胃蛋白酶原聯合窄帶成像放大內鏡指導靶向活檢對胃黏膜萎縮、異型增生及早癌的診斷價值

蘇振華 王亮 魏思忱

[摘要] 目的 評估窄帶成像放大內鏡（NBI-ME）在胃黏膜萎縮、異型增生及早癌中指導靶向活檢的價值。 方法 收集2015年8月～2017年5月于我院行普通胃鏡（C-WLI）檢查可見萎縮、糜爛及凹陷性病變需要內鏡隨訪的患者200例，隨機分為兩組復查，即C-WLI組（n=100）和NBI-ME組（n=100），均行病理活檢，以病理學檢查結果為金標準，檢測兩種檢查方法的準確性。完善胃蛋白酶原化驗，檢驗其對胃黏膜萎縮及早癌篩查的價值。 結果 ①C-WLI和NBI-ME診斷萎縮性胃炎及腸化生的敏感度分別是70.73%和89.41%（P<0.05），特異度分別是55.38%和67.27%（P<0.05），準確度分別是63.90%和78.57%（P<0.05），差異均有統計學意義，對萎縮性胃炎及腸化生的診斷NBI-ME優于C-WLI。②C-WLI和NBI-ME診斷異型增生及早癌病變的敏感度分別是70.58%和90.58%（P<0.05），特異度分別是53.84%和77.55%（P<0.05），準確度分別是56.67%和79.86%（P<0.05），差異均有統計學意義，對異型增生及早癌的診斷NBI-ME優于C-WLI。③入選病例診斷萎縮性胃炎及腸化生的患者PGI水平（69.2±9.2）μg/L，PGR值（3.1±1.8），診斷異型增生及早癌的患者PGI水平（65.6±7.6）μg/L，PGR值（3.2±1.2）。 結論 ①胃蛋白酶原篩查有助于提高對萎縮及早癌的診斷；②對于胃黏膜萎縮、異型增生及早癌的診斷，NBI-ME優于C-WLI，可用于內鏡精查。

[關鍵詞] 胃蛋白酶原；窄帶成像放大內鏡；靶向活檢；胃黏膜萎縮；異型增生

[中圖分類號] R735.2 [文獻標識碼] A [文章編號] 1673-9701（2018）22-0001-03

[Abstract] Objective To evaluate the value of NBI-ME in the guidance of targeted biopsy in gastric mucosa atrophy， dysplasia and early cancer. Methods 200 patients who were given routine gastroscopy（C-WLI） to detect atrophic， erosive and sulcus lesions and were in need of endoscopic follow-up from August 2015 to May 2017 in our hospital were collected. They were randomly divided into two groups for review， namely C-WLI group（n=100） and NBI-ME group （n=100）. All were given pathological biopsy. The results of the pathological examination were taken as the gold standard to test the accuracy of the two examination methods. The pepsinogen assay was improved， and the value for gastric mucosal atrophy and early cancer screening was tested. Results 1）The sensitivity of C-WLI and NBI-ME in the diagnosis of atrophic gastritis and intestinal metaplasia were 70.73% and 89.41% respectively（P<0.05）. The specificity was 55.38% and 67.27% respectively（P<0.05）. The accuracy was 63.90% and 78.57% respectively （P<0.05）. The difference was statistically significant. For the diagnosis of atrophic gastritis and intestinal metaplasia， NBI-ME was superior to C-WLI. 2） The sensitivity of C-WLI and NBI-ME in the diagnosis of dysplasia and early cancer lesions was 70.58% and 90.58% respectively （P<0.05）. The specificity was 53.84% and 77.55% respectively （P<0.05）. The accuracy was 56.67% and 79.86% respectively（P<0.05）. The difference was statistically significant. For the diagnosis of dysplasia and early cancer， C-WLI was superior to NBI-ME. 3）For the selected cases of patients who were diagnosed as atrophic gastritis and intestinal metaplasia， PGI level was （69.2±9.2） μg/L， and PGR value was （3.1±1.8）. For the patients diagnosed as dysplasia and early cancer， the PGI level was（65.6±7.6） μg/L， and PGR value was（3.2±1.2）. Conclusion 1） The screening of pepsinogen is beneficial to improving the diagnosis of atrophy and early cancer； 2） for the diagnosis of gastric mucosal atrophy， dysplasia， and early cancer， NBI-ME is superior to C-WLI and can be used for endoscopic examination.

[Key words] Pepsinogen； Narrowband imaging and magnifying endoscopy （NBI-ME）； Targeted biopsy； Gastric mucosal atrophy； Dysplasia

胃癌是常見的消化系統惡性腫瘤之一，其死亡率在各類惡性腫瘤中位列第二位[1]。有研究表明，早期胃癌患者行內鏡下黏膜完整剝離治療后，5 年生存率可高達90%[2]，而進展期胃癌患者即使接受了以外科手術為主的綜合治療，5 年生存率仍低于30%。所以，臨床中提高早期胃癌診斷率非常重要[3]。窄帶成像結合放大內鏡技術（narrow-band imaging magnifying endos-copy，NBI-ME）可觀察胃黏膜胃小凹、微血管形態等改變，對胃黏膜萎縮、腸化生、異型增生及早癌的診斷有較高的臨床價值。本研究通過對既往內鏡提示萎縮、糜爛及凹陷需隨診的患者進行C-WLI和NBI-ME兩種方式復查，并以病理學結果為金標準比較兩種檢查方法診斷上述疾病的準確性。現報道如下。

1 資料與方法

1.1 一般資料

選取2015年8月～2017年5月于我院行普通胃鏡（C-WLI）檢查可見萎縮、糜爛及凹陷性病變需內鏡隨訪的患者200例，隨機分為兩組復查，即C-WLI組（n=100）和NBI-ME組（n=100），均行病理活檢，以病理學結果為金標準，檢測兩種方法的準確性。……