附录：慢性胃炎的病理诊断标准

一、活检取材 活检取材块数和部位由内镜医师根据需要决定，一般为2-5块，如取5块，则胃窦2块取自距幽门2-3cm处的大弯和小弯，胃体2块取自距贲门8cm处的大弯（约胃体大弯中部）和距胃角近侧4cm处的小弯，胃角1块。     

对比两种活检钳在慢性胃炎诊断中的价值

慢性胃炎诊断主要包含内镜肉眼诊断及病理组织学诊断两方面内容。目前广泛认为,内镜下胃黏膜活检病理组织学检查可视为慢性胃炎诊断的金标准,以此判断慢性胃炎的     

慢性胃炎的病理诊断标准以及有关注意事宜

注解：1．慢性胃炎常见病变主要分为萎缩性和非萎缩性,不再用“浅表性”。因为“浅表”对应于“深沉”,是深浅的划分用语,不能反映胃黏膜腺体的多少。     

酒精性肝病的病理诊断标准分级、分期与分类

病理组织学检查在酒精性肝病（ALD）的诊断、分类及预后判定上占有重要地位,是衡量ALD炎症活动度、纤维化程度的金标准,也是进行分类的重要依据。但在诊断ALD前首先需确定患者是否嗜酒者,了解患者的饮酒史,包括饮酒年限、日饮酒量及戒酒史,以保证ALD诊断的准确性。关于嗜酒者的标准我们参考国内外标准,将日饮酒精量超过40g（合50度白酒100ml）,连续饮酒5年以上者定为嗜酒者,以此标准检出的136例嗜酒者,经肝穿无一不具ALD改变,包括轻症ALD 41例。说明日饮酒精≥40g已为不安全剂量。ALD组织学诊断标准包括4个方面：(1)肝细…     

慢性肝炎临床诊断与病理分级分期诊断的对比分析

１９１例慢性肝炎患者进行了肝活检，病理切片按Ｓｃｈｅｕｅｒ推荐标准进行了分级分期诊断，并与肝功能、肝脾Ｂ型超声检查对照，提示慢性肝炎随着炎症活动的严重和反复，肝内纤维化程度亦愈明显。慢性小叶性肝炎诊断必须依赖于病理诊断。肝硬化临床诊断与病理诊断符合率为３３％，故病理诊断分级分期是目前慢性肝炎，尤其是肝纤维化者的必要检查手段。     

慢性肝炎的诊断,分级和分期

慢性肝炎的诊断、分级和分期翟为溶，王泰龄，周晓军，张泰和慢性肝炎是病程在半年以上的肝内弥漫性炎症性疾病。这类常见病可由多种原因引起，由于病程较长、病因不一，其病变及相应的临床表现常呈多样性，如何确切地认识和描述复杂而多样的慢性肝炎，并予以恰当归类，是...     

慢性胃炎内镜诊断的要点及问题

慢性胃炎是胃黏膜的一种慢性病变，是日常内镜检查中最常见的一种疾病，但在内镜诊断中也存在下面一些问题。[第一段]     

慢性胃炎的内镜诊断标准及评价

Stahl于1728年首先提出了慢性胃炎（CG）的概念,但由于一直缺乏形态及病理资料,诊断一直都存在争论。直到内镜大范围应用,CG的内镜诊断及分型才开始被提及并进行深入的研究。由于CG的发病原因非常复杂、内镜表现与病理诊断相关性很差,所以,一直没有满意的、被广泛接受的内镜诊断及分型标准。本文介绍国内外几个影响力较大的CG内镜诊断及分型标准及其优缺点。     

