内镜下醋酸与美兰染色诊断胃黏膜肠上皮化生的临床价值

目的 探讨内镜下醋酸与美兰染色诊断胃黏膜肠上皮化生的临床价值.方法 采用数字表法将146例白光内镜怀疑慢性萎缩性胃炎和/或肠上皮化生的患者,随机分为内镜下醋酸喷洒组（76例）和内镜下美兰喷洒组（70例）,分别采用0.2%美兰溶液或1∶4的上海白醋进行胃黏膜喷洒,可疑部位活检,进行病理评价.结果 胃黏膜肠上皮化生在0.2%美兰喷洒后,表现为蓝色着色,与周围黏膜比较,分界清楚;胃黏膜肠上皮化生在醋酸喷洒后表现为黏膜白斑,病变区域较喷洒前显示得更为清楚.内镜下醋酸染色诊断胃黏膜肠上皮化生的敏感性、特异性分别为84.6%（55/65）、90.9%（10/11）;内镜下美兰染色诊断胃黏膜肠上皮化生的敏感性、特异性分别为82.8%（48/58）、100%（12/12）,与病理诊断均有较好的一致性.内镜下醋酸喷洒和内镜下美兰喷洒诊断胃黏膜肠上皮化生的检出率分别为73.7%（56/76）和68.6%（48/70）,差异无统计学意义（P〉0.05）.醋酸与美兰染色诊断胃黏膜肠上皮化生的敏感性,差异无统计学意义（P=0.769）,醋酸与美兰染色诊断胃黏膜肠上皮化生的特异性,差异有统计学意义,美兰染色优于醋酸染色（P=0.009）.结论 内镜下醋酸与美兰染色都有助于诊断胃黏膜肠上皮化生,有一定的临床应用价值.美兰染色诊断肠上皮化生的特异性优于醋酸染色.

Clinical value of acetic acid and methylene blue chromoendoscopy in the diagnosis of gastric intestinal metaplasia

Objective To evaluate the clinical value of acetic acid and methylene blue chromoendoscopy in the diagnosis of gastric intestinal metaplasia. Methods Cases from endoscopy center of Friendship Hospital, Capital Medical University, and Beijing Xiyuan Hospital, China Academy of Traditional Chinese Medicine, suspected chronic atrophic gastritis and/or intestinal metaplasia under white light endoscopy, were randomized into acetate acid group or endoscopic and methylene blue group respectively with 0. 2% methylene blue solution or 1 ： 4 Shanghai white vinegar spraying on gastric mucosa, then the suspected area was biopsied for pathological evaluation. Results Totally 146 cases with suspected chronic atrophic gastritis and/or intestinal metaplasia under white light endoscopy, were randomized into acetate acid group （ 76 cases ） or methylene blue group （ 70 cases ）. After 0. 2% methylene blue spraying, gastric intestinal metaplasia presented with blue coloring, and clearly demarcated with surrounding mueosa, while after acetic acid spraying, gastric intestinal metaplasia presented with blue coloring became more evidently whitening, and clearly demarcated with surrounding mucosa. After staining with acetic acid, the sensitivity and specificity in the diagnosis of gastric intestinal metaplasia were 84. 6% （55/ 65） and 90. 9% （10/11） respectively, which were 82. 8% （48/58） and 100% （12/12） for methylene blue, both consistent with pathological diagnosis. The diagnosing rate of gastric intestinal metaplasia with acetate acid and methylene blue staining were 73.7% （56/76） and 68.6% （48/70）, the difference was not statistically significant （P 〉 0. 05 ）. The diagnostic sensitivity of gastric intestinal metaplasia with acetate acid and methylene blue staining were 84. 6% and 82. 8% （ P = 0. 769）. The diagnostic specificity of gastric intestinal metaplasia with acetate acid and methylene blue staining were 90. 9% and 100% （P = 0. 009）. Conclusion Acetic acid and methylene blue staining both contribute to the diagnosis of gastric intestinal metaplasia. Acetic acid had higher specificity than methylene blue staining for the diagnosis of gastric intestinal metaplasia.