the diagnosis of the early gastric cancer, the pathological results of the biopsy tissue are used as the gold standard for the diagnosis of the early gastric cancer, and the ME-IDC is respectively applied to the ME-IDC, The diagnostic results of the three groups of ME-AA and ME-NBI were analyzed, and the difference between the three groups was not statistically significant. The accuracy of ME-NBI and ME-AA in the diagnosis of early gastric cancer, no difference between the two groups, was significantly higher than that of ME-IDC. The application of ME-NBI and ME-AA in the diagnosis of gastric cancer can significantly improve the accuracy of early diagnosis of gastric cancer and guide the target biopsy. It is a simple and effective method of early gastric cancer diagnosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2
[Abstract]:BACKGROUND: Gastric cancer is one of the most common malignant tumors, which is one of the most common malignant tumors. The incidence and mortality of gastric cancer in our country are 35.02/ 100,000 and 26.08/ 100,000 respectively, which are located in the first three positions of all the tumors, according to the 2006 National Cancer Registration Area. And bring serious harm to the people's health. A large number of studies have shown that the diagnosis and treatment of early gastric cancer and precancerous lesions is one of the important strategic measures for the prevention and treatment of the future. Objective: To study the diagnostic value of the combined magnifying endoscopy (ME-IDC), glacial acetic acid combined with endoscopy (ME-AA) and narrow-band imaging combined with endoscopic (ME-NBI) in the screening of precancerous lesions and early gastric cancer. Methods: From December 2014 to March,2016, a prospective case-control study was conducted in the patients of the digestive endoscopy center of the People's Hospital of Zhengzhou University from December 2014 to March,2016, and the patients with suspected lesions and who voluntarily agreed to join the study were randomly divided into three groups: ME-IDC, ME-AA and ME-NBI. During the operation, the biopsy site was selected for sampling, and the pathological department was specially assigned to the examination sheet to compare three groups of inflammation, intestinal metaplasia, low-grade intraepithelial neoplasia, early gastric cancer and positive lesion detection rate, and the diagnostic and pathological diagnosis sensitivity of the endoscope according to the VS standard. The specificity and the accuracy are compared, so that the clinical application value is evaluated. Results:1,81 patients with gastric mucosal lesion,18 (22.22%) were located in 1/3 of the stomach,15 (18.51%) were located in 1/3 of the stomach,46 (59.26%) were located in the lower 1/3 of the stomach, and the rate of inflammation in the three groups was 6 (21.43%) in the ME-IDC group, respectively. 10 (33.33%) of the ME-AA group and 10 (43.48%) of the ME-NBI group were not statistically significant (P = 2.850, P = 0.240.05). The positive rate of intestinal metaplasia in the three groups was 11 (39.29%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 8 (34.78%) in the ME-NBI group (P = 0.3460.05). The positive rate of LGIN in three groups was 5 (17.86%) in the ME-IDC group,6 (20.00%) in the ME-AA group and 1 (4.34%) in the ME-NBI group (P = 0. 2200.05). The positive rate of early gastric cancer in three groups was 6 (21.43%) in the ME-IDC group,8 (26.67%) in the ME-AA group and 4 (17.39%) in the ME-NBI group (P = 0.664, P = 0.71805). In this study, the positive rate of LGIN and early gastric cancer was included in 11 (39.29%) of the ME-IDC group,14 (46.67%) in the ME-AA group and 5 in the ME-NBI group (21.74%), and the difference was not statistically significant (1-2 = 3.562, P = 0.1680.05). The diagnosis results of the three groups of ME-IDC, ME-AA and ME-NBI were analyzed by the pathological results of the biopsy tissue as the gold standard for the diagnosis of early gastric cancer. The sensitivity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 50.00%, 77.78% and 100%, respectively. The specificity of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 59.09%, 85.71% and 89.47%, respectively. The accuracy of ME-IDC, ME-AA and ME-NBI in the diagnosis of early gastric cancer was 57.14%, 83.33% and 91.30%, respectively (P-2 = 9.473, P = 0.0090.05). In addition, the accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was higher than that of ME-IDC, and the difference was statistically significant (P = 4.795, P = 0.0290.05, HCO3-2 = 7.399, P = 0.0070.05). The accuracy of ME-AA and ME-NBI in the diagnosis of early gastric cancer was similar (83.33% vs 91.30%), and there was no significant difference between ME-AA and ME-NBI (P = 0.722, P = 0.6850.05). Conclusion:1. The proportion of the part where the gastric mucosa lesion is located, the lower 1/3 of the stomach is high, the endoscope doctor should focus on the prevention of the omission in the operation of gastroscopy,2, ME-NBI, ME-IDC and ME-AA are the effective means to detect early gastric cancer and precancerous lesions, because of its effects on inflammation, inflammation, intestinal metaplasia, The difference of the detection rate of the low-grade intraepithelial neoplasia, the early gastric cancer and the positive lesion was not statistically significant, and the screening of the gastroscope in various places can be selected according to the actual condition of the endoscope center; and 3, as a gold standard for the diagnosis of the early gastric cancer, the pathological results of the biopsy tissue are used as the gold standard for the diagnosis of the early gastric cancer, and the ME-IDC is respectively applied to the ME-IDC, The diagnostic results of the three groups of ME-AA and ME-NBI were analyzed, and the difference between the three groups was not statistically significant. The accuracy of ME-NBI and ME-AA in the diagnosis of early gastric cancer, no difference between the two groups, was significantly higher than that of ME-IDC. The application of ME-NBI and ME-AA in the diagnosis of gastric cancer can significantly improve the accuracy of early diagnosis of gastric cancer and guide the target biopsy. It is a simple and effective method of early gastric cancer diagnosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2
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