慢性胃炎内镜与病理诊断误差的探讨

背景:慢性胃炎是临床常见的消化系疾病,目前有内镜诊断和病理诊断两种诊断标准,两者的一致性如何,分歧原因何在,值得进一步研究和探讨。目的:了解慢性胃炎内镜诊断与病理诊断的符合率,以缩小两者间的误差,提高确诊率。方法:复习我院2000年内镜诊断为慢性胃炎者的内镜检查和活检病理报告,计算慢性胃炎内镜诊断与病理诊断的符合率。结果:共有11047例次受检查纳入统计分析。在胃窦部,内镜诊断为非萎缩性胃炎而病理诊断为慢性萎缩性胃炎(CAG)者926例次,内镜诊断为CAG而病理诊断为非萎缩性胃炎者1340例次,两者诊断一致者8781例次,总符合率为79.5%(κ=0.550,P<0.001)。在胃体部,内镜诊断为浅表性改变而病理诊断为萎缩性改变者43例次,内镜诊断为萎缩性改变而病理诊断为浅表性改变者143例次,两者诊断一致者383例次,总符合率为67.3%(κ=0.314,P<0.001)。结论:CAG是胃癌癌前状态之一,鉴于其诊断需依赖组织病理学检查,故强调内镜检查时应在胃窦和胃体部作多部位、多处活检,以提高CAG的确诊率。     

慢性肝炎的分类——诊断,分级和分期

慢性肝炎的分类──诊断、分级和分期徐有青译王宝恩校二十五年前第一次提出慢性肝炎（慢肝）的分类。那时，对慢性肝炎的病因还基本上不了解，推测大多数病例与自身免疫有关（称为狼疮性肝炎）。分类的目的是根据疾病的活动程度区分为亚组，为预后提供信息并为应用免疫抑...     

胃蛋白酶原在慢性萎缩性胃炎和胃癌筛查中的价值

迄今为止．全球范围内胃癌的发病率和病死率仍居高不下。由于进展期胃癌的预后差,早期筛查、诊断和干预胃肠化生、萎缩性胃炎和早期癌变对提高患者的生存率至关重要。本文旨在介绍胃蛋白酶原及其在筛查萎缩性胃炎和胃癌中的作用。     

激光共聚焦内镜对慢性萎缩性胃炎和肠上皮化生的诊断价值

目的 比较共聚焦内镜与普通白光内镜对萎缩性胃炎和肠上皮化生的诊断价值。方法对2012年1月至5月来我院行胃镜检查的89例患者,全部在普通白光内镜及共聚焦内镜下对胃黏膜进行观察,并对病变部位进行活检病理学诊断。结果89例患者共观察286个病变部位。普通内镜诊断萎缩性胃炎95个部位,共聚焦内镜诊断40个部位,病理学诊断萎缩37个部位,共聚焦内镜与病理学诊断符合率为94．6％,普通内镜与病理学诊断符合率为38．95％;普通内镜诊断肠上皮化生54个部位,共聚焦内镜诊断170个部位,靶向活检诊断161个部位,共聚焦内镜与病理学诊断符合率为84．47％,普通内镜与病理学诊断符合率为33．54％。共聚焦内镜对萎缩性胃炎和肠上皮化生的诊断符合率明显高于普通内镜组,并且共聚焦内镜与病理学诊断具有很好的一致性（P=0．453,kappa值=0．895和P=0．298,kappa值=0．577）。结论共聚焦内镜对萎缩性胃炎和肠上皮化生具有较高的诊断价值,值得临床推广。     

Diagnostic Criteria for Atrophic Rhinosinusitis

Background

Patients with atrophic rhinosinusitis have intractable upper airway symptoms that result from loss of the normal nasal epithelium. There is no consensus on how to diagnose this condition, and diagnostic criteria are not available to perform multicenter treatment trials. We sought to establish diagnostic criteria for atrophic rhinosinusitis.

Methods

Twenty-two patients for whom there was a consensus on the diagnosis of atrophic rhinosinusitis were compared with a control group of 22 randomly selected patients with garden-variety chronic rhinosinusitis. Medical records were reviewed on all patients and clinical data were tabulated. Clinical variables included the presence of nasal obstruction, epistaxis, anosmia, purulence, crusting, chronic inflammatory disease involving the upper airway, and multiple sinus surgeries.

