摘要
[目的]探究木村-竹本(Kimura-Takemoto)分类法与OLGA分级系统评估慢性萎缩性胃炎(CAG)的相关程度及影响其一致性的因素,推广应用Kimura-Takemoto分类法评估CAG的严重程度,以达到低创伤、高效率检查高危萎缩黏膜,预防早期胃癌的目的。[方法]选取2019年6月~2019年12月行胃镜检查且镜下评估为CAG的82例患者,应用Kimura-Takemoto分类法进行镜下萎缩程度分级,依据新悉尼系统标准予病理活检后,采用OLGA评估系统,结合胃黏膜萎缩程度进行分期。最后分析2个评估系统的相关性及诊断结果的一致性。[结果]经Spearman相关性分析和Kappa一致性检验,Kimura-Takemoto分类法与OLGA系统对CAG的诊断结果具有中度相关性(R=0.541,P<0.001)及中等一致性(Kappa=0.433,P<0.001)。其中Kimura-Takemoto分型中O2~O3重度萎缩黏膜对应OLGA分级系统中Ⅲ、Ⅳ期中的CAG患者癌变风险较高,O2~O3(Ⅲ/Ⅳ)组别中27例患者,有2例高级别上皮内瘤变,4例癌(其中1例胃窦部癌浸润至sm2,追加外科手术)。应用多因素Logistic回归分析得出Hp感染是影响2个系统诊断结果一致性的唯一独立因素(OR=2.955,95%CI1.150~7.592,P<0.05),而性别、年龄、吸烟、饮酒、家族史等对2个评估系统结果的影响差异无统计学意义(P>0.05)。[结论]内镜下Kimura-Takemoto分类与组织学上OLGA系统分期评估CAG的程度,具有中度相关性及一致性,故临床上可应用Kimura-Takemoto分类法低创伤、高效率评估背景黏膜,重视O2~O3(Ⅲ/Ⅳ)期的萎缩黏膜,达到快速筛查上消化道早癌的目的。
[Objective]To explore the relevance and consistency between the Kimura-Takemoto classification and the OLGA grading system in terms of evaluation of chronic atrophic gastritis(CAG),and to promote the Kimura-Takemoto classification in assessing the severity of CAG so as to achieve the examination of high-risk atrophy mucosa with low trauma and high efficiency.[Methods]Totally,82 patients with atrophic gastritis indicated by endoscopy from June to December in 2019 were selected.Kimura-Takemoto classification was used to grade the atrophy with endoscope.After biopsy according to the new sydney system standard,the OLGA system was used to evaluate clinical stages according to the degree of gastric mucosa atrophy.Finally,the relevance and consistency between the Kimura-Takemoto classification and the OLGA system was evaluated.[Results]Kimura-Takemoto classification and OLGA system had a moderate correlation(R=0.541,P<0.001)and a moderate consistency(Kappa 0.433,P<0.001)for CAG diagnosis results.Among them,O2-O3 severe atrophic mucosa in Kimura-Takamoto Classification matched high risk of CAG patients in stageⅢandⅣof OLGA system.Among the 27 patients in the O2-O3(Ⅲ/Ⅳ)group,there were 2 cases of high-grade intraepithelial neoplasia and 4 cases of carcinoma(including 1 case of carcinoma of gastric antrum,infiltrating into sm2,with additional surgery).Multivariate logistic regression analysis showed that Hp infection was the only independent factor(OR=2.955,95%CI 1.150—7.592,P<0.05)affecting the consistency of diagnostic results of the two systems.However,there was no statistical difference(P>0.05)in the factors of gender,age,smoking,drinking and family history on the diagnostic results of the two evaluation systems.[Conclusion]Kimura-Takemoto classification and OLGA system showed moderate correlation and consistency.Therefore,Kimura-Takemoto classification can be used to evaluate the background mucosa with low trauma and high efficiency.More attention should be paid to the atrophic mucosa of stage O2-O3(Ⅲ/Ⅳ),in order to achieve the purpose of screening early carcinoma of the upper digestive tract.
作者
余超
李杨
李方圆
王磊
王耀辉
肖君
YU Chao;LI Yang;LI Fang-yuan;WANG Lei;WANG Yao-hui;XIAO Jun(Gastroenterology Endoscopy Center,Affiliated Hospital to Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210000,China)
出处
《中国中西医结合消化杂志》
CAS
2020年第7期504-507,共4页
Chinese Journal of Integrated Traditional and Western Medicine on Digestion
