Receiver Operator Characteristic Analysis of Endoscopy as a Test for Gastritis

Endoscopic evaluation of the presence or absenceof gastritis is often performed in lieu of biopsy andhistologic diagnosis. The purpose of our study was toassess the value of endoscopic examination as a diagnostic test for gastritis. Twoendoscopists prospectively assessed the antrum of 73patients undergoing upper gastrointestinal endoscopy andgraded, on a scale of 0-4 (0 = completely absent, 4 = definitely present), the likelihood ofgastritis. The following features were also assessed atthe time of endoscopy: erythema, nodularity, erosion,edema, and friability. Two concomitant antral biopsies (3 cm from the pylorus on the greater curvatureof the stomach) were performed regardless of theendoscopic impression. The histologic findings weregraded independently on a scale of 0-3 by twopathologists who were not aware of the endoscopic findings.The following histologic features were graded: acuteinflammation, chronic inflammation, lymphoid aggregates,intestinal metaplasia, and quantity of Helicobacter pylori organisms. Receiver operatorcharacteristic analysis, a method derived from signaldetection theory, assesses the trade-off of sensitivityand specificity over all cutoff points of a test and is considered the best method by which to comparetests and determine the diagnostic utility of a giventest. Receiver operator characteristic analysis gave anarea of 0.65 ± 0.01 SE for endoscopy as a test for gastritis (0.5 = chance, 1 = perfect) asdefined by the histologic presence of inflammation.Additionally, endoscopy as a test for the presence ofhistologically proven Helicobacter pylori gave an area of 0.55 ± 0.01 SE. All endoscopicallygraded features treated as separate tests for gastritisand/or H. pylori gave areas of approximately 0.44-0.61,indicative of a poor test. While H. pylori was always associated with at least some degree ofinflammation, linear regression analysis revealed nocorrelation among any of the histologic features or ofany histologic feature with any endoscopic feature. We conclude that a tissue diagnosis is essentialfor the proper diagnosis of gastritis.     

穴位埋线对慢性胃炎患者胃电图及胃肠激素的影响

[目的]观察穴位埋线治疗慢性胃炎的临床疗效。[方法]将70例慢性胃炎患者随机分为治疗组(埋线组)与对照组 (针刺组)进行相应治疗,并观察胃电图及血浆胃泌素(Gas)、P物质(SP)含量的改变。 [结果]埋线组有效率为 88.89％,优于针刺组的76.47％,具有显著性差异(P<0.05);两组内治疗前后餐前、餐后胃电幅值和血浆Gas、SP的差 异都具有显著性(P<0.01或P<0.05),餐前胃电频率改变不明显(P>0.05),但餐后频率改变较明显(P<0.05);两组 之间相比,治疗后两组血浆Gas、SP含量差异有显著性(P<0.05),但两组治疗前后的餐前、餐后胃电幅值及胃电频率差 异都没有显著性(P>0.05)。[结论]穴位埋线治疗慢性胃炎有肯定疗效,能调节胃肠激素,增加胃电幅值,增快胃电频 率,从而调节了胃肠机能活动。     

香砂养胃丸对化疗所致上消化道副作用的抑制作用

【目的】探讨香砂养胃丸抑制由化疗引起的化学性胃炎及上消化道症状的有效性。【方法】将87例经组织病理学或细胞学确诊为恶性肿瘤并接受由阿霉素(adriamyein,ADM)、氮烯咪胺(adcarbazine,DTIC)、铂类(platinum-based)、伊立替康(irinotecan,CPT-11)和5-氟脲嘧啶(fluorouracil,5-FU)等抗癌药所组成的肿瘤化疗方案治疗的患者随机分为试验组(41例)和对照组(46例),对照组在化疗同时常规使用地塞米松和5-HT3受体拮抗剂以止呕,试验组则在此基础上加服中成药香砂养胃丸,观察7d内两组上消化道症状控制及出现胃炎的情况。【结果】化疗7d内上消化道症状和体征得到控制者的百分比在试验组为95．1％(39／41),对照组为76．1％(35／46);试验组症状性胃炎发生率为2．4％(1／41),而对照组为19．6％(9／46),组间比较差异具有统计学意义(P=0．0122)。【结论】香砂养胃丸对化疗引起的化学性胃炎及上消化道症状有抑制作用。