Results

Both groups had similar degrees of persistent nasal obstruction (82% vs 77%). The other 6 clinical features occurred more frequently in patients with atrophic rhinosinusitis than controls (P <.05). Patients with chronic rhinosinusitis and recurrent nasal purulence had a 25-fold (95% confidence interval [CI], 2.9-221.7) increased probability, those with recurrent epistaxis had a 12-fold increased probability (95% CI, 1.3-106.8), and those with 2 or more sinus surgeries had a 15-fold (95% CI, 3.5-66.7) increased probability of having atrophic rhinosinusitis. As the number of symptoms increased, there was an increasing probability of the predetermined diagnosis of atrophic rhinosinusitis (P <.05). The presence of chronic rhinosinusitis and any 2 of the 6 clinical features for 6 months or longer resulted in a sensitivity of 0.95 and specificity of 0.77 for the diagnosis of atrophic rhinosinusitis.

Conclusion

The diagnosis of the common secondary form of atrophic rhinosinusitis may be made with certainty if a patient with chronic rhinosinusitis demonstrates 2 or more clinical features for 6 months and longer. These features are patient-reported recurrent epistaxis or episodic anosmia; or physician-documented nasal purulence, nasal crusting, chronic inflammatory disease of the upper airway, or 2 or more sinus surgeries.     

Immunological Studies in Chronic Atrophic Gastritis and Chronic (Superficial) Gastritis

Detection of autoantibodies, HLA typing and immunofluoreseence studies on gastric biopsies were carried out in subjects with histologically proven chronic atrophic gastritis (CAG) and chronic superficial gastritis (CG). All were seronegative for parietal cell antibody and did not have pernicious anemia. Except for positive antismooth muscle and antimitochrondiral antibodies in one patient with CAG, autoantibodies (antinuclear, smooth muscle, mitochrondrial, parietal cell) were absent in patients with CAG and CG.
Immunofluorescence studies showed that Ig-G and Ig-A were present in the lamina propria of all cases with CAG or CGand and of subjects with normal gastric histology. Ig-M was seen less often, in about half the cases. Complement C3 wa an uncommon finding. being positive in only one casw with CAG and one case with CG and in none of the cases with normal gastric histology. Fibrinogen was more commonly seen in patients with CG (5/5 cases) than in those with CAG (3/11 cases). Fibrinogen was found in one case with normal gastric histology. The most consistent fluorescence was obtained with antiparietal cell antiserum. jects with CG and normal gastric histology had strong specific fluorescence.
An increased frequency of IILA-A1 plus HLA-B8 was found in subjects with CAG (20.7% in controls; 40% in CAG).     

血清胃蛋白酶原、胃泌素-17与慢性萎缩性胃炎

背景：目前慢性萎缩性胃炎的诊断主要依靠组织病理学检查，但日本、挪威、芬兰等国已实施通过血清胃蛋白酶原（PG）和胃泌素-17（G—17）检测筛查慢性萎缩性胃炎和胃癌。目的：探讨慢性萎缩性胃炎患者血清PGI、PGI／PGI／比值（PGR）和G—17的变化规律。方法：296例于2005年5月-2007年5月在北京友谊医院行胃镜检查且符合入选标准者纳入研究。根据病理诊断将入选病例分为3组：对照组42例，慢性非萎缩性胃炎组148例，慢性萎缩性胃炎组106例。以放射免疫测定检测血清PGⅠ、PGⅡ和G—17水平。结果：慢性萎缩性胃炎组与对照组相比．血清PGI水平和PGR显著降低，G—17水平显著升高（P〈0．05）。随着萎缩程度的加重，胃体萎缩、全胃多灶性萎缩的血清PGI水平和PGR进行性下降（P〈0．01），胃窦萎缩的血清G-17水平进行性下降（P〈0．01）。结论：联合检测血清PG和G—17水平可用于慢性萎缩性胃炎的筛查，如有异常，应进一步行胃镜检查以确诊并指导治疗。     

慢性萎缩性胃炎前瞻性观察──附50例临床资料分析

本文通过对５０例慢性萎缩性胃炎的临床随访观察，认为经健脾益气方药治疗的病例，远期疗效较为满意。随访期间，间歇使用健脾益气方药能巩固疗效。所观察５０例中，４９例未发生恶变。     

Biomarkers in Various Types of Atrophic Gastritis and Their Diagnostic Usefulness

