醋酸增强内镜技术在慢性萎缩性胃炎及肠上皮化生诊断中的价值

目的探讨醋酸增强内镜技术在慢性萎缩性胃炎及肠上皮化生诊断中的应用价值。方法110例病人，先行常规内镜检查，对胃窦、胃体大小弯、胃角各摄片l张，然后用1．5％醋酸5-10ml喷洒，一分钟后冲洗观察，再次对上述各部位摄片并取活检1块，送病理检查。将患者醋酸增强内镜前、后的内镜图像分别进行阅片诊断，与病理诊断进行对照分析。结果病理诊断慢性萎缩性胃炎41例，其中醋酸增强内镜和常规内镜的诊断符合率为轻度13：16、0：16，中度12：13、4：13，重度12：12、9：12；醋酸增强内镜和常规内镜诊断慢性萎缩性胃炎的各项指标为敏感性95．65％VS31．71％、特异性94．06％VS37．68％、准确性90．24％vs31．71％、阳性预测值92．5％VS23．21％、阴性预测值92．5％VS48．15％、约登指数0．86VS-0．31；醋酸增强内镜明显优于常规内镜，P〈0．001；轻中度慢性萎缩性胃炎在醋酸增强后黏膜呈现白色粗糙不平。有点状或片状粗大颗粒状或鱼鳞样隆起改变，贴近观察可见绒毛样或脑回状胃小凹。普通内镜未能观察到黏膜病变。结论醋酸增强内镜可提高慢性萎缩性胃炎伴肠上皮化生的诊断准确率。

The value of acetic acid-enhanced endoscopy in the diagnosis of chronic atrophic gastritis and specialized intestinal metaplasia

Objective To investigate the value of acetic acid-enhanced endoscopy in the diagnosis of chronic atrophic gastritis（CAG） and intestinal metaplasia（IM）. Methods One hundred and ten patients were evaluated endoscopically. After one photo was taken at the gastric antrum, body, angle separately by conventional gastroscopy, 5-10 ml of 1.5% acetic acid was sprayed. Photographing and biopsy were performed at the same locations above-mentioned one minute later. A contrast analysis was applied between the pathological examination with the diagnosis based on reading the images taken pre-and post-acetic acid-enhanced en- doscopy. Result CAG was diagnosed in 41 patients by pathological examination, diagnostic accordance rate of atrophic changes by conventional endoscopy were 0/16 （mild）,4/13 （moderate）,9/12 （severe）,whereas by acetic acid-enhanced endoscopy they were 13/16 （mild）,12/13 （moderate）,12/12 （severe）. The diagnostic power of acetic acid-enhanced group were better than the conventional group, with 95.65% vs 31.71% in Sensitivity, 94.06% vs 37.68% in specificity, 90.24% vs 31.71% in accuracy, 92.5% vs 23.21% in the positive predictive value, 92.5% vs 48.15% in negative predictive value, and 0.86 vs -0.31 in Youden＇s Index（P 〈 0.001）. After acetic acid-enhanced examination, mild and moderate CAG showed white and rough mucosa with petechial, flaky, massive granular or scaly protuberances. Villous-like or gyriform gastric pits were seen by close obser- vation. Conclusion Acetic acid-enhanced endoscopy could improve the diagnostic accuracy rate of chronic atrophic gastritis and specialized intestinal metaplasia.