慢性萎缩性胃炎内镜与病理诊断符合率的回顾性研究

Retrospective study on the correlation between endoscopic and pathological diagnosis of chronic atrophic gastritis

摘要:

目的： 比较慢性萎缩性胃炎（chronic atrophic gastritis，CAG）内镜诊断及病理诊断的相关性，探讨提高两者符合率的方法。方法： 纳入内镜诊断并行病理活检的慢性萎缩性胃炎患者192例，对内镜下表现与病理检查结果进行回顾性分析，研究CAG内镜下表现与病理检查结果的相关性，了解两者诊断CAG的符合率。结果： 192例内镜诊断为CAG患者中，同时被病理诊断的仅56例，两者的符合率为29.17%。将内镜下萎缩性胃炎分为胃黏膜红白相间、胃黏膜变薄伴有血管暴露且呈透明状、胃黏膜粗糙伴或不伴有结节和颗粒状、同时具备上述表现4种特性，其与病理诊断的符合率分别为33.7%、24.8%、32.8%、42.7%，四者之间差异无统计学意义（P=0.293）。将内镜下活检部位分为胃窦、胃角、胃体，其与病理诊断的符合率分别为25.9%、39.5%、47.5%，三者之间差异有统计学意义（P=0.019）。镜下活检标本数为1、2、3、4者，其CAG符合率分别为26.6%、34.5%、66.7%、100.0%，其中活检标本数为1块和大于1块（2~4块）的CAG符合率无统计学差异（P=0.089）。内镜下与病理诊断均为慢性萎缩性胃炎者幽门螺杆菌（Helicobacter pylori，HP）感染率为52.0%，病理诊断为非CAG患者中HP感染率为45.5%，两者的HP感染率无统计学差异（P=0.455）。病理确诊为CAG且行¹³C呼气实验50例，其中镜下A表现[胃黏膜红白相间，或（且）以白为主]、B表现（胃黏膜变薄，血管暴露且呈透明状）、C表现（胃黏膜粗糙状，伴或不伴有结节和颗粒状）HP感染率分别为48.5%、37.5%、29.2%，三者感染率无统计学差异（P=0.594）。结论： 内镜诊断CAG存在误诊和漏诊现象，临床工作中应充分认识内镜下萎缩性胃炎的多样性表现，并与病理诊断充分结合，进一步提高诊断准确率。

Abstract:

Objective: To compare the correlation between endoscopic and pathological diagnosis of chronic atrophic gastritis (CAG), and to explore how to improve the coincidence rate of these two diagnostic methods. Methods: This study included in 192 cases of CAG diagnosed by endoscopy combined with pathologic biopsy, and the coincidence rate between the endoscopic and pathological diagnosis of CAG was retrospectively studied by analyzing the correlation between endoscopic findings and pathological examination results. Results: Among 192 patients with CAG diagnosed by endoscopy, only 56 cases were also confirmed by pathological diagnosis at the same time, with coincidence rate of 29.17%. The atrophic gastritis under the endoscopy showed red and white mucosa, thin mucosa folds or some exposed and transparent blood vessels, mucosa with rough and/or granular or nodular performance and mucosa with these all four characteristics. The coincidence between them was 33.7%, 24.8%, 32.8%, 42.7%, respectively, without significant difference between them (P=0.293). The coincidence rate about endoscopic biopsy location of gastric antrum, gastric angle and gastric body was 25.9%, 39.5% and 47.5%, respectively, with statistical significance (P=0.019). The CAG coincidence rates of 1, 2, 3 and 4 biopsy specimens were 26.6%, 34.5%, 66.7% and 100.0%, respectively, among which the CAG coincidence rates of 1 biopsy specimen between those of more than 1 (2-4) biopsy specimen were not statistically significant (P=0.089).Helicobacter pylori (HP) infection rate of the patients with CAG diagnosed by both endoscopy and pathology was 52.0%, and that of the non-chronic atrophic gastritis cases diagnosed pathologically was 45.5%, with no significant difference between them (P=0.455). There were 50 patients pathologically diagnosed with CAG and they underwent¹³C breath test. They were divided into A (red and white gastric mucosa, or/and mainly white), B (thin gastric mucosa, exposed and transparent blood vessels) and C (mucosa with rough and/or granular or nodular performance) types according to different microscopic manifestations, and the HP infection rates of the three were 48.5%, 37.5% and 29.2%, respectively, without statistical differences (P=0.594). Conclusion: There are misdiagnosis and missed diagnosis of the CAG through endoscopic examination alone, the awareness of the diversified manifestations under endoscopy and the endoscopy and pathology should be combined to improve the diagnosis rate of the CAG.