Atrophic gastritis has been shown to involve either the oxyntic gland area, resulting in hypergastrinemia and hypopepsinogenemia I, the antral gland area, causing hypogastrinemia without change in serum pepsinogen I (diffuse antral gastritis; DAG), or the entire gastric mucosa (multifocal atrophic gastritis; MAG), resulting in both hypogastrinemia and hypopepsinogenemia I; and rare atrophic gastritis limited to the oxyntic gland area, with antibodies against oxyntic cells and/or intrinsic factor (autoimmune metaplastic atrophic gastritis; AMAG). This study was performed on 126 patients with various forms of gastritis and on 126 age- and gender-matched controls, who were subjected to endoscopy with biopsy, H. pylori testing (¹³C-UBT, serology), assays for serum gastrin and pepsinogen I, and testing for basal and pentagastrin-induced gastric acid secretion. The following groups of patients were examined: group I (N = 22), with AMAG; group II (N = 53), with DAG; group III (N = 51), with MAG; and group IV (N = 126), age- and gender-matched controls without gastritis. The following changes were found. In group I very high serum gastrin and very low pepsinogen I were observed, and all patients were achlorhydric and H. pylori negative. In group II, with low serum gastrin and normal pepsinogenemia and gastric chlorhydria, all patients were H. pylori positive. In group III, with lower serum gastrin and lower pepsinogen I levels and reduced chlorhydria, all patients were also H. pylori positive. And all group IV controls, with normal serum gastrin and pepsinogen I and normal gastric acid secretion without antral or fundic gastritis, were H. pylori negative. We conclude that measurements of serum gastrin and pepsinogen I and gastric acid secretion as well as testing for H. pylori infection may be useful in noninvasive diagnosis of various types of atrophic gastritis and in identification of patients with premalignant gastritis and a high risk of gastric cancerogenesis.     

Exploration of Tuina Effect and Mechanism in Chronic Atrophic Gastritis Rats

Background: Chronic atrophic gastritis is a very common condition in the general clinical practice of gastroenterology. Tuina treatment is widely used clinically. The aim of our study was to investigate the mechanisms of tuina in rats with chronic atrophic gastritis.Methods: Fifty-six specific pathogen-free grade rats were employed for our study. They were divided into 5 groups and treated differently. Body weight was recorded every week, and their small intestine propulsive ratio was measured after intragastric administration of carbon powder. Histopathological observation of gastric tissues was performed using hematoxylin and eosin staining. The levels of motilin and gastrin in serum were detected by enzyme-linked immunosorbent assay, and the expression levels of Bcl-2 and cytochrome C were measured by the western blot assay.Results: There was no significant difference in body weight and small intestine propulsive ratio between the chronic atrophic gastritis model group and the tuina group (P > .05). However, we can see some significant changes in histomorphology after treatment with tuina. For example, the atrophy of gastric mucosal epithelium and glands had improved, and the inflammatory cells infiltrating the lamina propria were decreased significantly. Moreover, the level of gastrointestinal hormone GAS was increased (P < .001), and there was no statistically significant difference in motilin, Bcl-2, and cytochrome-c after treatment with tuina (P > .05).Conclusion: Our research demonstrated the effectiveness of tuina treatment on chronic atrophic gastritis with a possible underlying mechanism that affected the secretion of gastric acid, which could provide some useful information for clinical application.     

萎胃散治疗大鼠慢性萎缩性胃炎实验研究

目的探讨萎胃散治疗慢性萎缩性胃炎(CAG)的疗效及其机制.方法用主动免疫、乙醇、去氧胆酸钠及热糊灌胃同时进行的综合方法,制成大鼠CAG模型.造模后治疗组以萎胃散大、小剂量治疗60d,观察指标以胃粘模固有腺体萎缩程度为依据.对照组仅予生理盐水灌胃.结果治疗组的CAG病变数量明显减少,病理检查可见腺体恢复正常.治疗组与模型组(不给药治疗)比较有显著性差异(P＜0.05).结论萎胃散的应用可使胃粘膜同有腺体增多,有良好的治疗CAG的作用.